IRCCS Materno Infantile Burlo Garofolo, Trieste, Italy.
Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy.
Arch Dis Child. 2021 Feb;106(2):167-172. doi: 10.1136/archdischild-2019-318695. Epub 2020 Aug 7.
To evaluate the pattern of cortical activation during a painful procedure, such as a venipuncture, in children with intellectual disability and compare it with that of cognitively healthy children.
A cohort study was conducted and cortical activation was assessed by multichannel cerebral near-infrared spectroscopy to monitor variations in oxyhaemoglobin and deoxyhaemoglobin (Hbb) in children with and without intellectual disability during a venipuncture for blood sampling with topical anaesthesia. Pain and distress were assessed as well using different validated pain scales (visual analogue scale and Non-Communicating Children's Pain Checklist-Postoperative Version for children with intellectual disability), and compared between groups.
16 children with severe to profound intellectual disability and 20 cognitively healthy peers (age range: 4-17 years).
When Hbb was analysed, children with intellectual disability exhibited a bilateral activation of the somatosensory (p<0.006) and right motor cortex (p=0.0045), whereas cognitively healthy peers never showed a cortical activation. Children with intellectual disability also showed more pain than controls (p=0.001).
When subjected to a painful procedure, only children with intellectual disability show an activation of the cerebral cortex, even if topical anaesthesia is applied, and express more pain than cognitively healthy peers. The role of other issues in painful procedures, such as anxiety, fear or physical restraint, deserves further investigation.
评估智力障碍儿童在进行静脉穿刺等疼痛性操作时的皮层激活模式，并与认知健康儿童进行比较。
本研究采用队列研究方法，通过多通道近红外脑光谱技术监测接受局部麻醉的静脉穿刺采血过程中智力障碍和非智力障碍儿童的氧合血红蛋白和脱氧血红蛋白（Hbb）变化，评估皮层激活。采用不同的验证疼痛量表（视觉模拟评分和非言语交流儿童疼痛检查表-术后版，适用于智力障碍儿童）评估疼痛和不适，并在组间进行比较。
16 名严重至重度智力障碍儿童和 20 名认知健康同龄儿童（年龄范围：4-17 岁）。
当分析 Hbb 时，智力障碍儿童表现出双侧体感皮层（p<0.006）和右侧运动皮层的激活（p=0.0045），而认知健康同龄儿童从未表现出皮层激活。智力障碍儿童的疼痛程度也高于对照组（p=0.001）。
即使使用局部麻醉，接受疼痛性操作的智力障碍儿童仅表现出大脑皮层的激活，且表达的疼痛程度高于认知健康同龄儿童。在疼痛性操作中，其他问题（如焦虑、恐惧或身体约束）的作用值得进一步研究。
