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大鼠镇痛药物注射后坐骨神经损伤:组织病理学检查

Sciatic nerve injury following analgesic drug injection in rats: A histopathological examination.

作者信息

Bostan Habib, Cabalar Murat, Altinay Serdar, Kalkan Yildiray, Tumkaya Levent, Kanat Ayhan, Balik Sabri, Erkut Adem, Altuner Dudu, Salihoglu Ziya, Kocer Abdulkadir

机构信息

Department of The Ministry of Justice, Council of Forensic Medicine, Istanbul, Turkey.

Department of Pathology, Selcuk University Faculty of Medicine, Konya, Turkey.

出版信息

North Clin Istanb. 2018 Sep;5(3):176-185. doi: 10.14744/nci.2017.28190.

Abstract

OBJECTIVE

Sciatic nerve neuropathy can be observed following intramuscular gluteal injections. The histopathological examination of sciatic nerve damage following intramuscular injection in the gluteal region for acute pain treatment is not feasible in humans due to the inability to dissect and examine the nerve tissue. To overcome this issue, we used a rat model for demonstrating damage to the sciatic nerve tissue after the application of commonly used drug injections.

METHODS

We investigated possible damage following the intramuscular injection of diclofenac, lornoxicam, morphine, and pethidine in a rat model based on histopathological characteristics such as myelin degeneration, axon degeneration, epineurium degeneration, fibrosis, epineurium thickening, perineurium thickening, lymphocyte infiltration, vacuolization, and edema.

RESULTS

All the analgesic drugs used in our study induced histopathological changes in the sciatic nerve. Anti-S100 positivity, showing nerve damage, was found to be the lowest in the group treated with diclofenac. Neurotoxic effects of diclofenac on the sciatic nerve were greater than those of the other drugs used in the study. Lornoxicam induced the least histopathological changes in the nerve.

CONCLUSION

Diclofenac induced severe nerve damage not only after direct injection in the sciatic nerve but also after injection in the area around the nerve. Thus, we recommend restricting the use of intramuscular gluteal injections of diclofenac. Intramuscular use of morphine and pethidine should also be overviewed.

摘要

目的

臀肌内注射后可观察到坐骨神经病变。由于无法解剖和检查神经组织,在人体中对用于急性疼痛治疗的臀肌区域肌内注射后坐骨神经损伤进行组织病理学检查是不可行的。为克服这一问题,我们使用大鼠模型来证明常用药物注射后坐骨神经组织的损伤。

方法

我们基于髓鞘变性、轴突变性、神经外膜变性、纤维化、神经外膜增厚、神经束膜增厚、淋巴细胞浸润、空泡化和水肿等组织病理学特征,研究了双氯芬酸、氯诺昔康、吗啡和哌替啶在大鼠模型中的肌内注射后可能造成的损伤。

结果

我们研究中使用的所有镇痛药均在坐骨神经中引起了组织病理学变化。发现双氯芬酸治疗组中显示神经损伤的抗S100阳性率最低。双氯芬酸对坐骨神经的神经毒性作用大于研究中使用的其他药物。氯诺昔康在神经中引起的组织病理学变化最少。

结论

双氯芬酸不仅在直接注射到坐骨神经后,而且在神经周围区域注射后均会引起严重的神经损伤。因此,我们建议限制双氯芬酸的臀肌内注射使用。吗啡和哌替啶的肌内使用也应进行评估。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1c9d/6323560/cdad2dd94d43/NCI-5-176-g001.jpg

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