兔胫神经阻滞中乙醇扩散的影响因素

关键词：神经溶解  胫神经  乙醇  扩散

Keywords:neurolysis  tibial nerve  alcohol  diffusion

摘要：

      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0.3ml 50%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。

Abstract:

      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.