賈磊 習(xí)羽 殷潔婷 殷姜文 李燕
摘要:目的 本研究通過(guò)光遺傳學(xué)技術(shù)特異性激活雄性Sprague-Dawley(SD)大鼠中腦腹側(cè)被蓋核投射至臂旁核多巴胺能通路(VTADA-PBN),探究該通路在丙泊酚麻醉蘇醒中的作用。方法 將32只雄性SD大鼠隨機(jī)分為ChR2+Light on組、ChR2+Light off組、mCherry+Light on組和mCherry+Light off組,每組8只。各組大鼠經(jīng)尾靜脈以11 mg·kg-1劑量進(jìn)行丙泊酚麻醉誘導(dǎo),以48 mg·kg-1·h-1劑量麻醉維持30 min,記錄翻正反射消失(LORR)和翻正反射恢復(fù)(RORR)時(shí)間;通過(guò)免疫熒光染色驗(yàn)證病毒注射部位;通過(guò)在體腦電(EEG)記錄麻醉誘導(dǎo)和蘇醒期間的皮層腦電變化。結(jié)果 光遺傳學(xué)激活VTADA-PBN通路,LORR時(shí)間無(wú)統(tǒng)計(jì)學(xué)差異(P>0.05),RORR時(shí)間縮短(P<0.001);與mCherry組相比,ChR2組VTA中c-Fos蛋白表達(dá)明顯更高(P<0.001);EEG結(jié)果顯示:RORR期間,光激活組β波功率百分比高于光對(duì)照組(P<0.05),而δ波功率百分比低于光對(duì)照組(P<0.01)。結(jié)論 VTADA-PBN通路參與調(diào)控丙泊酚麻醉蘇醒階段,激活這一通路起到促覺(jué)醒作用。
關(guān)鍵詞:中腦腹側(cè)被蓋核;臂旁核;多巴胺;丙泊酚;光遺傳學(xué)
中圖分類號(hào):中圖分類號(hào)R614.1文獻(xiàn)標(biāo)志碼:A文獻(xiàn)標(biāo)識(shí)碼
Optogenetic activation of dopaminergic neurons in the ventral tegmental area facilitates general anesthesia via projections to the parabrachial nucleus
in Rats
JIA? Lei1,2,XI? Yu1,2,YIN? Jieting1,2,YIN? Jiangwen1,2,LI? Yan1,2*
(1 The First Affiliated Hospital/NHC Key Laboratory of Prevention and Treatment of Central Asia High
Incidence Diseases, Shihezi University,
Shihezi,Xingjiang 832000, China; 2 Ministry of Education Key Laboratory of Xinjiang Endemic and
Ethnic Disease, Shihezi University, Shihezi,Xinjiang 832000, China)
Abstract:? Objectives In this study, we specifically activated the dopaminergic pathway from the ventral tegmental nucleus projecting to the parabrachial nucleus (VTADA-PBN) in the midbrain of male Sprague-Dawley rats by optogenetic techniques to investigate the role of the pathway in the emergence from propofol anesthesia. Methods 32 male SD rats were randomly divided into ChR2+Light on group, ChR2+Light off group, mCherry+Light on group and mCherry+Light off group, with 8 rats in each group. Rats in each group were induced with propofol anesthesia at a dose of 11 mg·kg-1 via the tail vein, and anesthesia was maintained at a dose of 48 mg·kg-1·h-1 for 30 min, and the time of loss of righting reflex and recovery of the righting reflex were recorded. Immunofluorescence verified viral injection sites. The electroencephalogram (EEG) was used to record the changes of during induction and recovery of anesthesia. Results Optogenetic activation of the VTADA-PBN pathway showed no statistically significant difference in LORR time (P>0.05) and a shortened RORR time (P<0.001). Compared with the mCherry group, c-Fos expression was significantly higher in the VTA of the ChR2 group (P<0.001); The EEG results showed that the percentage of β-wave power was higher in the light-activated group than in the light-control group during RORR (P<0.05), while the percentage of δ-wave power was lower than in the light-control group (P<0.01). Conclusion The VTADA-PBN pathway are involved in the regulation of the emergence stage of propofol anesthesia, and activation of this pathway may play a pro-arousal role.
