儿科人群中对伤害感受的功能性近红外光谱反应的特征分析。

Characterization of the functional near-infrared spectroscopy response to nociception in a pediatric population.

作者信息

Olbrecht Vanessa A, Jiang Yifei, Viola Luigi, Walter Charlotte M, Liu Hanli, Kurth Charles D

机构信息

Department of Anesthesia, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.

Department of Bioengineering, University of Texas at Arlington, Arlington, TX, USA.

出版信息

Paediatr Anaesth. 2018 Feb;28(2):103-111. doi: 10.1111/pan.13301. Epub 2017 Dec 27.

DOI:10.1111/pan.13301

PMID:29280254

Abstract

BACKGROUND

Near-infrared spectroscopy can interrogate functional optical signal changes in regional brain oxygenation and blood volume to nociception analogous to functional magnetic resonance imaging.

AIMS

This exploratory study aimed to characterize the near-infrared spectroscopy signals for oxy-, deoxy-, and total hemoglobin from the brain in response to nociceptive stimulation of varying intensity and duration, and after analgesic and neuromuscular paralytic in a pediatric population.

METHODS

We enrolled children 6 months-21 years during propofol sedation before surgery. The near-infrared spectroscopy sensor was placed on the forehead and nociception was produced from an electrical current applied to the wrist. We determined the near-infrared spectroscopy signal response to increasing current intensity and duration, and after fentanyl, sevoflurane, and neuromuscular paralytic. Heart rate and arm movement during electrical stimulation was also recorded. The near-infrared spectroscopy signals for oxy-, deoxy-, and total hemoglobin were calculated as optical density*time (area under curve).

RESULTS

During electrical stimulation, nociception was evident: tachycardia and arm withdrawal was observed that disappeared after fentanyl and sevoflurane, whereas after paralytic, tachycardia persisted while arm withdrawal disappeared. The near-infrared spectroscopy signals for oxy-, deoxy-, and total hemoglobin increased during stimulation and decreased after stimulation; the areas under the curves were greater for stimulations 30 mA vs 15 mA (13.9 [5.6-22.2], P = .0021; 5.6 [0.8-10.5], P = .0254, and 19.8 [10.5-29.1], P = .0002 for HbO , Hb, and Hb , respectively), 50 Hz vs 1 Hz (17.2 [5.8-28.6], P = .0046; 7.5 [0.7-14.3], P = .0314, and 21.9 [4.2-39.6], P = .0177 for HbO , Hb, and Hb , respectively) and 45 seconds vs 15 seconds (16.3 [3.4-29.2], P = .0188 and 22.0 [7.5-36.5], P = .0075 for HbO and Hb , respectively); the areas under the curves were attenuated by analgesics but not by paralytic.

CONCLUSION

Near-infrared spectroscopy detected functional activation to nociception in a broad pediatric population. The near-infrared spectroscopy response appears to represent nociceptive processing because the signals increased with noxious stimulus intensity and duration, and were blocked by analgesics but not paralytics.

摘要

背景

近红外光谱技术能够检测区域脑氧合和血容量中与伤害感受相关的功能性光信号变化，类似于功能磁共振成像。

目的

本探索性研究旨在描述儿科人群中，不同强度和持续时间的伤害性刺激以及使用镇痛剂和神经肌肉阻滞剂之后，大脑中氧合血红蛋白、脱氧血红蛋白和总血红蛋白的近红外光谱信号特征。

方法

我们纳入了6个月至21岁在手术前接受丙泊酚镇静的儿童。将近红外光谱传感器置于前额，并通过施加于手腕的电流产生伤害感受。我们测定了近红外光谱信号对电流强度增加、持续时间增加以及使用芬太尼、七氟醚和神经肌肉阻滞剂后的反应。同时记录电刺激期间的心率和手臂运动。氧合血红蛋白、脱氧血红蛋白和总血红蛋白的近红外光谱信号通过光密度×时间（曲线下面积）来计算。

结果

在电刺激期间，伤害感受明显：观察到心动过速和手臂回缩，在使用芬太尼和七氟醚后消失，而在使用肌肉松弛剂后，心动过速持续存在，手臂回缩消失。刺激期间氧合血红蛋白、脱氧血红蛋白和总血红蛋白的近红外光谱信号增加，刺激后降低；30 mA刺激与15 mA刺激相比，曲线下面积更大（分别为氧合血红蛋白13.9 [5.6 - 22.2]，P = 0.0021；脱氧血红蛋白5.6 [0.8 - 10.5]，P = 0.0254；总血红蛋白19.8 [10.5 - 29.1]，P = 0.0002），50 Hz刺激与1 Hz刺激相比（分别为氧合血红蛋白17.2 [5.8 - 28.6]，P = 0.0046；脱氧血红蛋白7.5 [0.7 - 14.3]，P = 0.0314；总血红蛋白21.9 [4.2 - 39.6]，P = 0.0177），45秒刺激与15秒刺激相比（分别为氧合血红蛋白16.3 [3.4 - 29.2]，P = 0.0188；脱氧血红蛋白22.0 [7.5 - 36.5]，P = 0.0075）；曲线下面积被镇痛剂减弱，但未被肌肉松弛剂减弱。