上胸段硬膜外交感阻滞对兔脑血管痉挛的影响.doc

上胸段硬膜外交感阻滞对兔脑血管痉挛的影响 哈尔滨医科大学附属第一医院麻醉科（150001，哈尔滨市） 王华民 李志学 李恩有 董英伟 张云安 曲仁海 [中文摘要] 目的 探讨上胸段硬膜外交感神经阻滞(HTESB)对兔实验性蛛网膜下腔出血(SAH)后脑血管痉挛(CVS)的影响。方法 采用枕大池二次注血法注入非抗凝自体动脉血1mL/kg，二次间隔48h，制备SAH后CVS模型；切开T3-4硬膜外间隙，向头侧置入硬膜外导管，每2h注入0.5%利多卡因0.5mL，制备成硬膜外T1-5交感神经阻滞模型。选择日本大耳白兔24只，随机分为三组(n=8)。对照组(假手术)：枕大池注入生理盐水1mL/kg，硬膜外注入生理盐水0.5mL/2h；SAH组：枕大池注入动脉血1mL/kg，硬膜外注入生理盐水0.5mL/2h；HTESB组：枕大池注入动脉血1mL/kg，硬膜外注入0.5%利多卡因0.5mL/2h。观察动物进食量和神经功能障碍，经颅多普勒超声测定实验前和实验第7天颈总动脉血流数据。结果 SAH组与对照组及HTESB组相比进食量减少的天数和发生神经功能障碍的天数差异显著(P0.05)，但HTESB组与对照组相比差异不明显(P0.05)。心率在HTESB组实验第7天与实验前相比明显减慢，且与对照组及SAH组相比差异显著(P0.05)。颈总动脉平均血流速度(Vm)、收缩期峰血流速度(Vs)、舒张末血流速度(Vd)在SAH组实验第7天与实验前及对照组相比明显增加，搏动指数(PI)、阻力指数(RI)下降(P0.05)。HTESB组实验第7天Vm、Vs、Vd、PI与实验前及对照组相比下降，RI与实验前相比下降；与SAH组相比Vm、Vs、Vd明显下降，而PI、RI值增加(P0.05)。结论 低浓度利多卡因HTESB可使兔实验性SAH后进食量恢复，神经功能障碍减轻，心率减慢，颈总动脉血流速度下降，脑血流增加，对治疗SAH后因交感神经兴奋引起的CVS和心血管功能紊乱有效，提示交感神经兴奋可能是引起CVS的因素之一。 [关键词] 血管痉挛颅内；蛛网膜下腔出血；交感神经，自主神经阻滞，硬膜外 The effects of high thoracic epidural sympathetic block on cerebral vasospasm after experimental subarachnoid hemorrhage in rabbits WANG Hua-min, LI Zhi-xue, LI En-you, et al. Department of Anesthesiology, First Affiliated Hospital, Harbin Medical University, Harbin 150001, China [Abstract] Objective The purpose of the study was to evaluate the effects of high thoracic epidural sympathetic block (HTESB) on cerebral vasospasm (CVS) after experimental subarachnoid hemorrhage (SAH) in rabbits. Methods CVS models were developed by injecting non-anticoagulant autologous arterial blood 1 mL/kg twice through the cistern magna 48 hours apart. HTESB models were established by incision T3-4 epidural space and introducing epidural catheter, 0.5% lidocaine 0.5 mL/2h was injected through the catheter to block T1-5 sympathetic nerves. Twenty-four rabbits were randomly divided into 3 groups (n=8). Group A (control): normal saline 1 mL/kg was injected through the cistern magna twice and 0.5 mL/2h injected through epidural catheter. Group B (SAH): non-anticoagulant autologous arterial blood 1