Department of General Pediatrics, Children's Hospital Boston, Boston, MA 02115, USA.
J Palliat Med. 2013 Apr;16(4):455-8. doi: 10.1089/jpm.2012.0103. Epub 2012 Aug 7.
Infants with neurologic impairment (NI) as a result of injury to the central nervous system have a significant rate of pain. Problems associated with pain in children with NI include increased tone. This secondary hypertonia may contribute to apnea as a result of alterations in airway tone and chest wall movement. Infants are at greatest risk given their smaller airways, lower functional residual capacity, and the high rate of unrecognized pain at this age.
We report two cases of infants with NI, identified to have significant improvement in apnea following empiric treatment with gabapentin for presumed central pain and/or visceral hyperalgesia. This correlation between pain and apnea, with resolution in apnea following effective treatment of these presumed sources, has not been previously reported in the literature.
Infants with NI and apnea should have careful pain assessment and treatment, when considering other causes and interventions for apnea.
由于中枢神经系统损伤而导致神经功能障碍（NI）的婴儿有很高的疼痛发生率。患有 NI 的儿童的疼痛相关问题包括肌张力增加。这种继发性高肌张力可能会导致呼吸暂停，因为气道张力和胸壁运动发生改变。由于婴儿的气道较小、功能残气量较低，以及这个年龄段未被识别的疼痛发生率较高，因此他们面临着最大的风险。
我们报告了两例患有 NI 的婴儿的病例，在对疑似中枢性疼痛和/或内脏痛觉过敏的婴儿进行加巴喷丁经验性治疗后，其呼吸暂停显著改善。在文献中，之前没有报道过疼痛和呼吸暂停之间的这种相关性，以及在有效治疗这些疑似病因后呼吸暂停的缓解。
对于患有 NI 和呼吸暂停的婴儿，应在考虑其他呼吸暂停的原因和干预措施时，仔细评估和治疗疼痛。
