【作者】 童基均；

【导师】 陈裕泉；

【作者基本信息】 浙江大学 ， 生物医学工程， 2008， 博士

【摘要】 疼痛是日常生活中最重要的感觉之一，痛觉本质的研究和机理性研究为疼痛的有效治疗和积极控制提供必要的保证。传统的中医技术针灸在疼痛治疗中显示了很好的应用潜力，针灸镇痛机理的研究与疗效的客观评价标准是中医现代化的主要内容。本论文主要借助电生理技术(EEG)与脑功能成像技术(fMRI)，从脑部神经电活动的调制和脑功能解剖学两个角度研究痛觉机制，并在此机基础上，研究针灸镇痛过程中脑电信号的特征变化和脑区功能代谢变化，以取得针灸镇痛的机理和潜在的客观评价标准。论文首先设计了疼痛诱发刺激对比实验，通过在左肩部注射当归注射液和等渗生理盐水，建立一种有效的人体疼痛刺激模式。接着提取了在这两种刺激前后脑电信号的四个频段(δ、θ、α、β)能量百分比特征以及脑电信号的双相干谱的峰值和体积特征，同时利用功能磁共振成像技术，研究刺激前后的脑功能区的反应。研究发现，在疼痛刺激过程中，脑电δ波呈上升趋势，而θ、α、β波呈下降趋势，疼痛对这四个频段的调制区域略有不同，但主要都集中在左额区，左颞区，左中央区，左顶区以及左右枕区，表明这些区域受痛信息调制最显著。双相干谱是高阶统计量特征，双相干谱的峰值直接反映了信号的不同频率分量间的相位耦合程度，而双相干谱的体积反映了信号相对于高斯随机分布的偏离度。研究显示它们对疼痛刺激非常敏感，和疼痛强度呈正相关性，表明疼痛刺激能够使得脑电信号的非高斯性增强，其主要反应区域为左右枕叶区，右额叶区。功能磁共振成像显示疼痛刺激能激活广泛的脑功能区，主要为前叶、枕叶、脑桥、中脑等部位，显示中枢系统的这些解剖区域与痛觉的形成具有密切的关系。结合上述脑电信号特征具有显著变化的脑区，两者具有很好的一致性。论文最后对针灸镇痛机理以及与脑电关联性进行了研究。探讨了各种针灸模式下(合谷穴经皮电刺激和手针刺激)脑电信号的变化以及脑功能区的变化，分析针刺模式对中枢系统的调制作用。研究表明，合谷穴经皮电刺激和手针刺激具有一定的镇痛效果，并且作为反应脑电信号能量分布比率的边缘频谱特征SEF90与针灸镇痛程度具有很好的正相关性，有望作为针灸镇痛程度的一个客观评价标准。论文比较分析了合谷穴手针刺激与经皮电刺激激活脑功能区的异同。研究表明手针刺激与经皮穴位电刺激镇痛是通过激活与痛觉调制相关的多个脑功能区而实现的，但手针刺激激活的区域要比经皮穴位电刺激更加广泛，激活的程度也更加强。更多还原

【Abstract】 Pain is one of the most important sensations in daily life, it is necessary to get theessence and mechanism of pain in pain treatment and control. The TraditionalChinese Medicine (TCM) such as acupuncture has shown great potential in pain relief.The research of principle and objective assessment criterion of acupuncture anesthesiaare the key point of the modernization of TCM. In this article the EEG(Electroencephalogrpah) and fMRI (Functional Magnetic Resonance Imaging)techniques were used to study the brain nerve activity and functional metabolismwhich was modulated by pain. Furthermore, the brain nerve activity was studiedduring the acupuncture in pain relief to get the mechanism and assessment criterion ofacupuncture anesthesia.Firstly the pain stimulation experiment was designed. The pain was inducedthrough injection angelica on the left shoulder, as placebo-control stimulation, theisotonic saline was injection. Then the EEG feature, the power percentile ofδ、θ、α、βand the peak and volume of bicoherence, were extracted during the experiment.At the same time, the activated brain function areas were analyzed.The research demonstrated that theδband energy ratio increased and theθ、α、βband energy ratio decreased after pain stimulation, though the activated areas werenot strictly same, they mainly located on left frontal cortex, left temporal cortex, leftparietal cortex, occipital cortex. It indicated that these areas were modulatedsignificantly by pain stimulation.Bicoherence is the High Order Statistic, the peak of the bicoherence was a directindicator of the degree of Quadratic Phase Coupling (QPC) and the volume of thebicoherence indicates the deviation from Gaussian distribution. They were sensitiveand positive related to the pain stimulation, the main activated areas were occipitalcortex, right frontal cortex. It indicated the pain stimulation could increase thenon-Gaussianity of EEG.The fMRI research indicated the pain stimulation could activate wide brain functional areas, they mainly located on anterior lobe, occipital lobe, pons andmidbrain. It showed these areas had tightly connection with pain perception.In the end, the principle and assessment criterion of acupuncture in pain relief werestudied. The changes of EEG and the activated brain functional area were studied atdifferent acupuncture mode, transcutaneous electrical acupoint stimulation (TEAS)and manual needle on Hegu acupoint.The research indicated the TEAS and manual needled acupuncture on Heguacupoint had good effect on pain relief. And the spectral edge frequency (SEF90) hadpositive relationship with pain extent. It had shown the potential to be used asassessment criterion of acupuncture anesthesia.The different activated brain area between TEAS and manual needle on Heguacupoint were studied. The effect of pain relief of manual needle and TEAS wererealized through active brain functional area with pain perception, but the manualneedle active wider area than TEAS.更多还原