Pain activates cortical areas in the preterm newborn brain
Pain activates cortical areas in the preterm newborn brain
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DOI：
10.1016/j.pain.2006.01.015
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发表时间：
2006-05-01
期刊：
影响因子：
7.4
通讯作者：
Anand, KJS
中科院分区：
文献类型：
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作者：
Bartocci, M;Bergqvist, LL;Anand, KJS
为了研究新生儿脊髓上疼痛处理的模式，我们假设急性疼痛引起与初级躯体感觉皮层激活相关的血流动力学变化。对40例孕28-36周（平均32.0周）和25-42小时（平均30.7小时）的早产儿进行标准化触觉（皮肤消毒）和疼痛（静脉穿刺）刺激。区域脑血流动力学的变化进行了监测，近红外光谱（NIRS）在两个躯体感觉皮层的29名新生儿，和对侧的躯体感觉和枕叶区的II新生儿。同时记录心率（HR）和外周血氧饱和度（SaO（2））以及MRS参数：氧合[HbO（2）]、脱氧和总血红蛋白。触觉刺激对HR或SaO无影响（2）。在静脉穿刺后的前20 s内，HR增加（p < 0.001），而SaO（2）在40 s内下降（p < 0.0001）。在触觉或疼痛刺激后，无论刺激哪只手，双侧[HbO（2）]均增加（p < 0.0001）。疼痛引起的对侧躯体感觉皮层[HbO（2）]的增加（p < 0.05）在枕叶皮层没有反映出来（p > 0.1）。疼痛相关的[HbO（2）]升高在男性新生儿中更为明显（左侧p < 0.05，右侧p < 0.00 1），与胎龄呈负相关（r = -0.53，p = 0.01; r = -0.42，p = 0.05）与出生后年龄直接相关（左侧r = 0.75，P < 0.0001;右侧r = 0.67，P < 0.0001）。疼痛和触觉刺激引起特定的血流动力学反应的躯体感觉皮层，这意味着有意识的感觉知觉早产儿。躯体感觉皮层激活发生在单侧刺激后的双侧，这些变化在男性新生儿或胎龄较低的早产儿中更为明显。(c)2006年国际疼痛研究协会。Elsevier B. V.出版，保留所有权利。
To Study the patterns of supraspinal pain processing in neonates, we hypothesized that acute pain causes haemodynamic changes associated with activation of the primary somatosensory cortex. Forty preterm neonates at 28-36 weeks of gestation (mean = 32.0) and at 25-42 h (rnean = 30.7) of age were studied following standardized tactile (skin disinfection) and painful (venipuncture) stimuli. Changes in regional cerebral haemodynamics were monitored by near infrared spectroscopy (NIRS) over both somatosensory cortices in 29 newborns, and over the contralateral somatosensory and occipital areas in I I newborns. Heart rate (HR) and peripheral oxygen saturation (SaO(2)) were recorded simultaneously with MRS parameters: oxygenated [HbO(2)], deoxygenated, and total hemoglobin. Tactile stimulation produced no changes in HR or SaO(2). HR increased in the first 20 s (p < 0.001), while SaO(2) decreased during the 40 s after venipuncture (p, < 0.0001). Following tactile or painful stimulation, [HbO(2)] increased bilaterally regardless of which hand was stimulated (p < 0.0001). Pain-induced [HbO(2)] increases in the contralateral somatosensory cortex (p < 0.05) were not mirrored in the occipital cortex (p > 0.1). Pain-related [HbO(2)] increases were more pronounced in male neonates (p < 0.05 on left, p < 0.00 1 on right), inversely correlated with gestational age (r = -0.53 on left, p < 0.01; r = -0.42 on right, p < 0.05) and directly correlated with postnatal age (r = 0.75 on left, P < 0.0001; r = 0.67 on right, p < 0.0001). Painful and tactile stimuli elicit specific haemodynamic responses in the somatosensory cortex, implying conscious sensory perception in preterm neonates. Somatosensory cortical activation occurs bilaterally following unilateral stimulation and these changes are more pronounced in male neonates or preterm neonates at lower gestational ages. (c) 2006 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.