Key words: ventral tegmental area;parabrachial nucleus;dopamine;propofol;optogenetic
全身麻醉自應(yīng)用于臨床以來(lái),麻醉患者的蘇醒方式還未發(fā)生過(guò)根本性改變,目前尚無(wú)有效方法主動(dòng)逆轉(zhuǎn)全麻蘇醒。研究表明,控制覺(jué)醒的大腦區(qū)域參與調(diào)控全身麻醉[1],激活腦內(nèi)的促覺(jué)醒核團(tuán),能夠縮短全身麻醉蘇醒時(shí)間[2-3]。此外,不同的覺(jué)醒區(qū)域通過(guò)神經(jīng)元的投射和連接形成復(fù)雜的神經(jīng)環(huán)路[4],從而實(shí)現(xiàn)麻醉狀態(tài)的逆轉(zhuǎn)及意識(shí)的恢復(fù)[5-6]。
中腦腹側(cè)被蓋核(VTA)的多巴胺(DA)能神經(jīng)元參與調(diào)控生理性睡眠—覺(jué)醒的作用已被證實(shí)[7]。近年來(lái)的研究表明,VTA DA能神經(jīng)元對(duì)全麻蘇醒具有促進(jìn)作用[8-9]。此外,VTA投射至下游核團(tuán)形成的神經(jīng)環(huán)路亦調(diào)控全身麻醉。據(jù)報(bào)道,通過(guò)光遺傳學(xué)和化學(xué)遺傳學(xué)特異性激活VTA投射到伏隔核的DA能神經(jīng)元,延長(zhǎng)麻醉誘導(dǎo)時(shí)間并促進(jìn)麻醉蘇醒,抑制這一通路則產(chǎn)生相反的作用[10]。此外,激活VTA投射至前邊緣皮層DA能通路,能夠延長(zhǎng)大鼠七氟醚麻醉的誘導(dǎo)時(shí)間,并縮短蘇醒時(shí)間[11]。
臂旁核(PBN)是促進(jìn)和維持覺(jué)醒的關(guān)鍵核團(tuán),在產(chǎn)生和維持腦電(EEG)覺(jué)醒和行為覺(jué)醒方面發(fā)揮不可或缺的作用[12-13]。有研究通過(guò)熒光示蹤技術(shù)發(fā)現(xiàn),VTA和PBN之間形成相互投射[14]。通過(guò)病毒示蹤技術(shù)研究發(fā)現(xiàn),VTA 多巴胺能神經(jīng)元的軸突末梢在PBN內(nèi)高密度表達(dá),VTA投射到PBN的神經(jīng)元約50%是DA能的,通過(guò)光遺傳學(xué)操縱VTA投射到PBN的DA能神經(jīng)元能抑制進(jìn)食相關(guān)行為[15]。本研究通過(guò)光遺傳學(xué)特異性激活VTA投射至PBN的 DA能通路(VTADA-PBN),結(jié)合翻正反射行為學(xué)實(shí)驗(yàn)、c-Fos免疫熒光染色及在體腦電記錄探究VTADA-PBN通路在丙泊酚麻醉中的作用。
1 材料與方法
1.1 實(shí)驗(yàn)動(dòng)物及分組
280~320g雄性SD大鼠購(gòu)于濟(jì)南朋悅實(shí)驗(yàn)動(dòng)物繁育有限公司,許可證編號(hào):SCXK(魯)20190003。大鼠安置在石河子大學(xué)動(dòng)物實(shí)驗(yàn)室中心分部管理的動(dòng)物飼養(yǎng)中心,光/暗周期為12 h,環(huán)境溫度為(23±2)℃,相對(duì)濕度為(55%±2%),隨意獲取食物和水。所有實(shí)驗(yàn)程序經(jīng)由石河子大學(xué)動(dòng)物倫理委員會(huì)批準(zhǔn)(編號(hào):A2018-025-01)。為觀察VTADA-PBN通路在丙泊酚麻醉中的作用及光刺激影響,將32只大鼠隨機(jī)分為4組:光激活組(ChR2+Light on組)和光激活對(duì)照組(ChR2+Light off組),病毒對(duì)照組(mCherry+Light on組和mCherry+Light off組),每組各8只。
1.2 實(shí)驗(yàn)試劑
丙泊酚注射液購(gòu)自Fresenius Kabi Austria GmbH (Graz, Austria) 兔抗酪氨酸羥化酶抗體、小鼠抗c-Fos抗體購(gòu)自Abcam公司(批號(hào):#ab137869,#ab302667)。二級(jí)抗體為與Alexa 488偶聯(lián)的山羊抗兔抗體、山羊抗小鼠抗體購(gòu)于北京中杉金橋有限公司(批號(hào):ZF-0511,ZF-0512)。
