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脊髓吗啡抑制未麻醉大鼠排尿反射期间药物对膀胱张力的影响

Drug effects on urinary bladder tone during spinal morphine-induced inhibition of the micturition reflex in unanesthetized rats.

作者信息

Durant P A, Yaksh T L

机构信息

Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota 55905.

出版信息

Anesthesiology. 1988 Mar;68(3):325-34. doi: 10.1097/00000542-198803000-00002.

Abstract

In an unanesthetized chronic rat model involving the placement of one catheter in the bladder for cystometrography and one catheter in the intrathecal (IT) space for drug injections, 10 micrograms morphine sulfate injected intrathecally (it) produced long-lasting inhibition of the volume-evoked micturition reflex. During inhibition of the micturition reflex, intravesical pressure rose with infusion until a continuous emission of urine (dribbling) was observed. Such a level of intravesical pressure (overflow pressure) was significantly greater than the premorphine bladder opening pressure (+56%). During dribbling, no periodic vesical contractions were observed, and the effects of a variety of agents on bladder tone were assessed. Significant (P less than 0.05) increases in vesical pressure over that produced by morphine were observed after intraperitoneal (ip) injection of carbachol (+86%), bethanechol (+55%), norepinephrine (+53%), methoxamine (+88%), and ST-91, an alpha 2-adrenergic agonist (+70%). The increased vesical pressure was not accompanied by an increase in the rate of urine expression. Intraperitoneal injection of serotonin produced no effects on intravesical pressure or urine expression. Significant decreases in the otherwise elevated intravesical pressure were observed after ip injection of isoproterenol (-30%) and phentolamine (-21%), with no change in the rate of urine expression. In contrast, ip injection of apomorphine (dopamine agonist) resulted in significant decreases in vesical pressure (-49%) and near maximal emptying of the bladder. Apomorphine produced no effects on it morphine-induced antinociception as assessed by the tail flick response. Regarding potential treatments of spinal morphine-induced urinary retention, the present study suggests that: 1) cholinomimetic and alpha-adrenergic agonist agents might be harmful; 2) beta-adrenergic agonist and alpha-adrenergic blocking agents might be useful; and 3) dopaminergic agonist agents might be the drugs of choice.

摘要

在一个未麻醉的慢性大鼠模型中,将一根导管置于膀胱用于膀胱压力描记,另一根导管置于鞘内(IT)空间用于药物注射,鞘内注射10微克硫酸吗啡可产生对容量诱发排尿反射的持久抑制。在排尿反射抑制期间,膀胱内压随灌注升高,直至观察到尿液持续排出(滴沥)。这种膀胱内压水平(溢出压)显著高于吗啡给药前的膀胱开放压(+56%)。在滴沥期间,未观察到周期性膀胱收缩,并评估了多种药物对膀胱张力的影响。腹腔注射卡巴胆碱(+86%)、氨甲酰甲胆碱(+55%)、去甲肾上腺素(+53%)、甲氧明(+88%)和α2肾上腺素能激动剂ST-91(+70%)后,观察到膀胱压力相对于吗啡产生的压力有显著(P<0.05)升高。膀胱压力升高并未伴随尿液排出速率增加。腹腔注射5-羟色胺对膀胱内压或尿液排出无影响。腹腔注射异丙肾上腺素(-30%)和酚妥拉明(-21%)后,原本升高的膀胱内压显著降低,尿液排出速率无变化。相比之下,腹腔注射阿扑吗啡(多巴胺激动剂)导致膀胱压力显著降低(-49%),膀胱几乎排空。通过甩尾反应评估,阿扑吗啡对鞘内注射吗啡诱导的镇痛无影响。关于脊髓吗啡诱导的尿潴留的潜在治疗方法,本研究表明:1)拟胆碱能和α肾上腺素能激动剂药物可能有害;2)β肾上腺素能激动剂和α肾上腺素能阻断剂可能有用;3)多巴胺能激动剂药物可能是首选药物。

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