【作者】 尉志文；

【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)建立犬的利多卡因静脉注射、蛛网膜下腔麻醉、硬膜外麻醉致死的死后再分布动物模型; (2)比较三种死后再分布模型致死犬常温下不同时间点利多卡因在心血、周围血、肝脏和脑中的分布规律,为利多卡因硬膜外麻醉意外死亡和中毒案件的法医学鉴定提供科学依据; (3)比较三种死后再分布模型致死犬在常温下不同时间点心血、周围血、肝脏和脑中利多卡因的分布特点, 探讨死后再分布机制。方法1 动物模型每种模型各用犬9 只,随机分为实验组(6 只)和对照组(3 只)两组,实验组犬5 分钟内分别经股静脉、蛛网膜下腔、硬膜外腔匀速注入利多卡因5×15mg/kg,对照组分别在对应部位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死后再分布模型从开始给药到动物死亡的心电、血压和呼吸等主要生命体征的变化。3 样品采集与处理心电、血压和呼吸全部消失后,置于室温下,分别于死后0,1,4,8,24,48,72 小时取心血、周围血、肝脏、大脑,检测实验组犬上述检材中利多卡因含量,对照组犬各对应检材用作空白; 样品经酸、碱化处理后,乙醚萃取,根据利多卡因的特征离子峰、保留时间气相色谱-质谱联用定性,内标法、工作曲线法气相色谱定量。结果( 1 ) 症状静脉注射实验组动物开始给药后出现瞳孔缩小、呼吸困难、口吐粘稠状白色泡沫、角弓反张、大小便失禁。蛛网膜下腔麻醉、硬膜外腔麻醉实验组动物出现症状与上述相似。三种模型对照组均未出现以上症状,未出现死亡。更多还原

【Abstract】 OBJECTIVE: 1.To establish the models of postmortem redistribution in dogs with an intravenous, a subarachnoid or an epidural administration of lidocaine hydrochloride. 2. To compare the distribution of lidocaine in the cardiac blood, peripheral blood, liver and cerebrum of anesthesia accident death dogs in different times at room temperature, and provide a scientific evidence for the forensic identification of the epidural anesthesia accident caused by lidocaine. 3. Investigate whether there was a postmortem distribution of lidocaine in anesthesia accident death dogs,and discuss its mechanism. METHOD: 1. Animal model: Twenty seven dogs were randomly allocated to one of three groups (n=9 per group ) .Six dogs in each group was given an intravenous injection, a subarachnoid anesthesia ,or an epidural anesthesia with an even speed in ten minutes for 5×15mg/kg weight of lidocaine hydrochloride(n=6 per group), and the other 3 dogs in each group was given the same 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 of dogs from the beginning of the administration to the death were recorded. 3. Collection of samples: A dog died from anesthesia was placed at room temperature, collected cardiac blood, peripheral blood, liver and cerebrum in 0,1,4,8,24,48,72 hours after the death and was analyzed. 4. Analysis method: These obtained samples were extracted by ether. Analysis was performed with a GC equipped with a NPD and a GC-MS. Qualitative analysis was based on retention time in the chromatographic system coupled with the ion fragmentation spectrum in the mass spectrometer. Quantitative analysis was based on an internal standard method. RESULTS: 1. Symptom Pupil decrease, respiratory arrest, opisthotonos, incontinence of urine and excrement, and extensive sensory occurred at 1~2 min after the intravenous administration of lidocaine. The symptom of the subarachnoid anesthesia and epidural anesthesia were similar with intravenous administration. 2. Postmortem redistribution of lidocaine in anesthesia accident death dogs: Anesthesia accident dogs showed different changes of lidocaine concentration in cardiac blood, peripheral blood, liver and cerebrum after the intravenous administration, the subarachnoid anesthesia or the epidural anesthesia, which showed the most remarkable change in the acardiac blood. Postmortem cardiac blood lidocaine concentrations were decreased from 123.5±14.5μg/ml to 32.1±4.6μg/ml in 72h after the intravenous administration death. There was also no significant difference between the antenortem and after death for 8 hours lidocaine concentrations in peripheral blood, liver and cerebrum. After the death for 48 h ,the cardiac blood lidocaine concentration in subarachnoid anesthesia dogs was the highest. There were no significant changes of peripheral blood or liver lidocaine concentration in them. Liver and cerebrum lidocaine levels were steadier than cardiac and peripheral blood in epidural anesthesia. Peripheral blood lidocaine concentrations were similar with cardiac blood. CONCLUSION: 1. The study has established the postmortem redistribution models of intravenous administration, subarachnoid anesthesia and epidural anesthesia with lidocaine. Marked differences between heart and femoral blood, liver and cerebrum lidocaine concentrations were observed in both of the above-mentioned models. Each model has characteristic of itself, this study has demonstrated that an anesthesia accident should be think about postmortem redistribution. The chosen site and time for postmortem matrices sampling can greatly influence the concentration of lidocaine measured. 2. The data of postmortem redistribution in different matrices after intravenous suharachonid and epidural application in dogs may apply to the study on forensic identification.更多还原