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春暖花开 x吧有你_

来源: 南方日报网络版     时间:2019-11-12 03:47:08

春暖花开 x吧有你

本周二,麻醉一科古晨博士为大家解读文献《Dexmedetomidine enhances ropivacaine-induced sciatic nerve injury in diabetic rats》。

文献解读本周二,麻醉一科古晨博士为大家解读文献《Dexmedetomidine enhances ropivacaine-inducedsciatic nerve injury in diabetic rats》

Dexmedetomidine enhances ropivacaine-inducedsciatic nerve injury in diabetic ratsZ. Y. Yu, etc. British Journal of Anaesthesia,122(1):141-149 Background: Previous studies suggest that dexmedetomidine has a protective effect against local anaesthetic-induced nerve injury in regional nerve blocks. Whether this potentially protective effect exists in the context of diabetes mellitus is unknown.Methods: A diabetic state was established in adult male Spraguee-Dawley rats with intraperitoneal injection of streptozotocin. Injections of ropivacaine 0.5%, dexmedetomidine 20 mg/kg(alone and in combination), or normal saline (all in 0.2 ml) were made around the sciatic nerve in control and diabetic rats (n=8 per group). The duration of sensory and motor nerve block and the motor nerve conduction velocity (MNCV) were determined. Sciatic nerves were harvested atpost-injection day 7 and assessed with light and electron microscopy or used for pro-inflammatory cytokine measurements.Results: Ropivacaine and dexmedetomidine alone or in combination did not produce nerve fibre damage in control nondiabeticrats. In diabetic rats, ropivacaine induced significant nerve fibre damage, which was enhanced by dexmedetomidine. This manifested with slowed MNCV, decreased axon density, and decreased ratio of inner to outer diameter of the myelin sheath (G ratio). Demyelination, axon disappearance, and empty vacuoles were also found using electron microscopy. An associated increase in nerve interleukin-1b and tumour necrosis factor-a was also seen.Conclusions: Ropivacaine 0.5% causes significant sciatic nerve injury in diabetic rats that is greatly potentiated by high dose dexmedetomidine. Although the dose of dexmedetomidine used in this study is considerably higher than that used in clinical practice, our data suggest that further studies to assess ropivacaine (alone and in combination with dexmedetomidine) use for peripheral nerve blockade in diabetic patients are warranted.Keywords: diabetes mellitus; local anaesthetics; peripheral nerve injuries; neurotoxicity右美托咪定增加糖尿病大鼠中罗哌卡因引起的坐骨神经损伤背景:前期研究提示右美托咪定对区域神经阻滞中局部麻醉药引起的神经损伤有保护作用,它在糖尿病个体中是否具有潜在保护作用仍是未知

方法:通过对成年雄性S-D大鼠腹腔注射链脲霉素建立糖尿病模型

在对照组和糖尿病大鼠组中分别在坐骨神经周围单独或联合注射0.5%罗哌卡因和右美托咪定20mg/kg,或注射生理盐水(每组各8只,每只注射总量均为0.2mL),并分别测定感觉和运动神经阻滞时间和运动神经传导速度

注射7天后获取坐骨神经标本,使用光镜和电镜评估,并测定促炎性细胞因子

结果:在对照-非糖尿病大鼠中,罗哌卡因和右美托咪定单独或联合使用不引起神经纤维破坏

在糖尿病大鼠中,罗哌卡因引起显著神经纤维损伤,这一作用被右美托咪定增强,表现为运动神经传导速度减慢、轴突密度减少和髓鞘内外径比减小,电镜下可见脱髓鞘、轴突消失和空泡形成,亦检测到神经中白介素-1b和肿瘤坏死因子- a升高

结论:0.5%罗哌卡因在糖尿病大鼠中引起显著坐骨神经损伤,大剂量右美托咪定可增加这一损伤作用

尽管本研究中的右美托咪定剂量比临床常用剂量大,我们的数据建议应行进一步研究,以评估罗哌卡因(单独或与右美托咪定联合)在糖尿病患者周围神经阻滞的作用

关键词:糖尿病;局部麻醉药;周围神经损伤;神经毒性PPT分享文献原文123456789




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