本文選題：羅哌卡因 + 利多卡因　； 參考：《山西醫(yī)科大學》2014年碩士論文

【摘要】：研究目的：探討局麻藥物局部浸潤對GM-CSF(粒細胞-巨噬細胞集落刺激因子)表達及皮膚愈合的影響。研究背景：近年來研究發(fā)現(xiàn)局麻藥存在新型作用。這些新型的作用屬于亦或超出了，臨床麻醉及疼痛治療的范疇，且對局麻藥的臨床應用和器官，組織功能的影響利弊共存�，F(xiàn)已有大量研究結(jié)果顯示局麻藥在全身給藥時有明顯的抗炎作用。然而在局部給藥時，由于組織損傷后固有細胞以及局部神經(jīng)結(jié)構(gòu)通過神經(jīng)末梢釋放的肽類物質(zhì)共同參與了局部炎癥反應。所以局麻藥局部浸潤所產(chǎn)生的效應可能與全身應用時所產(chǎn)生的效應完全不同。已有研究證明局麻藥可能會影響傷口愈合，但其影響愈合的機制尚不明確。 研究內(nèi)容及方法： 采用小鼠全層皮膚損傷模型。經(jīng)腹腔內(nèi)麻醉以后，在背部正中線近頸側(cè)建造一個1cm×1cm大小的全層皮膚損傷創(chuàng)面。120只(雄性昆明小鼠)創(chuàng)面造模成功后，采用單籠飼養(yǎng)的方式，依次將每籠編號，分別為1~120號，然后嚴格按照完全隨機原則，將小鼠分為三個大組即：對照組（S組，n=40),0.5%羅哌卡因浸潤組（P組，n=40)，0.5%利多卡因浸潤組（D組，n=40)。再將每個大組分為五個時相點，分別為8只。S組用0.9%生理鹽水0.1ml/12h創(chuàng)面局部浸潤，P組用0.5%羅哌卡因0.1ml/12h創(chuàng)面局部浸潤，D組用0.5%利多卡因0.1ml/12h創(chuàng)面局部浸潤。分別于傷后第3,5,7,10天，切取創(chuàng)面處的組織，采用ELISA法測定創(chuàng)面GM-CSF表達，，并用BCA蛋白定量法檢測各個相應標本中總蛋白的含量，用測量所得的ELISA值與與其相應的BCA值之比表示GM-CSF濃度，來進行組間的比較；分別于傷后第5天和第10天取創(chuàng)面組織檢測其病理變化；S組，P組，D組各8只小鼠飼養(yǎng)直至創(chuàng)面愈合以觀察創(chuàng)面愈合的時間。 結(jié)果: （1）應用ELISA法測定結(jié)果顯示：小鼠背部缺損創(chuàng)面造模成功后第3d和第5d，P組和D組小鼠的皮膚損傷創(chuàng)面處的GM-CSF的表達顯著高于S組（P0.05)；且P組和D組間比較，其差異具有統(tǒng)計學意義，P組創(chuàng)面處的GM-CSF表達高于D組（P0.05)。（2）病理學結(jié)果:術(shù)后第5天:間質(zhì)內(nèi)有肉芽組織形成。P2組:間質(zhì)內(nèi)有毛細血管，較多成纖維細胞，炎細胞減少。D2組：間質(zhì)內(nèi)少量成纖維細胞及炎細胞。S2組：間質(zhì)內(nèi)肉芽組織極少見，間質(zhì)僅見少量成纖維細胞。術(shù)后第10天，P4組：表面鱗狀上皮明顯增生增厚，膠原纖維明顯增多。D4組：表面鱗狀上皮增厚，有呈梭形的膠原纖維。S4組：表面見鱗狀上皮增生，另外可見膠原纖維及少量炎細胞浸潤于間質(zhì)內(nèi)。（3）各實驗組的創(chuàng)面愈合時間：對照組創(chuàng)面愈合的時間為（20.75±2.38）d；0.5%羅哌卡因組創(chuàng)面愈合時間為（16.13±1.36）d；0.5%利多卡因組創(chuàng)面愈合時間為（18.25±1.67）d。P組較D組提前（2.13±1.73）d；D組較S組提前（2.50±1.78）d 結(jié)論：局部浸潤局麻藥物可促進創(chuàng)面GM-CSF的表達有利于皮膚的愈合；羅哌卡因的作用優(yōu)于利多卡因。
[Abstract]:Objective: to investigate the effect of local anesthetic infiltration on the expression of GM-CSFF (granulocyte-macrophage colony stimulating factor) and skin healing. Background: in recent years, local anesthetics have been found to have new effects. These new effects belong to, or go beyond, clinical anaesthesia and pain treatment, and coexist with the clinical application of anesthetic and the effects of organ and tissue functions. A large number of studies have shown that local anesthetics have a significant anti-inflammatory effect when administered throughout the body. However, during local administration, endogenous cells and peptides released by local nerve structures through nerve endings are involved in the local inflammatory reaction due to tissue injury. So the effect of local anesthetic infiltration may be completely different from that of systemic application. Local anesthetic may affect wound healing, but its mechanism is unclear. Contents and methods of the study: The whole skin injury model of mice was used. After intraperitoneal anesthesia, an 1cm 脳 1cm size full-thickness skin injury wound was constructed on the median line of the back near the neck. After successful modeling of the wound, each cage was numbered from 1 to 120 by single cage feeding. Then, according to the principle