早期反复疼痛刺激与早产儿脑发育的关系

Early repetitive pain in preterm infants in relation to brain development

随着医疗水平的提高,早产儿(胎龄<37周)存活率显著提高,而其远期脑神经发育受到越来越多关注。入住新生儿重症监护室(neonatal intensive care unit,NICU)的早产儿因诊疗需要,暴露于频繁的致痛性操作,而此时其大脑正处于快速发育阶段,有感知疼痛所需的伤害性回路,但感觉系统在功能上尚未发育成熟,无力表达和抗拒疼痛损伤。同时由于早产儿脊髓神经调节系统发育不成熟,早期反复疼痛刺激导致中枢神经系统伤害性信号的增加。此外,反复疼痛刺激可导致中枢神经系统中特定细胞群遭受氧化应激和炎症应激,对早产儿脑发育带来影响。因此,制定合理的镇痛管理流程十分重要。

With the improvement of medical care the survival rate of preterm infants(gestational age<37 weeks) increased dramatically, however long-term neurodevelopmental and behavioral problems are still a concern.During their stay in neonatal intensive care unit preterm patients suffer lots of repeated painful procedures while it′s a period of rapid brain development.Preterm infants have the nociceptive circuitry to feel the pain, but this system is functionally immature.Because the spinal neuromodulation system is immature that repeated pain stimulation leads to increased nociceptive signaling in the central nervous system.Besides, specific cell populations in the central nervous system of preterm infants are particularly vulnerable to oxidative stress and inflammation.Therefore, it is important that pain-related stress in preterm infants is appropriately managed.