【作者】 贺文艳；

【导师】 贠克明；

【作者基本信息】 山西医科大学 ， 法医学， 2005， 硕士

【摘要】 目的: 1 建立犬利多卡因硬膜外麻醉致死动物模型,观察利多卡因硬膜外麻醉致死过程的生命体征和死后组织脏器的病理改变; 2 研究利多卡因在硬膜外麻醉致死犬体内分布,为利多卡因硬膜外麻醉致死案件的检材采取、检测、结果分析、死因判定及法医学鉴定提供科学依据。方法1 动物模型犬9 只,随机分为实验组(6 只)和对照组(3 只),实验组犬5 分钟内硬膜外腔注射利多卡因5×15mg/kg,对照组犬注入等体积生理盐水。2 生命体征记录方法BL-生物机能实验系统全程记录从开始给药到动物死亡的心电、血压和呼吸等生命体征的变化; 3 样品采集与处理心电、血压和呼吸全部消失时,迅速解剖动物,取大脑、侧脑室脑脊液、背侧脑脊液、不同节段脊髓(颈段脊髓、胸段脊髓、腰段脊髓、骶段脊髓)、心、肺、肝、脾、肾、胆汁、尿、心血、周围血、注射部位肌肉和注射部位20cm 以外肌肉等组织脏器和体液,即刻检测实验犬各组织和体液中利多卡因含量,对照组犬各脏器和体液用作空白检材; 4 病理观察取大脑、脊髓、心、肺、肝、脾、肾,用4%甲醛固定,石蜡包埋,切片,HE 染色,光镜观察; 5 检测利多卡因方法样品经酸、碱处理后,乙醚萃取,气相色谱和气相色谱-质谱联用检测,根据利多卡因的特征离子峰、保留时间定性与内标法、工作曲线法定量。结果1 症状实验组犬在注药开始后5~8min 即出现瞳孔缩小、呼吸困难、烦躁、流涎、口吐粘稠状白沫、肌肉震颤、对外界刺激敏感等中毒症状,更多还原

【Abstract】 OBJECTIVE:1.To develop an lidocaine epidural administration death model , and observe three mainly vital signs and pathology of dogs after a fatal epidural anesthesia with lidocaine hydrochlorid. 2.To investigate the distribution of lidocaine in dead dogs to provide a scientific evidence for the forensic identification of the anesthesia accident caused by lidocaine. METHOD: 1. Animal model: Nine dogs were randomly allocated to two group,one group were given an epidural anesthesia with an even speed in five minutes with 75mg/kg weight of lidocaine hydrochloride (n=6 per group ) ;the other group were given the equate volume of physiological salt solution (n=3 per group ). 2. Record of vital signs: By a biological function system ,the vital signs such as electro cardia, blood pressure and respiration from beginning of the administration to the death of dogs were recorded. 3. Collection of samples: A dog died from the anesthesia was dissected as soon as its vital signs disappeared, and then its specimens—the brain, cerebrospinal fluid (CSF) in lateral ventricle, lumbar CSF in subarachnoid space, spinal cord (cervical spinal cord, thoracic spinal cord, lumbar spinal cord, sacrum spinal cord ), heart, lung, liver, spleen, kidney, bile, urine, heart blood, peripheral blood, muscle in injection location and muscle in no injection location —were collected and sampled immediately. 4. Pathology: The brain, spinal cord, cerebrum, heart, lung, liver, spleen and kidney were fixed with 4% formaldehyde, cut into sections and stained with a HE staining for a light microscopic examination. 5. Analysis: These obtained samples were extracted by ethyle ether. Analysis was performed with a GC equipped with a NPD and a GC-MS. The analytes identification were based on retention time in the chromatographic system coupled with the ion fragmentation spectrum in the mass spectrometer. The quatitative analysis was on an internal standard method . RESULTS: 1.The pupil decrease, salivate, dyspnoea, fidget, foam at the mouth, aphonia, muscle tremble occureed at 5~8 min after an epidural administration of lidocaine.During the anesthesia, paralysis of the four legs, rigidity, hyperkinesias, muscle tremble, incontinence of urine and excrement and extensive sensory occureed. 2. The time from the beginning of the administration to the disappearance of the electro cardiac, blood pressure and respiration was 33.2±9.1min,28.7±7.66min and 27.2±6.65min, respectively in the epidural anesthesia group. 3. The experimented dogs showed a pathology of the sudden death. 4. The concentrations detected in the urine, kidney, brain, heart, bile, lumbar spinal cord, muscle in injection location, sacrum spinal cord, spleen, thoracic spinal cord, cervical spinal cord, liver, muscle in no injection location, peripheral blood, heart blood, lumbar CSF in subarachnoid space, cerebrospinal fluid (CSF) in lateral ventricle and lung were 83.0±42ug/ml, 76.9±49.5ug/g, 48.3±29.6ug/g, 44.7±38.8ug/g, 30.4±17.2/ml, 27.8±14.7ug/g, 26.0±21.9ug/g, 25.7±13.9ug/g, 8.1±5.8ug/g, 24.1±14.7ug/g, 22.3±14.9ug/g, 20.2±15.7ug/g, 16.8±15.8ug/g, 16.1±14.6ug/ml, 14.7±12.7ug/ml, 14.3±10.3ug/ml, 12.2±8.9ug/ml and 24.8±17.7ug/g. Ratios of lidoocaine in the urine, kidney, brain, heart and bile to peripheral blood were 7.8±4.3, 5.9±2.5, 3.9±2, 2.8±1.4 and 4.1±3.5 respectively. CONCLUSION: 1. The study has established one dog model of the epidural anesthesia accident death. The changes of vital signs, symptom and pathology of experimental group dogs were similar to those of the case associated with an accidental anesthesia death. So the established model was available for the forensic identification study on the epidural anesthesia accident. 2. The distribution of lidocaine in epidural administration dogs can be applied to the forensic identification study on the epidural anesthesia accident .更多还原