术中功能磁共振下右美托咪定超前镇痛的功能脑网络特性

doi:10.19854/j.cnki.1008-2425.2023.05.0001

立体定向和功能性神经外科杂志 ›› 2023, Vol. 36 ›› Issue (5): 257-261.DOI: 10.19854/j.cnki.1008-2425.2023.05.0001

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术中功能磁共振下右美托咪定超前镇痛的功能脑网络特性

刘乾, 焦萌, 姚东旭, 王前, 聂超然, 王天龙, 王小华

100053 北京首都医科大学宣武医院麻醉手术科;国家老年疾病临床研究中心;北京市老年疾病医疗研究中心

收稿日期:2023-07-18 出版日期:2023-10-25 发布日期:2023-12-05
通讯作者: 王小华 15910851623@163.com
基金资助:
北京市卫生和计划生育委员会“老年重大疾病关键技术研究”项目(编号:PXM2017_026283_000002)

Functional brain network characteristics of preemptive analgesia with dexmetomidine under intraoperative fMRI

Liu Qian, Jiao Men, Yao Dongxu, et al

Department of Anesthesiology,Xuanwu Hospital,Capital Medical University; National Clinical Research Center for Geriatric Disorders,Beijing,China.Beijing Medical Research Center for Geriatric Diseases,Beijing,100053,China

Received:2023-07-18 Online:2023-10-25 Published:2023-12-05

摘要/Abstract

摘要： 目的右美托咪定(简称右美)是一种高度选择性的α2-肾上腺素能受体激动剂,具有显著的镇痛和交感神经阻滞作用。本研究拟利用我院术中核磁共振扫描比较单纯阿片组与右美超前镇痛组涉及的镇痛相关功能脑网络的差异。方法选取2023年1月至3月拟行术中磁共振引导下癫痫射频消融术患者12例患者为研究对象。将纳入的研究对象随机分为右美组( DEX组) (n=6)和单纯阿片组(OPI组)(n=6)。OPI组:麻醉诱导前持续泵入同等液速生理盐水,持续输注15 min后麻醉诱导,后持续输注30 min后开始术中核磁扫描。DEX组:于麻醉诱导前持续泵入右美1.5 ug/kg/h,15 min,在麻醉诱导后持续继续输注30 min,后开始核磁扫描。比较并分析两组功能脑网络连接及差异,发现右美超前镇痛的独特的功能脑网络。结果所有患者术前一般情况及术中生命体征变化差异无统计学意义。相比于OPI组,DEX组AmyCM-PAG (TL=5.483,P<0.001) (T_R=5.953,P<0.001),AmyLB-PAG (T_R=6.748,P<0.001),AmySF-PAG (T_R=5.714,P<0.001); AmyLB-LC (T_R=4.931,P<0.001); 和 LC-RVM (TL=6.049,P<0.001) (T_R=5.956,P<0.001)镇痛相关脑功能连接显著增高。结论相比于OPI组,右美组镇痛相关的Amy-PAG-LC脑功能连接显著增高,提示右美通过此脑网络进一步加强镇痛的作用。

关键词: 右美托咪定, 超前镇痛, 癫痫, 射频消融, 功能脑网络

Abstract: Objective Dexmetomidine(DEX) is a highly selective α 2-adrenergic receptor agonist with significant analgesic and sympathetic blockade.The purpose of this study was to compare the differences of functional brain networks related to analgesia between the simple opioid administration and the preemptive analgesia with DEX.Methods Twelve patients with right epilepsy from January to March 2023 were selected for radiofrequency ablation of right epilepsy guided by magnetic resonance.The enrolled subjects were randomly divided into two groups:DEX group and OPI group.OPI group:continuous infusion of saline with the same liquid velocity before anesthesia induction,continuous infusion of 15min,induction of anesthesia,and continuous infusion of 30 min followed by intraoperative fMRI scanning.In DEX group,1.5ug dexmetomidine was pumped continuously for 15 minutes before anesthesia induction,30min was infused continuously after anesthesia induction,and fMRI scanning was performed.The connections and differences of functional brain networks between the two groups were compared and analyzed,and the unique functional brain network of preemptive analgesia was found.Results There was no significant difference of patients between two groups.Compared with OPI group,AmyLB-LC; AmyCM-PAG; AmyLB-PAG; AmySF-PAG; LC-RVM analgesia-related brain functional connections were significantly increased in DEX group.Conclusion Compared with OPI group,the brain functional connections of Amy-PAG-LC related to analgesia in DEX group are significantly increased,suggesting that DEX can enhance analgesia effect through this brain network.

