利多卡因对免蛛网膜下腔出血后脑血管痉挛的防治

目的：研究枕大池注入利多卡因是否能缓解蛛网膜下腔出血后脑血管的痉挛。方法：30只新西兰大白兔随机分为假手术组、蛛网膜下腔出血组出血组、利多卡因治疗组（治疗组），每组10只。出血组和治疗组的动物于枕大池注入自体动脉血1．5ml，假手术组注入1．5ml生理盐水，30min后假手术组和出血组的动物从枕大池注入0．1ml生理盐水，治疗组注入0．1 ml 2％利多卡因。72h后观察脑基底动脉管腔面积，另测定术前和72h后血浆中的内皮素（ET）和降钙基因相关肽（CGRP）。结果：各组术前的血浆ET，CGRP无显著差别（P〉0．05）；术后72h出血组的血浆ET高于假手术组和治疗组（P〈0．05），各组术后血浆ET比术前高（P〈0．01或P〈0．001）；术后72h血浆CGRP没有统计学差别（P〉0．05），与术前比较，假手术组和出血组的术后CGRP低于术前水平（P〈0．01或P〈0．001）；出血组的血管腔面积低于假手术组和治疗组（P〈0．001）。结论：枕大池注入利多卡因能减轻兔蛛网膜下腔出血后脑血管痉挛。

An Experimental Study on Prevention of Cerebral Vasospasm with Lidocaine Injection in A Rabbit Model of Subarachnoid Hemorrhage

Objective: To investigate the prevention of cerebral vasospasm by injecting lidocaine into cisterna magna of a rabbit model of subarachnoid hemorrhage(SAH).Methods: Thirty New Zealand white rabbits are randomized to control group(A),subarachnoid hemorrhage group(B),and lidocaine therapy group(C).There were ten animals in each group.The animals of groups B and C were injected with 1.5 ml of nonheparinized autologous arterial blood into cisterna magna as mimic SAH,while those in group A received 1.5 ml saline into cisterna magna instead. In thirty minutes after SAH,the animals in group A and group B were injected with 0.1 ml of saline into cisterna magna,while 0.1 ml of 2% lidocaine were injected into cisterna magna of rabbits in group C.The animals were killed in 72 hours after SAH and their basilar arteries were prepared for morphometric analysis.The blood contents of endothelin(ET) and calcitonin gene-related peptide(CGRP) were determined before and 72 hours after SAH.Results: The preoperative blood contents of ET and CGRP were not significantly different in all of the animals.The blood contents of ET of 3 groups after SAH were higher than those before operation(P<0.01 or P<0.001).The content of ET in B group was higher than those of groups A and C after SAH(P<0.05).The contents of CGRP were not significantly different among groups after SAH(P>0.05),but were lower than those before operation(P<0.01 or P<0.001).The cross-section areas of basal arteries were smaller in B group than those of the other two groups(P<0.001).Conclusions: The study results prove that lidocaine injection in cisterna magna can prevent the cerebral vasospasm in rabbit model of subarachnoid hemorrhage.