目的 探讨功能性近红外光谱成像技术应用于全身麻醉儿童疼痛评估的效果。方法 该研究为前瞻性研究,纳入2021-11至2022-09在解放军总医院第七医学中心行尿道下裂修补术或隐匿型阴茎矫治术的45例0~14岁患儿为研究对象,根据是否行阴茎背神经阻滞分为全身麻醉组(G组,n=30)和全身麻醉+阴茎背神经阻滞组(N组,n=15)。两组均采用连续波功能性近红外光谱成像设备采集切皮前5 min至切皮后5 min左侧前额叶脑组织血氧参数和心率,比较切皮前后左侧前额叶脑组织血氧参数和心率的平均值和峰值变化。结果 与切皮前基线(T1)相比,G组切皮后左侧前额叶皮质被激活,脑组织血氧参数均在3 s内达到峰值(T2),T2时氧合血红蛋白平均浓度、脱氧血红蛋白平均浓度、总血红蛋白平均浓度、平均心率均显著增加或增快,差异均有统计学意义(P＜0.05);而N组切皮后左侧前额叶皮质未被明显激活,T2时氧合血红蛋白平均浓度、脱氧血红蛋白平均浓度、总血红蛋白平均浓度、平均心率无显著变化,差异均不具有统计学意义。G组接受切皮刺激后,与心率到达峰值的时间[(2.100+0.845)s]相比,患儿左侧前额叶脑组织血氧参数到达峰值的时间更早,其中脱氧血红蛋白浓度[(1.723±0.783)s,P=0.041]和总血红蛋白浓度[(1.763±0.770)s,P=0.028]到达峰值的时间差异具有统计学意义。结论 功能性近红外光谱成像技术可用于全身麻醉儿童的疼痛评估,与常规的生理指标心率相比更具灵敏性,在优化临床疼痛评估及管理方面有巨大潜力。
Abstract
Objective To explore the effect of functional near-infrared spectroscopy (fNIRS) in pain assessment under general anesthesia. Methods This prospective study included 45 children aged 0-14 years who underwent hypospadias repair or cryptic penile correction in the Seventh Medical Center of PLA General Hospital from November 2021 to September 2022. They were divided into general anesthesia group (G group, n=30) and general anesthesia+dorsal penile nerve block group(N group, n=15) according to whether or not they underwent dorsal penile nerve block. Continuous wave functional near infrared spectroscopy imaging equipment was used to collect the blood oxygen parameters and heart rate of the left prefrontal brain tissue from 5 min before skin resection to 5 min after skin resection. The mean value and peak value of blood oxygen parameters and heart rate of the left prefrontal brain tissue before and after skin resection were compared. Results Compared with baseline before skin resection (T1), the left prefrontal cortex of group G was activated after skin resection, the blood oxygen parameters of brain tissue all reached the peak within 3 s (T2), and the mean concentration of oxygenated hemoglobin, deoxyhemoglobin, total hemoglobin and average heart rate increased significantly at T2, with statistical significance (P<0.05). However, compared with baseline before skin resection (T1), the left prefrontal cortex of group N was not significantly activated after resection, and there were no significant changes in the average oxygenated hemoglobin concentration, the average deoxyhemoglobin concentration, the average total hemoglobin concentration and the average heart rate at T2, with no statistical significance. After G group receiving the stimulation of skin resection, compared with the time when the heart rate reached the peak, the blood oxygen parameter of the left prefrontal brain tissue reached the peak time earlier than the heart rate [(2.100±0.845)s], in which the Deoxy-Hb concentration [(1.723±0.783) s, P=0.041] and Total-Hb concentration [(1.763±0.770) s, P=0.028] had a statistically significant difference in the peak time. Conclusions fNIRScan be used to evaluate pain in children under general anesthesia. Compared with conventional physiological indicators, fNIRS is more sensitive and has great potential to optimize clinical pain assessment and management.
关键词
疼痛 /
评估 /
脑组织血氧参数 /
儿童 /
全身麻醉 /
功能性近红外光谱
Key words
pain /
evaluate /
blood oxygen parameters of brain tissue /
children /
general anesthesia /
functional near-infrared spectroscopy
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基金
装备军内科研项目(LB201820010007);首都临床特色应用研究(Z181100001718002)
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