国际麻醉学与复苏杂志   2016, Issue (8): 7-7
    
不同剂量右美托咪定预注对利多卡因神经毒性的影响
罗小玲1()
1.广东省深圳市盐田区人民医院或深圳市第七人民医院
Effects and possible mechanism of different doses dexmedetomidine pretreatment on lidocaine toxicity to nervus centralis of albino rabbit
 全文:
摘要:

目的  比较不同剂量右美托咪定(dexmedetomidine, Dex)预注对利多卡因致白兔中枢神经毒性的影响及可能机制。 方法 将40只新西兰白兔按随机数字表法分为4 组(A、B、C、D组),每组10只:A组通过颈内静脉泵入含Dex 10 μg/kg的生理盐水8 ml,10 min后以4 mg·kg-1·min-1泵入利多卡因直到出现惊厥;B组泵入含Dex 5 μg/kg的生理盐水8 ml, 同法泵入利多卡因;C组泵入等量生理盐水, 同法泵入利多卡因;D组只泵入生理盐水8 ml。于白兔惊厥时抽血测利多卡因浓度,记录利多卡因剂量及发生惊厥时间,测脑组织天冬氨酸(aspartate, Asp)、谷氨酸(glutamic acid, Glu)、甘氨酸(glycine, Gly)、γ-氨基丁酸(γ-aminobutyric acid, GABA)的含量。 结果 产生中枢神经毒性所需利多卡因剂量、利多卡因血药浓度及发生惊厥时间,A组[分别为:(240±48) mg,(6.4±0.8) μg/kg,(822±122) s]、B组[分别为:(230±51) mg,(6.3±0.5) μg/kg,(802±114) s] 较C 组[分别为:(137±37) mg,(5.4±0.6) μg/kg,(510±76) s]明显增加,差异有统计学意义(P<0.05);Asp、Glu、Gly、GABA 的含量,A组[分别为:(3.5±1.0)、(4.0±1.9)、(10.1±1.9)、(16.5±2.2) μmol/g]、B组[分别为:(3.7±0.8)、(4.2±1.9)、(11.4±2.2)、(17.4±2.4) μmol/g]、C组[分别为:(4.7±1.0)、(6.8±1.9)、(13.7±1.9)、(20.9±3.4) μmol/g]明显高于D组[分别为:(1.5±0.8)、(2.4±1.2)、(4.7±1.6)、(5.7±2.8) μmol/g],差异有统计学意义(P<0.05),而C组又明显高于A、B组(P<0.05)。 结论 预注Dex可以延缓利多卡因致惊厥反应的发生,增加利多卡因神经毒性的阈值,对中枢神经有一定的保护作用。

关键词: 右美托咪定; 利多卡因; 中枢神经毒性; 白兔
Abstract:

Objective To investigate the effects and possible mechanism of different doses dexmedetomidine(Dex) pretreatment on lidocaine toxicity to nervus centralis of albino rabbit. Methods Forty New-Zealand albino rabbit were randomly divided into 4 groups (n=10). Group A and B were received infusion of 8 ml mixture Dex (respectively, 5 μg/kg and 10 μg/kg) and saline,10 min later lidocaine was pumped at the rate of 4 mg·kg-1·min-1 until occurrence of hyperspasmia. The equal dosis of saline and lidocaine were given in group C, but group D were only received saline. The hematoplasma density of lidocaine was measure when hyperspasmia occurred, the doses of lidocaine, the appearing times of lidocaine-induced hyperspasmia were observed, the concentration of aspartate, glutamic acid, glycine and γ-aminobutyric acid in brain architecture were recorded. Results Compared with group C[(137±37) mg,(5.4±0.6) μg/kg, (510±76) s, respectively], the doses of lidocaine when neurotoxicity occur, the plasmic density of lidocaine and the appearing times of lidocaine-induced hyperspasmia were all increased obviously in group A [(240±48) mg,(6.4±0.8) μg/kg,(822±122) s, respectively] and B[(230±51) mg,(6.3±0.5) μg/kg,(802±114) s, respectively] (P<0.05). Compared with group D [(1.5±0.8), (2.4±1.2), (4.7±1.6), (5.7±2.8) μmol/g, respectively], the concentration of aspartate, glutamic acid, glycine and gamma-aminobutyric acid in brain architecture were all increased in group A[(3.5±1.0), (4.0±1.9), (10.1±1.9), (16.5±2.2) μmol/g, respectively], B[(3.7±0.8), (4.2±1.9), (11.4±2.2), (17.4±2.4) μmol/g, respectively] and C[(4.7±1.0), (6.8±1.9), (13.7±1.9), (20.9±3.4) μmol/g, respectively](P<0.05), then in group C obviously higher than in group A and B (P<0.05). Conclusions  Dex pretreatment may postpone the occurrence of lidocaine-induced hyperspasmia and raise the neurotoxic threshold of lidocaine, so it has protection on nervus centralis.

Key words: Dexmedetomidine; Lidocaine; Central Neurotoxicity; Albino rabbit