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Near-Infrared Spectroscopy (NIRS) to measure nociception following noxious stimulation in critically ill infants.

机译：近红外光谱（NIRS）用于测量危重症婴儿中有害刺激后的伤害感受。

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Background An admission to the intensive care unit causes major physical and psychological stress for children. Pain contributes significantly to this distressing experience. To optimize pain relief, a sound pain assessment tool is essential. Although this need is recognized, only a few pain assessment instruments have been thoroughly tested with this population using a rigorous scientific approach, and none have been shown to be superior to the other. Recent studies using near-infrared spectroscopy (NIRS) in term and premature infants indicate that nociceptive stimuli cause haemodynamic changes in specific cortical regions. This suggests a new avenue for assessing and quantifying pain processing in critically ill infants that could be more sensitive and specific to the nociceptive response.;Aims In this series of studies we examined regional cerebral and systemic haemodynamic changes, as well as behavioural reactions in critically ill infants with congenital heart defect (CHD) during chest drain removal following open heart surgery. Specifically, we examined changes within subjects, as well as individual factors (age, sex, medication) affecting the change and associations between cerebral haemodynamic changes, systemic physiological changes, and Face Legs Activity Cry Consolability (FLACC) pain scores.;Subjects Critically ill infants less than 12 months of age admitted to a cardiac intensive care unit after cardiac surgery for CHB comprised the sample.;Outcome measures Changes in cerebrovascular haemoglobin concentrations (NIRS), as well as heart rate (ECG), systemic arterial oxygen saturation (pulse oximetry), and mean arterial blood pressure (arterial line) were recorded during three distinct epochs (Baseline, Tactile stimulation, and Chest-drain removal). Behavioural manifestations were also captured through video and were subsequently rated for pain with the FLACC scale.;Design Descriptive correlational design.;Results We studied 32 infants with CHD and obtained FLACC pain scores in 20 of these infants. Cerebral deoxygenated haemoglobin concentrations significantly increased across the epochs (p<.01). Physiological systemic responses were not found to be associated with the cerebral haemodynamic parameters. Mean FLACC pain scores significantly increased across the epochs (p < .001) with a mean score of 7/10 during the noxious procedure, despite administration of an analgesic agent (morphine). Sex of patients was found to be a determining factor in the cerebral haemodynamic responses and pain FLACC scores. Pharmacological treatments, age and weight of patients were significantly associated with cerebral and systemic haemodynamic responses, as well as the FLACC pain scores. The administration of a sedating agent (midazolam) had a significant dampening effect on the pain behaviours as assessed by the FLACC scale.;Conclusions Using a multidimensional pain measurement approach, we demonstrated that significant cerebral, physiological and behavioural activity was present in response to a noxious procedure in critically ill infants despite the administration of analgesic treatment. Although pain behaviours were significantly dampened by the sedating agent, the cerebral response was still evident. Thus, assessment of cerebral haemodynamics in the context of pain seems to be an important addition when a sedating agent is administered. Our data suggest that NIRS is a potentially useful technique for assessing pain evoked cerebral activation in critically ill infants.
机译：背景进入重症监护室会给儿童带来严重的身心压力。痛苦为这种令人痛苦的经历做出了重要贡献。为了优化止痛效果，完善的疼痛评估工具至关重要。尽管已认识到这种需求，但仅使用严格的科学方法对该人群进行了彻底的疼痛评估工具的测试，并且没有一种被证明优于其他工具。近期对足月和早产儿使用近红外光谱（NIRS）的研究表明，伤害性刺激会引起特定皮质区域的血流动力学变化。这为评估和量化重症婴儿的疼痛过程提供了一条新途径，该途径可能对伤害性反应更加敏感和特异。目的在这一系列研究中，我们研究了局部脑和全身血流动力学变化以及重症患者的行为反应心脏手术后在胸腔引流期间患有先天性心脏缺陷（CHD）的患病婴儿。具体来说，我们检查了受试者的变化以及影响该变化的个体因素（年龄，性别，药物）以及脑血流动力学变化，全身生理变化和面部腿活动哭泣可安慰性（FLACC）疼痛评分之间的关​​联。心脏手术后入院心脏重症监护病房的未满12个月的婴儿为样本。;结果测量脑血管血红蛋白浓度（NIRS）以及心率（ECG），全身动脉血氧饱和度（脉冲）的变化在三个不同的时期（基线，触觉刺激和胸腔引流术）中记录了血氧饱和度和平均动脉血压（动脉线）。还通过视频捕获了行为表现，然后用FLACC量表对疼痛表现进行了评分。设计描述性相关设计。结果我们研究了32例CHD婴儿，并在其中20例婴儿中获得了FLACC疼痛评分。整个时期的大脑脱氧血红蛋白浓度显着增加（p <.01）。未发现生理系统反应与脑血流动力学参数有关。尽管使用了镇痛药（吗啡），但在有害过程中，整个时期的平均FLACC疼痛评分明显增加（p <.001），平均评分为7/10。发现患者的性别是脑血流动力学反应和疼痛FLACC评分的决定因素。药物治疗，患者的年龄和体重与脑和全身血流动力学反应以及FLACC疼痛评分显着相关。用FLACC量表评估，镇静剂（咪达唑仑）的给药对疼痛行为有显着的抑制作用。结论结论使用多维疼痛测量方法，我们证明了在反应中存在明显的大脑，生理和行为活动尽管使用了止痛药，但危重婴儿仍采取了有害的程序。尽管镇静剂可明显缓解疼痛行为，但大脑反应仍很明显。因此，在服用镇静剂时，评估在疼痛情况下的脑血流动力学似乎是一项重要的补充。我们的数据表明，NIRS是一种潜在的有用技术，可用于评估重症婴儿的疼痛诱发的大脑激活。

著录项

  • 作者

    Ranger, Manon.;

  • 作者单位

    McGill University (Canada).;

  • 授予单位 McGill University (Canada).;
  • 学科 Biology Neuroscience.;Health Sciences Nursing.
  • 学位 Ph.D.
  • 年度 2012
  • 页码 198 p.
  • 总页数 198
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类
  • 关键词

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