兔胫神经阻滞中乙醇扩散的影响因素

The influencing factors of alcohol injectate diffusion after rabbits' tibial nerves block

目的:探讨乙醇推注速度、浓度和容量对乙醇在组织中扩散特征的影响,为溶神经技术的临床应用提供依据。方法:27只新西兰大白兔,54条胫神经干,分为3组。在神经电刺激仪引导下准确定位胫神经干后,注射用非离子型碘造影剂标记的乙醇。第Ⅰ组(推注速度组)胫神经18条,分成3个亚组(Ⅰa、Ⅰb、Ⅰc),分别接受以不同推注速度(0.004ml/s;0.01ml/s;0.1ml/s)注射0.3ml无水乙醇。第Ⅱ组(浓度组)胫神经干12条,分成2个亚组(Ⅱa,Ⅱb),分别接受以0.01ml/s推注速度注射0.3ml50%乙醇和无水乙醇。第Ⅲ组胫神经24条,分成4个亚组(Ⅲa、Ⅲb、Ⅲc、Ⅲd),分别接受以0.01ml/s推注速度注射无水乙醇0.1ml、0.3ml、0.5ml、1.0ml。注射后第10min行16排螺旋CT扫描,计算乙醇扩散体积,并将图像行三维重建观察乙醇扩散方式。结果:Ⅰc亚组乙醇扩散体积明显高于Ⅰa、Ⅰb亚组(P<0.05).乙醇浓度对乙醇扩散体积没有影响(P>0.05)。容量组各亚组间比较发现各亚组间乙醇扩散体积均有显著性差异(P<0.05)。结论:乙醇扩散的形态为纵向,推注速度以及容量显著影响乙醇扩散体积,但是乙醇浓度对扩散体积无影响。

Objective：To explore the effects of different injection speed, concentration and volume on the feature of injectate diffusion and provide the basis for the clinical application of chemical neurolysis. Method： Fifty-four tibial nerves of rabbit were randomly assigned to speed group（SG,n=18）, concentration group（CG,n=12）and volume group （VG,n=24）.All tibial nerves were successfully located with a nerve stimulator and neurolyzed with a mixed solution of alcohol and contrast medium. The three subgroups of SG each received 0.3ml dehydrated alcohol at three different speed of injection（0.004ml/s,0.01ml/s,0.1ml/s）. The two subgroups of CG each received 0.3 ml alcohol of different concentration （50%,100%） at the same speed of injection （0.01ml/s）. The four subgroups of VG each received different volume of dehydrated alcohol （0.1ml,0.3ml,0.5ml, 1.0ml） at the same speed of injection（0.01ml/s）. After 10min of injection, helical CT scanning was performed to calculate the volume of injectate diffusion and evaluate its diffusion pattern by three-dimensional reconstruction. Result： The volume of alcohol diffusion of subgroup Ic was more than that in subgroup Ia and Ib （P〈0.05）.There was no statistically difference between the volumes of alcohol diffusion of the two subgroups of CG（P〉0.05）. The group VG demonstrated significant differences among subgroups of VG （P〈0.05）. Conclusion： Alcohol diffuses longitudinally along the tibial nerve. The speed and volume except for concentration of injectate can significantly influence the volume of alcohol diffusion.