Eur J Pain. 2005 Apr;9(2):105-8.
Opioid analgesia in the newborn.
Nandi R1, Fitzgerald M.
Abstract
Pain in neonates is now well established. Studies of the developmental
neurobiology of pain have revealed that pain processing in the immature is
very different from that in the mature nervous system. Neonates undergo
considerable maturation of peripheral, spinal and supraspinal afferent pain
transmission over the early postnatal period but are able to respond to
tissue injury with specific behaviour and with autonomic, hormonal and
metabolic signs of stress and distress. Opioid analgesia is now
widely used in neonates. There is evidence that morphine requirements may
be low in the youngest patients. Sensory threshold testing in rat pups has
shown that the analgesic potency of systemic morphine mechanical stimulation
is significantly greater in the neonate and declines with postnatal age.
The changing morphine sensitivity in the postnatal period may be part of
a general reorganization in the structure and function of primary afferent
synapses, neurotransmitter/receptor expression and function and excitatory
and inhibitory modulation from higher brain centres. Importantly opioid
receptor expression undergoes significant developmental regulation - mu opioid
receptors, observed to be exuberantly expressed in the neonatal rat,
have been found to be functional. These findings have important implications
for the human
neonate as they provide a possible explanation for the differences in morphine
requirements observed in the youngest patients. The study of the underlying
mechanisms of pain and analgesia in development has enabled important changes
in clinical practice. However, pain in the newborn remains poorly understood
and continued research and intensive study in this area is essential for
further effectiveanalgesic intervention and the discovery of new targets for
therapy.
我解读的部分如下
1.Pain in neonates is now well established. Studies of the developmental
neurobiology of pain have revealed that pain processing in the immature is
very different from that in the mature nervous system.
主要在讲神经构造的发展成熟度，会导致疼痛的发生过程（机转）非常不一样
2.Neonates undergo considerable maturation of peripheral, spinal and
supraspinal afferent(传入的) pain transmission over the early postnatal
period but are able to respond to tissue injury with specific behaviour and
with autonomic, hormonal and metabolic signs of stress and distress.
疼痛在小儿身上，会因造成某种身体上的压力，会导致贺尔蒙及代谢的现象发生
3. There is evidence that morphine requirements may be low in the youngest
patients. Sensory threshold testing in rat pups has shown that the analgesic
potency of systemic morphine mechanical stimulation is significantly greater
in the neonate and declines with postnatal age
证据显示，吗啡的需求剂量，在年纪越小的小朋友需求越低。在老鼠的疼痛阈值试验中，
显示出，因吗啡刺激所造成止痛的强度，在neonate上是有显著的好，
并且declines with postnatal age。(什么是declines with postnatal age?)
4. Importantly opioid receptor expression undergoes significant
developmental regulation - mu opioid receptors, observed to be exuberantly
expressed in the neonatal rat, have been found to be functional.
These findings have important implications for the human neonate as they
provide a possible explanation for the differences in morphine requirements
observed in the youngest patients.
这段在说，吗啡的受体，在刚出生的小鼠有显著的成熟，并且是有功能的。
这个发现说明了，为什么在年纪小的病人，吗啡的需求量会差异这么大。
以上就是我所了解的部分，不过是非常残缺不全的理解
请版上大大帮忙了
感谢