of complete randomness, the mice were divided into three groups: control group (group S): control group (group S) with 0.5% ropivacaine infiltration group (group P) and group P with 0.5% lidocaine infiltration group (group D). Each large group was divided into five time points: group S was treated with 0.9% normal saline 0.1ml/12h and group P was treated with 0.5% ropivacaine 0.1ml/12h. Group D was treated with 0.5% lidocaine 0.1ml/12h. The tissue of the wound was cut off on the 10th day after injury, and the expression of GM-CSF was measured by ELISA method. The total protein content of each specimen was detected by BCA protein quantitative method. The GM-CSF concentration was expressed by the ratio of the measured ELISA value to the corresponding BCA value. The histopathological changes of wound tissue were detected on the 5th and 10th day after injury. The rats in group S were fed with 8 mice in group P until the wound healed to observe the time of wound healing. Results: 1) the results of ELISA assay showed that the expression of GM-CSF in the wound of skin injury in group P and D was significantly higher than that in group S on the 3rd and 5th day after the model was established, and the expression of GM-CSF in group P and group D was significantly higher than that in group S, and the expression of GM-CSF in group D was significantly higher than that in group P, and the expression of GM-CSF in group D was significantly higher than that in group S. The expression of GM-CSF in the wound surface of P group was significantly higher than that in D group (P 0.05N. 2) pathological results: on the 5th day after operation, there were granulation tissue formation in interstitial tissue. P2 group: there were capillaries and more fibroblasts in interstitial tissue. In group D 2, a small number of fibroblasts were found in the interstitial cells, and only a few fibroblasts were found in the interstitial cells. On the 10th day after operation, in the P4 group: the surface squamous epithelium was thickened obviously, the collagen fiber was obviously increased. D4 group: the surface squamous epithelium thickened, and the spindle collagen fibers were seen in the S4 group: the squamous epithelium proliferation was observed on the surface. In addition, collagen fibers and a small amount of inflammatory cells infiltrated the interstitial stroma.) the wound healing time of each experimental group was 20.75 鹵2.38 days of ropivacaine 0.5% ropivacaine group was 16.13 鹵1.36 days old and 0.5% lidocaine group wound healing time was 16.13 鹵1.36 days. 2. 13 鹵1. 73 days in group D and 2. 50 鹵1. 78 days earlier in group D than in group S. 18. 25 鹵2. 25 鹵1. 78 days earlier than group D Conclusion: local anesthetic infiltration can promote the expression of GM-CSF in wound and ropivacaine is superior to lidocaine.
【學位授予單位】：山西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R614

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