1.3 腦立體定位病毒注射
使用2%戊巴比妥鈉進(jìn)行麻醉,按照50 mg·kg-1劑量對(duì)大鼠進(jìn)行腹腔注射麻醉。待大鼠意識(shí)消失后,固定于腦立體定位儀。頭皮下注入1%利多卡因進(jìn)行局部浸潤(rùn)麻醉后剪開頭皮,暴露顱骨表面并進(jìn)行調(diào)平,使前后囟門處于同一水平面,高度差小于0.03 mm。根據(jù)第五版大鼠腦圖譜《The Rat Brain in Stereotaxic Coordinates》確定VTA(前后-5.0 mm,左右±0.9 mm,深度-8.3 mm)和PBN(前后-8.9 mm,左右±1.9 mm,深度-6.8 mm)的注射位點(diǎn)。用顱骨鉆在相應(yīng)核團(tuán)位點(diǎn)的顱骨表面鉆孔,挑破硬腦膜暴露腦組織。
將500 nL? rAAV2/9-TH-DIO-hChR2-mCherry-WPRE或rAAV2/9-TH-DIO-mCherry-WPRE注射到單側(cè)VTA,將500 nL逆行腺相關(guān)病毒rAAV2/Retro-TH-Cre-WPRE注射到同側(cè)PBN。注射速度為80 nL·min-1,注射完畢后針尖停留10 min,藥物充分?jǐn)U散后緩慢退針。病毒轉(zhuǎn)染3周后行在體腦電電極植入。
1.4 EEG電極植入
使用2%戊巴比妥鈉(50 mg·kg-1)腹腔麻醉后,用顱骨鉆在大鼠顱骨表面鉆孔,植入四顆連有導(dǎo)絲的腦電螺釘,用于連接腦電電極監(jiān)測(cè)腦電信號(hào)。EEG螺釘分布位置:兩顆螺釘植于前額葉位置上方,Bergma點(diǎn)向前3.9 mm,左右相距2 mm。另外兩顆螺釘植于Bergma點(diǎn)向后4 mm,相互間隔5 mm。然后將大鼠電極放置顱骨表面,電極底座上的四根導(dǎo)絲與螺釘上的導(dǎo)絲相連,四組導(dǎo)絲互不接觸。通過(guò)牙科丙烯酸樹脂(牙科水泥)將顱骨、螺釘和腦電電極固定在一起。實(shí)驗(yàn)后,連續(xù)3 d肌注青霉素20 U減少感染。植入腦電電極大鼠單獨(dú)飼養(yǎng)1周后,尾靜脈置管進(jìn)行翻正反射實(shí)驗(yàn)。進(jìn)行腦電電極植入的同時(shí),在VTA上方100 μm處放置陶瓷插芯。
1.5 翻正反射實(shí)驗(yàn)
各組大鼠以11 mg·kg-1丙泊酚尾靜脈泵入,將開始給藥到大鼠處于四肢向上且無(wú)法主動(dòng)恢復(fù)正常姿勢(shì)的這段時(shí)間,記為L(zhǎng)ORR,代表麻醉誘導(dǎo)時(shí)間;為評(píng)估翻正反射恢復(fù)時(shí)間,持續(xù)尾靜脈泵入丙泊酚(48 mg·kg-1·h-1)30 min,確保大鼠處于足夠的麻醉深度。停藥后到大鼠自主恢復(fù)俯臥位并四肢著地的這段時(shí)間,記為RORR,代表麻醉蘇醒時(shí)間。在LORR和RORR期間,為了評(píng)估翻正反射,每15 s將行為箱翻轉(zhuǎn)90°,并全程記錄腦電信號(hào)。
1.6 光遺傳學(xué)實(shí)驗(yàn)
病毒轉(zhuǎn)染3周后植入EEG電極和陶瓷插芯。翻正反射實(shí)驗(yàn)前連接腦電前置信號(hào)放大器,將光纖跳線一邊和植入的插芯通過(guò)套管相連,另一邊連接473 nm藍(lán)光激發(fā)器。使用藍(lán)光激發(fā)器對(duì)VTADA-PBN通路進(jìn)行光刺激。使用AFG1022波形發(fā)生器設(shè)置激光脈沖參數(shù)。通過(guò)功率計(jì)測(cè)試光纖尖端光強(qiáng)度,校正為10~15 mW。麻醉誘導(dǎo)期和蘇醒期,應(yīng)用473 nm藍(lán)光(頻率20 Hz、波寬10 ms)對(duì)大鼠進(jìn)行光激活。記錄LORR和RORR時(shí)間及腦電信號(hào)。
1.7 免疫熒光實(shí)驗(yàn)
