Epidural Anesthesia Accelerates the Recovery of Postischemic Bowel Motility in the Rat
Epidural Anesthesia Accelerates the Recovery of Postischemic Bowel Motility in the Rat
复制标题
硬膜外麻醉加速大鼠缺血后肠蠕动的恢复
DOI：
10.1097/00000542-199404000-00016
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发表时间：
1994
期刊：
影响因子：
8.8
通讯作者：
Y. Haskel
中科院分区：
文献类型：
--
作者：
R. Udassin;D. Eimerl;J. Schiffman;Y. Haskel
背景：肠道缺血与胃肠运动紊乱有关。无控制的临床观察表明，硬膜外注射布比卡因使各种腹部手术后肠动力恢复更快，这使我们评估硬膜外麻醉可以加速术后立即胃肠动力恢复的假设。方法：对大鼠进行硬膜外麻醉和肠缺血，在不引起手术创伤的情况下进行肠道运动研究。将硬膜外利多卡因与硬膜外生理盐水在肠缺血30分钟后对肠蠕动的影响进行比较。结果：小肠完全缺血导致明显的缺血后动态肠梗阻，研究期结束时，只有0.7%的小肠总长度填充了标记餐（运输指数），而对照组为84.4%。利多卡因硬膜外麻醉导致动态肠梗阻明显更快地消失（60.3%的肠道填充了标记餐，而注射生理盐水的对照组为30.9%）。结论：与硬膜外生理盐水相比，硬膜外利多卡因能加速大鼠肠缺血30分钟后胃肠运动的恢复。这种效应可能是由交感神经传出抑制通路的衰减或交感神经阻滞引起的血管扩张引起的。这些结果表明，利多卡因硬膜外阻滞不仅可以减轻缺血性肠损伤的疼痛，还可以加速缺血性麻痹性肠梗阻的恢复。
Background:Intestinal ischemia is associated with derangement of gastrointestinal motility. Uncontrolled clinical observations that bupivacaine injected into the epidural space causes faster recovery of bowel motility after various abdominal operations led us to assess the hypothesis that epidural anesthesia can hasten the recovery of gastrointestinal motility in the immediate postischemic period. Methods:Gut motility studies were performed in rats in which epidural anesthesia and intestinal ischemia could be initiated without the need to provoke surgical trauma. Epidural lidocaine was compared to epidural saline in their effect on intestinal motility after a 30-min period of bowel ischemia. Results:Total ischemia to the small bowel resulted in pronounced postischemic adynamic ileus as evidenced by only 0.7% of the total length of the small bowel filled with a marker meal at the end of the study period (transit index) compared with 84.4% in the control group. Lidocaine epidural anesthesia caused significantly more rapid resolution of the adynamic ileus (60.3% of the bowel filled with the marker meal vs. 30.9% in the controls in which saline was injected). Conclusions:Epidural lidocaine compared to epidural saline hastens the recovery of gastrointestinal motility in rats after a 30-min period of bowel ischemia. This effect may be elicited by attenuation of sympathetic efferent inhibitory pathways or by vasodilatation caused by the sympathetic block. These results suggest that lidocaine epidural block not only alleviates pain in situations of ischemic injury to the bowel but may also hasten the recovery from postischemic paralytic ileus.