背景：布比卡因神经毒性、心脏毒性的报道屡见不鲜，而关于布比卡因所致肌肉毒性的文章却不多。目的：建立并评价局部肌肉注射布比卡因不同时间点大鼠多裂肌组织形态和超微结构变化。 方法：选用体质量280-320 g 的雄性 SD 大鼠54只随机分为空白组(18只)、模型组(18只)、模型对照组(18只)，每组随机分为4，7，14 d 3个亚组，每个亚组6只大鼠。麻醉后于双侧 L4-5多裂肌注射0.5%布比卡因溶液，通过光学显微镜和透射电子显微镜观察分析造模后4，7，14 d 多裂肌形态及超微结构改变。 结果与结论：①肌肉注射0.5%布比卡因可导致大鼠骨骼肌损伤。②苏木精-伊红染色可见局部多裂肌纤维出现坏死、炎细胞浸润、少量巨噬细胞等。③透射电镜下可见肌原纤维以及各带、线排列紊乱，结构崩解，甚至消失；线粒体结构异常，嵴减少、消失等；模型7，14 d 组可见多裂肌增生、修复等变化。④模型组骨骼肌超微结构变化分值明显高于空白组和模型对照组(P <0.05)；模型4 d 组高于模型7，14 d组(P <0.05)；模型7 d 组高于模型14 d 组(P <0.05)。⑤结果表明一次性肌肉注射0.5%布比卡因，可发生大鼠骨骼肌形态学超微结构上的病理改变，以此建立的大鼠多裂肌损伤模型较为理想。%BACKGROUND: The neurotoxicity and cardiotoxicity of bupivacaine have been reported frequently. However, the studies on bupivacaine-induced muscle toxicity are few. OBJECTIVE: To establish and evaluate local intramuscular injection of bupivacaine on the changes in histomorphology and ultrastructure of rat multifidus muscle at various time points. METHODS: A total of 54 male Sprague-Dawley rats weighing 280-320 g were randomly divided into black group (n=18), model group (n=18) and model control group (n=18). Each group was then equal y subdivided into three subgroups according to time points (4, 7 and 14 days) (n=6). Both sides of multifidus muscle of the rats (L4 and L5) were injected with 0.5% bupivacaine. The morphological and ultrastructural changes of multifidus muscle were observed and analyzed with light microscope and transmission electron microscope at 4, 7 and 14 days after model establishment. RESULTS AND CONCLUSION: (1) A single intramuscular injection of 0.5% bupivacaine induced muscular damage. (2) Hematoxylin-eosin staining results showed fiber necrosis, inflammatory cel infiltration, and a smal amount of macrophages in local skeletal muscle. (3) Under the transmission electron microscope, the structure of myofibrils was destroyed or disintegrated; kinds of bands and lines were indistinct, disrupted or disappeared; the structure of mitochondria was abnormal, the mitochondrial cristae were reduced or disappeared. In the 7- and 14-day groups, multifidus muscle proliferated and repaired. (4) Ultrastructural change scores in skeletal muscle were significantly higher in the model group than in the blank and model control groups (P < 0.05). Above scores were significantly greater in the 4-day group than in the 7- and 14-day groups (P < 0.05), and higher in the 7-day group than in the 14-day group (P < 0.05). (5) Results suggest that a single intramuscular injection of 0.5% bupivacaine can result in pathological changes of skeletal muscle from morphology and ultrastructure. This method can establish a suitable model of skeletal muscle injury.
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