行為學(xué)實(shí)驗(yàn)結(jié)束后光激活各組大鼠VTA區(qū)15 分鐘后,灌注取腦,冰凍切片。冰凍腦組織用Triton X-100滲透(0.2%, 3 min)。在37℃下用10% BSA封閉1 h。然后滴加一級(jí)抗體(anti-c-Fos antibody, 1∶250; anti-tyrosine hydroxylase antibody)并在4℃過(guò)夜。PBS漂洗3次后,滴加對(duì)應(yīng)二級(jí)抗體(goat anti-rabbit conjugated to Alexa 488, goat anti-Mouse conjugated to Alexa 488, 1∶75 dilution, ZSGO-BIO, China),室溫下避光孵育2 h。PBS再次漂洗后,切片用0.5μg·mL-1 DAPI標(biāo)記細(xì)胞核后,用抗熒光衰減封片劑封片,熒光顯微鏡下觀察。
1.8 EEG記錄及分析
整個(gè)實(shí)驗(yàn)過(guò)程中,使用Pinnacle 8200(Pinnacle Technology,USA)記錄系統(tǒng)采集腦電圖信號(hào),采樣率為400Hz,并用MATLAB 2016a(MathWorks,Cambridge,UK)對(duì)麻醉誘導(dǎo)期和蘇醒期的數(shù)據(jù)進(jìn)行功率譜分析,使用Lunion Stage系統(tǒng)繪制腦電時(shí)頻圖(http://www.luniondata.com, Shanghai, China)。濾除50 Hz工頻干擾,分離出0.25~60Hz數(shù)據(jù)進(jìn)行分析。通過(guò)平均每個(gè)頻帶頻率范圍內(nèi)的信號(hào)功率(δ: 0.25~4 Hz, θ: 4~8 Hz, α: 8~13 Hz, β: 13~25 Hz, γ: 25~60 Hz),除以0.25~60 Hz的總功率,計(jì)算出不同頻帶的功率百分比。
1.9 統(tǒng)計(jì)學(xué)分析
使用Graphpad prism 8.0進(jìn)行統(tǒng)計(jì)分析。所有數(shù)據(jù)均經(jīng)過(guò)正態(tài)性檢驗(yàn)。分析組間c-Fos蛋白表達(dá)的比較采用非配對(duì)t檢驗(yàn)。LORR和RORR時(shí)間的比較采用單因素方差分析。EEG頻帶百分比差異的比較采用雙因素方差分析,并進(jìn)行Bonferroni檢驗(yàn)。數(shù)據(jù)表示為均數(shù)±標(biāo)準(zhǔn)差,認(rèn)為P<0.05具有統(tǒng)計(jì)學(xué)差異。
2 結(jié)果
2.1 光激活病毒的表達(dá)及驗(yàn)證
光激活病毒的表達(dá)及驗(yàn)證見圖1。
在雄性SD大鼠的上游核團(tuán)VTA中單側(cè)注射含有ChR2的重組腺相關(guān)病毒,在下游核團(tuán)PBN中同側(cè)注射特異性標(biāo)記多巴胺能神經(jīng)元的逆行示蹤病毒。下游FLP元件逆行至VTA中與fDIO結(jié)合后,使得病毒標(biāo)記的多巴胺能神經(jīng)元帶有mCherry紅色熒光。通過(guò)免疫熒光實(shí)驗(yàn)驗(yàn)證病毒表達(dá)位置,TH染色證實(shí)VTA中被轉(zhuǎn)染的神經(jīng)元是多巴胺能神經(jīng)元(圖1)。
2.2 光激活VTADA-PBN通路引起丙泊酚麻醉蘇醒時(shí)間縮短
翻正反射行為學(xué)實(shí)驗(yàn)結(jié)果顯示各組間丙泊酚麻醉誘導(dǎo)時(shí)間無(wú)統(tǒng)計(jì)學(xué)差異(ChR2+Light on vs ChR2+Light off:31.88±5.44 s vs 30.63±4.14 s,P=0.9305,n =8;ChR2+Light on vs mCherry+Light on:31.88 ± 5.44 s vs 31.38±1.69 s,P=0.9305,n=8)。
翻正反射行為學(xué)實(shí)驗(yàn)結(jié)果顯示丙泊酚麻醉蘇醒時(shí)間明顯縮短(ChR2+Light on vs ChR2+Light off:1052.0±91.02 s vs 1423.0±117.46 s,P<0.0001,n =8;ChR2+Light on vs mCherry+Light on:1052.0±91.02 s vs 1372.0±129.74 s,P=0.0003,n =8)(圖2)。
