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应用无创性技术检测早产儿体感诱发电位时脑氧代谢的变化。

Somatosensory evoked changes in cerebral oxygen consumption measured non-invasively in premature neonates.

机构信息

A.A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA; Laboratoire Psychologie des Actions Langagières et Motrices, Université de Caen Basse-Normandie, France.

出版信息

Neuroimage. 2014 Jan 15;85 Pt 1(0 1):279-86. doi: 10.1016/j.neuroimage.2013.01.035. Epub 2013 Jan 28.

Abstract

The hemodynamic functional response is used as a reliable marker of neuronal activity in countless studies of brain function and cognition. In newborns and infants, however, conflicting results have appeared in the literature concerning the typical response, and there is little information on brain metabolism and functional activation. Measurement of all hemodynamic components and oxygen metabolism is critical for understanding neurovascular coupling in the developing brain. To this end, we combined multiple near infrared spectroscopy techniques to measure oxy- and deoxy-hemoglobin concentrations, cerebral blood volume (CBV), and relative cerebral blood flow (CBF) in the somatosensory cortex of 6 preterm neonates during passive tactile stimulation of the hand. By combining these measures we estimated relative changes in the cerebral metabolic rate of oxygen consumption (rCMRO2). CBF starts increasing immediately after stimulus onset, and returns to baseline before blood volume. This is consistent with the model of pre-capillary arteriole active dilation driving the CBF response, with a subsequent CBV increase influenced by capillaries and veins dilating passively to accommodate the extra blood. rCMRO2 estimated using the steady-state formulation shows a biphasic pattern: an increase immediately after stimulus onset, followed by a post-stimulus undershoot due to blood flow returning faster to baseline than oxygenation. However, assuming a longer mean transit time from the arterial to the venous compartment, due to the immature vascular system of premature infants, reduces the post-stimulus undershoot and increases the flow/consumption ratio to values closer to adult values reported in the literature. We are the first to report changes in local rCBF and rCMRO2 during functional activation in preterm infants. The ability to measure these variables in addition to hemoglobin concentration changes is critical for understanding neurovascular coupling in the developing brain, and for using this coupling as a reliable functional imaging marker in neonates.

摘要

在无数关于大脑功能和认知的研究中,血流动力学功能反应被用作神经元活动的可靠标志物。然而,在新生儿和婴儿中,文献中出现了关于典型反应的相互矛盾的结果,并且关于脑代谢和功能激活的信息很少。测量所有血流动力学成分和氧代谢对于理解发育中大脑的神经血管耦合至关重要。为此,我们结合了多种近红外光谱技术,在 6 名早产儿接受手部被动触觉刺激期间测量体感皮层中的氧合和脱氧血红蛋白浓度、脑血容量 (CBV) 和相对脑血流量 (CBF)。通过结合这些测量值,我们估计了脑氧代谢率的相对变化 (rCMRO2)。CBF 在刺激开始后立即开始增加,并在血液量之前返回基线。这与前毛细血管小动脉主动扩张驱动 CBF 反应的模型一致,随后 CBV 增加受毛细血管和静脉被动扩张以适应额外血液的影响。使用稳态公式估计的 rCMRO2 显示出双相模式:刺激开始后立即增加,随后由于血液回流速度快于氧合,刺激后出现下冲。然而,由于早产儿不成熟的血管系统,假设从动脉到静脉隔室的平均通过时间更长,会减少刺激后的下冲,并增加流量/消耗比,使其更接近文献中报告的成人值。我们是第一个报告早产儿在功能激活期间局部 rCBF 和 rCMRO2 变化的人。除了血红蛋白浓度变化外,测量这些变量的能力对于理解发育中大脑的神经血管耦合以及将这种耦合用作新生儿可靠的功能成像标志物至关重要。

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