利多卡因对造影剂及胰管结扎所致兔胰腺炎动物模型的影响

Effects of lidocaine in an experimental model of acute pancreatitis induced by contrast medium and pancreatic duct ligation

目的:探讨利多卡因对兔胰管括约肌压力和造影剂及胰管结扎相关胰腺炎的影响.方法:日本大耳兔24只随机分为4组,每组6只.采用300 g/L的泛影葡胺0.5 mL/kg经兔胰管内逆行注射+胰管阻塞的方法造模.Ⅰ,Ⅱ组造模前分别用利多卡因或蒸馏水在胰管远端括约肌处进行局部喷洒,观察其对于兔胰管括约肌压力的影响及术后24 h胰腺病理形态学研究.Ⅲ组只进行胰管括约肌测压,Ⅳ组为对照组,只做开腹术.结果:术前利多卡因乳头局部喷洒组与蒸馏水喷洒组相比,术后24 h胰头部分的病理组织学评分结果表明胰腺的病理改变主要表现为轻微的水肿和炎细胞浸润,其水肿、炎细胞浸润、出血以及坏死的程度显著减轻(水肿:0.83±0.75 vs 2.83±0.41:炎细胞浸润:1.33±0.52 vs 3.00±0.00:出血:0.00±0.00 vs 0.67±0.52:坏死:0.17±0.41 vs 1.50±0.55,均P<0.05).利多卡因乳头局部喷洒组与蒸馏水喷洒组及单纯测压组相比,利多卡因可显著降低胰管括约肌压力,差异有统计学意义(19.98±6.47 vs 34.77±8-36,32.67±7.79,均P<0.05).结论:利多卡因在胰管远端括约肌的乳头部喷洒,可以明显降低括约肌压力,有效预防造影剂及胰管结扎所致胰腺炎.

AIM： To explore the effects of lidocaine in an experimental model of acute pancreatitis induced by contrast medium and pancreatic duct ligation, as well the rabbits＇ pancreatic sphincter pressure. METHODS： Twenty-four rabbits were randomly divided into four groups, each containing six animals. The rabbit model of acute pancreatitis was set up by retrograde injection of 300 g/L Urografin in biliopancreatic duct and pancreatic duct obstruction. Before operation, lidocaine or distilled water was locally sprayed on the pancreatic duct distal sphincter in the I or II group, respectively. Then the pancreatic sphincter pres- sure was determined and pancreas pathologi-cal changes were observed after 24 hours. The group III rabbits only underwent manometry of pancreatic duct sphincter, and group IV underwent sham operation. RESULTS： The histopathological score of pancreas in rabbits showed that sprayed with lidocaine before operation, the head of the pancreas exhibited very mild edema and inflammatory cell infiltration, and the amounts of edema, inflammatory cell infiltration, necrosis and hemorrhage were significantly decreased compared with those in rabbits sprayed with distilled water （edema, 0.83 ± 0.75 vs 2.83 ± 0.41; inflam- matory cell infiltration, 1.33 ± 0.52 vs 3.00 ± 0.00; hemorrhage, 0.00 ± 0.00 vs 0.67 ± 0.52; necrosis, 0.17 ± 0.41 vs 1.50 ± 0.55; all P 〈 0.05）; and the pancreatic sphincter pressure was significantly reduced in group Ⅰcompared with that in groups Ⅱ and Ⅱ （19.98 ± 6.47 vs 34.77 ± 8.36, 32.67 ± 7.79; both P 〈 0.05）. CONCLUSION： Before operation, topical application of lidocaine significantly can reduce pancreatic sphincter pressure, and can also prevent pancreatitis induced by contrast medium and pancreatic duct ligation.