丁卡因法医毒物分析研究进展

Advances of Tetracaine in Forensic to Toxicological Analysis

丁卡因是一种芳香酯类局部麻醉药。自20世纪30年代起,丁卡因已经被应用于各种临床实践中,多用于表面麻醉、传导麻醉、脊髓麻醉和硬膜外麻醉,一般不用于浸润麻醉。该药物在使用过程中会引起中枢神经系统和心血管系统的毒性反应,代谢系统不成熟的新生儿、老年人、患有心脏疾病及肝/肾功能障碍的人、孕妇等是局麻药中毒的高危群体。近几年,随着医疗整形美容行业的兴起,丁卡因逐渐被应用到整容、纹眉、纹身等领域。然而,因操作不当致使丁卡因进入血液、剂量过高、过敏反应等引发的中毒、休克甚至死亡的医疗事故或案件时有发生,这不仅给公众的健康带来了极大的威胁,而且也给社会的稳定埋下了隐患。在司法实践中,通常根据中毒者或死者的血液(心血)或其他生物组织中药物的含量推断中毒或死亡的原因。由于丁卡因在血液中会被拟胆碱酯酶迅速水解为对丁氨基苯甲酸,因此,在实际案件中,在人体血液中很难检测到丁卡因。本文综述了丁卡因的药理和毒理作用、体内代谢、法医毒物动力学、代谢组学以及分析检测技术的研究进展,并对后续丁卡因的深入研究方向做了探讨,以期为法医毒物工作者提供一定的参考和借鉴。

Tetracaine is a common aromatic ester local anesthetic.Since the early 1930s,tetracaine has been wildly used in clinical practices,mostly for surface anesthesia,conduction anesthesia,spinal anesthesia,epidural anesthesia,but generally not for infiltration anesthesia.Yet,tetracaine can trigger off a lot of toxic reactions to the central nervous system and cardiovascular system in the course of medication.In addition,newborns with immature metabolic systems,the elderly,people with renal dysfunction and cardiac diseases and hepatic dysfunction,and pregnant women are high risk groups for local anesthetic systemic toxicity.In the last few years,with the rise of medical plastics and beauty industry,tetracaine has been gradually applied to cosmetic surgery,eyebrow tattooing,tattoos,and otherfields.Nevertheless,the medical malpractice or cases of poisoning,shock and even death caused by improper operation of drugs into blood vessels,excessive dosage,and allergic reactions to drugs happen from time to time.Consequently,that not only brings a great threat to public health,but also gives rise to a large amount of hidden troubles for social stability.In current judicial practice,the cause of poisoning or death is usually inferred from the amount of drugs in the whole blood/heart blood sample or other biological tissues of the poisoned or deceased.Since tetracaine is rapidly hydrolyzed to metabolites(4-(butylamino)benzoic acid)by pseudocholine esterase in human blood,detection of tetracaine in human tissues or blood samples has been considered difficultly in practical cases.According to the above reasons,we review the research progress of tetracaine about its pharmacology,toxicological effects,metabolism in vivo,forensic toxicokinetics,metabolomics,and analytical technique in this article,which will be of reference value for forensic toxicological researchers.In the meantime,it is necessary to discuss the direction of in-depth study of tetracaine so as to provide reference for forensic toxicologist.