Caselli Antonella, Uccioli Luigi, Khaodhiar Lalita, Veves Aristidis
Joslin-Beth Israel Deaconess Foot Center, Department of Surgery, Microcirculation Laboratory, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Microvasc Res. 2003 Sep;66(2):134-9. doi: 10.1016/s0026-2862(03)00053-0.
To evaluate the effect of local anesthesia on the skin vasodilation induced by the iontophoresis of sodium nitroprusside and heating.
Skin vascular reactivity, in response to iontophoresis of sodium nitroprusside (SNP), was evaluated at the forearm and foot in 13 neuropathic diabetic (DN) and 11 nonneuropathic diabetic (D) patients and 9 healthy, nondiabetic subjects who served as controls (C). The direct (DI) and nerve axon reflex-related (N-V) vasodilation were measured by using two single-point laser Doppler probes. The vasodilation in response to local warming was also assessed. A topical anesthetic was applied on the contralateral forearm and foot and all the measurements were repeated.
Dermal anesthesia resulted in a reduction of the direct vasodilation to SNP at the forearm [C: 58.1 +/- 16, D: 60.6 +/- 11%, and DN: 48.3 +/- 37% (postanesthesia percentage of reduction; mean +/- SEM), P<0.01] and at the foot in all three groups (D: 38.5 +/- 12%, P<0.01; C: 27.2 +/- 14% and DN: 11.3 +/- 17.5%, P=NS). The N-V related vasodilation was very low before and did not change after local anesthesia. The postanesthesia hyperemic response to warming was significantly reduced at low temperatures but did not change at 44 degrees C.
The sodium nitroprusside-related vasodilation is reduced after local anesthesia in a similar way in healthy subjects and diabetic patients with and without neuropathy. The response to heating is also reduced at low temperatures. This indicates a stabilizing effect of local anesthesia on the smooth muscle cell.
评估局部麻醉对硝普钠离子导入及加热诱导的皮肤血管舒张的影响。
对13例糖尿病性神经病变（DN）患者、11例非糖尿病性神经病变（D）患者以及9例健康非糖尿病对照者（C）的前臂和足部皮肤血管对硝普钠离子导入的反应性进行评估。使用两个单点激光多普勒探头测量直接（DI）和神经轴突反射相关（N-V）的血管舒张。还评估了对局部升温的血管舒张反应。在对侧前臂和足部涂抹局部麻醉剂后重复所有测量。
皮肤麻醉导致三组患者前臂对硝普钠的直接血管舒张均降低[C组：58.1±16，D组：60.6±11%，DN组：48.3±37%（麻醉后降低百分比；均值±标准误），P<0.01]，足部的直接血管舒张在三组中也均降低（D组：38.5±12%，P<0.01；C组：27.2±14%，DN组：11.3±17.5%，P=无显著性差异）。局部麻醉前后，N-V相关的血管舒张很低且无变化。低温下麻醉后对升温的充血反应显著降低，但在44℃时无变化。
在健康受试者以及有和无神经病变的糖尿病患者中，局部麻醉后硝普钠相关的血管舒张均以相似方式降低。低温下对加热的反应也降低。这表明局部麻醉对平滑肌细胞有稳定作用。