Key words: Dexmetomidine, Preemptive analgesia,Pain hypersensitivity, Epilepsy, Radiofrequency ablation, Functional brain network

中图分类号:

R742.1

刘乾, 焦萌, 姚东旭, 王前, 聂超然, 王天龙, 王小华. 术中功能磁共振下右美托咪定超前镇痛的功能脑网络特性[J]. 立体定向和功能性神经外科杂志, 2023, 36(5): 257-261.

Liu Qian, Jiao Men, Yao Dongxu, et al. Functional brain network characteristics of preemptive analgesia with dexmetomidine under intraoperative fMRI[J]. Chinese Journal of Stereotactic and Functional Neurosurgery, 2023, 36(5): 257-261.

参考文献

[1] Chu LF,Angst MS,Clark D.Opioid-induced hyperalgesia in humans:Molecular mechanisms and clinical considerations[J].Clin J Pain,2008,24(6):479~496.
[2] McQuay HJ.Pre-emptive analgesia[J].Br J Anaesth,1992,69:1~3.
[3] 黄毅,李琼阁,聂彬彬,等.利用术中功能磁共振探索右美超前镇痛关键性核团[J].立体定向和功能性神经外科杂志,2022,35(2):43~47.
[4] 张思源,黄毅,王前,等.右美托咪定在鼻颅底肿瘤切除术中超前镇痛作用的临床研究[J].北京医学,2022,44(11)1037~1042.
[5] Woolf CJ,Chong MS.Pre- emptive analgesia:treating postoperative pain by preventing the establishment of central sensitization[J].Anesth Analg,1993,77:362~379.
[6] Angst MS,Koppert W,Pahl I,et al.Short-term infusion of the mu opioid agonist remifentanil in humans causes hyperalgesia during withdrawal[J].Pain,2003,106:49~57.
[7] M.Belgrade,S.Hall,Dexmedetomidine infusion for the management of opioid induced hyperalgesia[J].Pain Med,2010,11:1819~1826.
[8] Mackie S,Chambers D,Sebastian J.Dexmedetomidine as a rescue agent during intracranial neurosurgery in the setting of opioid tolerance[J].Anaesth Rep,2022,Jul 19,10(2):e12178.
[9] Thompson SJ,Bushnell MC.Rodent functional and anatomical imaging of pain[J].Neurosci Lett,2012,520(2):131~139.
[10] Ma QP,Han JS.Naloxone blocks the release of opioid peptides in periaqueductal gray and N.accumbens induced by intra-amygdaloid injection of morphine[J].Peptides,1991,12(6):1235~1238.
[11] Helmstetter FJ,Tershner SA,Poore LH,et al.Antinociception following opioid stimulation of the basolateral amygdala is expressed through the periaqueductal gray and rostral ventromedial medulla[J].Brain Res,1998,779(1-2):104~118.
[12] Kim JH,Gangadharan G,Byun J,et al.Yin-and-yang bifurcation of opioidergic circuits for descending analgesia at the midbrain of the mouse[J].Proc Natl Acad Sci U S A.2018,115(43):11078~11083.
[13] Ma QP,Han JS.Naloxone blocks the release of opioid peptides in periaqueductal gray and N.accumbens induced by intra-amygdaloid injection of morphine[J].Peptides,1991,12(6):1235~1238.
[14] Helmstetter FJ,Tershner SA,Poore LH,et al.Antinociception following opioid stimulation of the basolateral amygdala is expressed through the periaqueductal gray and rostral ventromedial medulla.Brain Res,1998,779(1-2):104~118.
[15] Hayashida KI,Obata H,Nakajima K,et al.Gabapentin acts within the locus coeruleus to alleviate neuropathic pain[J].Anesthesiology,2008,109(6):1077~1084.
[16] Haaker J,Yi J,Petrovic P,et al.Endogenous opioids regulate social threat learning in humans[J].Nat Commun,2017(25):8:15495.

术中功能磁共振下右美托咪定超前镇痛的功能脑网络特性

Functional brain network characteristics of preemptive analgesia with dexmetomidine under intraoperative fMRI

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