摘要
目的 对比观察硬膜外腔注射不同组合药物对兔神经根炎症、硬膜外粘连的治疗效果。方法 实验用大白兔 4 8只 ,手术切开法硬膜外置管 ,2 4h后经导管注入每毫升含 1mg消毒滑石粉的生理盐水 0 2ml·kg- 1 ,3d后上述动物随机分为 8组。Ⅰ组 :不做处理 ,常规饲养 ;Ⅱ组 :硬膜外注入生理盐水 ;Ⅲ组 :硬膜外注入利多卡因 ;Ⅳ组 :硬膜外注入利多卡因、地塞米松复合液 ;Ⅴ组 :硬膜外注入利多卡因、强的松龙复合液 ;Ⅵ组 :硬膜外注入利多卡因、地塞米松、维生素B1 复合液 ;Ⅶ组 :硬膜外注入利多卡因、地塞米松、维生素B6 复合液 ;Ⅷ组 :硬膜外注入利多卡因、地塞米松、维生素B1 2复合液。一周后空气栓塞处死 ,将脊髓、硬膜和神经根一同取出制作切片标本 ,光镜观察组织学改变。结果 肉眼观察硬膜外粘连程度 :Ⅰ组与Ⅱ、Ⅲ组 ,Ⅱ、Ⅲ组与Ⅳ、Ⅴ、Ⅵ、Ⅶ、Ⅷ组差异无显著性 (P >0 0 5 ) ,Ⅰ组与Ⅳ、Ⅴ、Ⅵ、Ⅶ、Ⅷ组相比差异有显著性 (P <0 0 1) 光镜观察神经根炎症 :Ⅰ、Ⅱ、Ⅲ组之间差异无显著性 (P >0 0 5 ) ,Ⅰ、Ⅱ、Ⅲ组与Ⅳ、Ⅴ、Ⅵ、Ⅶ、Ⅷ组相比差异有显著性 (P <0 0 1) ,而Ⅳ、Ⅴ、Ⅵ、Ⅶ、Ⅷ组之间差异无显著性 (P >0 0 5 )。结论 在炎症早期硬膜外注射局麻药利多卡因加类固醇激素 (地塞米松。
Objective To compare the effects of epidural administration of different combinations of lidocaine, corticosteroids (dexamethasone, prednisolone) and vitamins(B 1,B 6,B 12 ) on epidural space adhesion and nerve root inflammation in rabbits Methods Forty eight adult Japannese white rabbits of either sex weighing (2 38±0 31)kg were anesthetized with intramuscular ketamine 15 mg·kg -1 and midazolam 0 2 0 3 mg·kg -1 A catheter was inserted into epidural space at L 2 when the ligamentum flavum was exposed by surgery and advanced caudally for 2 3cm Correct placement of the catheter in epidural space was confirmed by injecting 0 5% lidocaine 0 2 ml through the cathter when the animal was awake 24h after epidural cathter placement 0 2ml·kg -1 of normal saline containing talcum power 1mg·ml -1 was injected into epidural space 3 days later the animal were randomly divided into 8 groups: group Ⅰ received no treatment, group Ⅱ epidural normal saline 0 2ml·kg -1 , group Ⅲ epidural 0 5% lidocaine 0 2ml·kg -1 , group Ⅳ epidural compound lidocaine solution 1 (lidocaine 100mg +dexamethasone 10 mg in 20 ml normal saline) 0 2ml·kg -1 , group V epidural compound lidocaine solution 2 (lidocaine 100mg+prednisolone 50 mg in 20 ml normal saline)0 2 ml·kg -1 , group Ⅳ epidural compound lidocaine solution 3 (lidocaine 100mg+dexamethasone 10 mg+vitamin B 1 200mg in 20 ml normal saline) 0 2 ml/kg, group Ⅵ epidural compound lidocaine solution 4 ( lidocaine 100mg+dexamethasone 10 mg+vitamin B 6 200mg in 20 ml normal saline) 0 2 ml/kg, and group Ⅷ epidural compound lidocaine solution 5 (lidocaine 100mg+dexamethasone 10 mg+vitamin B 12 200mg in 20 ml normal saline) 0 2 ml/kg One week later animals were killed by intravenous injection of air Spinal column below L 1 was removed Epidural space and nerve root adhesion was checked first with naked eye then examined under microscope Epidural space adhesion was divided into 4 grades according to Rydell Results 1 Macroscopic examination of epidural space for adhesion: there was no significant different between group Ⅰ and group Ⅱ,Ⅲ, also between group Ⅱ,Ⅲ and group Ⅳ,Ⅴ,Ⅵ,Ⅶ,Ⅷ; there was significant different between group Ⅰ and groupⅣ,Ⅴ,Ⅵ,Ⅵ,Ⅷ (P<0 01) 2 Microscopic examination of nerve root for inflammation: there was no significant different among group Ⅰ, Ⅱ and Ⅲ; however there was significant different between group Ⅰ, Ⅱ, Ⅲ and group Ⅳ, Ⅴ, Ⅵ, Ⅶ ,Ⅷ; there was no significant different among group Ⅳ, Ⅴ, Ⅵ, Ⅶ and Ⅷ Conclusions Epidural administration of lidocaine combined with corticosteroid (dexamethasone, prenisolone) in early stage of inflammation can eliminate nerve root inflammation, prevent or alleviate epidural space adhesion Vitamin B 1 or B 6 or B 12 combined with lidocaine and corticosteroids does not enhance their therapeutic effect
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2001年第8期479-482,共4页
Chinese Journal of Anesthesiology
基金
河南省科技攻关项目 (9612 0 0 43 1)
关键词
硬膜外注射
药物疗法
硬膜外腔粘连
神经根炎
Injections, epidural
Adhesions
Radicutitis
Drug the rapy
Epidural space
