Kang Sinyoung, Brennan Timothy J
Department of Anesthesia, University of Iowa Hospitals and Clinics, Iowa City, Iowa 52242, USA.
Anesthesiology. 2009 Jul;111(1):155-64. doi: 10.1097/ALN.0b013e3181a16443.
The authors have demonstrated a decrease in pH in the incisional wound environment, suggesting a possible contribution of low pH to postsurgical pain. In this study, the authors characterized the acid-responsiveness of nociceptors innervating the plantar aspect of the rat hind paw 1 day after plantar incision and compared this to plantar skin from unincised control rats.
Using the rat glabrous in vitro skin-tibial nerve preparation, afferent nerve activities from single mechanosensitive nociceptors were recorded. Differences in mechanosensitivity, spontaneous activity, and chemosensitivity of units were evaluated. For chemosensitivity, acid-responsiveness of nociceptors to lactic acid (pH 5.5 to 6.5) was studied.
C-fibers showed dose-dependent, sustained responses to lactic acid. A greater proportion of C-fibers from 2 mm or less from the incision was activated by pH 6.0 lactic acid (52.9%) compared to control (14.3%). Total evoked potentials during acid exposure were greater in C-fibers innervating 2 mm or less from the incision compared to those in unincised skin. The prevalence of acid responses and total evoked potentials during acid exposure in C-fibers innervating more than 2 mm from the incision were not different from control. Few A-fibers responded to lactic acid, with a range of pH 5.5 to 6.5 in both incision and control groups. Increased spontaneous activity and mechanosensitivity were also evident.
C-fibers in the vicinity of the incision showed qualitatively and quantitatively greater chemosensitivity to pH 6.0 lactic acid compared to control. This change was localized to 2 mm or less from the incision, suggesting increased chemosensitivity of nociceptive C-fibers 1 day after plantar incision.
作者已证明切口伤口环境中的pH值降低,提示低pH可能对术后疼痛有影响。在本研究中,作者对足底切开术后1天支配大鼠后爪足底的伤害感受器的酸反应性进行了表征,并将其与未切开的对照大鼠的足底皮肤进行比较。
使用大鼠无毛体外皮肤-胫神经标本,记录单个机械敏感伤害感受器的传入神经活动。评估单位的机械敏感性、自发活动和化学敏感性的差异。对于化学敏感性,研究了伤害感受器对乳酸(pH 5.5至6.5)的酸反应性。
C纤维对乳酸表现出剂量依赖性的持续反应。与对照组(14.3%)相比,切口2mm或以内的C纤维中有更大比例被pH 6.0的乳酸激活(52.9%)。与未切开皮肤中的C纤维相比,支配切口2mm或以内的C纤维在酸暴露期间的总诱发电位更大。支配切口2mm以外的C纤维在酸暴露期间的酸反应发生率和总诱发电位与对照组无差异。很少有A纤维对乳酸有反应,在切口组和对照组中pH范围均为5.5至6.5。自发活动和机械敏感性也明显增加。
与对照组相比,切口附近的C纤维对pH 6.0的乳酸在定性和定量上表现出更高的化学敏感性。这种变化局限于切口2mm或以内,提示足底切开术后1天伤害性C纤维的化学敏感性增加。