2.3 VTA區(qū)c-Fos蛋白表達(dá)
c-Fos蛋白在被刺激后能夠快速誘導(dǎo)表達(dá),代表神經(jīng)元被激活的標(biāo)志。VTA中c-Fos蛋白免疫熒光結(jié)果顯示,ChR2+Light on組c-Fos蛋白和mCherry紅色熒光病毒共表達(dá)數(shù)量明顯高于對(duì)照組(ChR2+Light on vs mCherry+Light on:56.31±5.26 vs 36.33±5.48,P<0.0001,n =6),本研究通過(guò)統(tǒng)計(jì)c-Fos蛋白和多巴胺能神經(jīng)元共表達(dá)數(shù)量,證明了光遺傳學(xué)有效激活VTADA-PBN通路;此外,激活組大鼠在丙泊酚麻醉蘇醒期間VTA區(qū)多巴胺能神經(jīng)元活性明顯增強(qiáng)(圖3)。
2.4 光激活VTADA-PBN通路引起皮層腦電覺(jué)醒
光激活VTADA-PBN通路,RORR期間EEG信號(hào)分析結(jié)果顯示,δ波段功率百分比(ChR2 + Light on vs mCherry + Light on:22.72%±1.86% vs 29.12%±1.38%,P=0.0008,n=6)降低,β波段百分比(ChR2 + Light on vs mCherry + Light on: 31.16%±2.84% vs 26.22%±3.36%,P=0.0134,n=6)升高。頻譜圖也表現(xiàn)出相應(yīng)趨勢(shì),表明在丙泊酚麻醉蘇醒期,激活VTADA-PBN通路,能夠引起皮層腦電覺(jué)醒(圖4)。
3 討論
越來(lái)越多的報(bào)道表明,全麻引起意識(shí)可逆性的消失和恢復(fù)是多種神經(jīng)環(huán)路間互相調(diào)節(jié)的結(jié)果[16]。通過(guò)光遺傳學(xué)和化學(xué)遺傳學(xué)激活VTA投射到伏隔核的多巴胺能神經(jīng)元,延長(zhǎng)麻醉誘導(dǎo)時(shí)間并促進(jìn)麻醉蘇醒[10]。Tokita等[17]通過(guò)熒光示蹤發(fā)現(xiàn),VTA和PBN之間形成相互投射關(guān)系。此外,VTA中多巴胺能神經(jīng)元和PBN形成的神經(jīng)環(huán)路,動(dòng)態(tài)調(diào)控動(dòng)物飽食感有效抑制食物的攝入,同時(shí),還發(fā)現(xiàn)增強(qiáng)下游核團(tuán)臂旁外側(cè)核中的多巴胺D1受體的活性,能夠產(chǎn)生終止覓食行為的效果[15]。本研究通過(guò)光遺傳學(xué)方法特異性激活VTADA-PBN上行通路,發(fā)現(xiàn)能夠縮短丙泊酚麻醉蘇醒時(shí)間,并發(fā)生皮層腦電覺(jué)醒。這些研究結(jié)果表明VTADA-PBN通路參與調(diào)控丙泊酚麻醉蘇醒,且激活這一通路能夠促進(jìn)麻醉蘇醒。
我們的研究發(fā)現(xiàn),光遺傳學(xué)激活VTADA-PBN通路,對(duì)麻醉蘇醒階段起調(diào)控作用,誘導(dǎo)時(shí)間無(wú)顯著變化。這與EEG結(jié)果相一致,LORR期間,腦電圖各波段幾乎無(wú)明顯差異。有研究也觀察到類似結(jié)果,6-OHDA選擇性毀損VTA DA神經(jīng)元僅延長(zhǎng)了丙泊酚蘇醒時(shí)間[18]。另有研究表明在丙泊酚和異氟醚麻醉中,PBN神經(jīng)元的激活并未延長(zhǎng)誘導(dǎo)時(shí)間,EEG結(jié)果顯示在麻醉期間大腦皮層活動(dòng)沒(méi)有差異[19]。越來(lái)越多的研究支持這樣的觀點(diǎn),即全身麻醉誘導(dǎo)和蘇醒的兩個(gè)過(guò)程可能不是鏡像,而是由不同的神經(jīng)環(huán)路控制[20]。此外,有觀點(diǎn)認(rèn)為睡眠誘導(dǎo)不僅需要睡眠系統(tǒng)的激活,還需要關(guān)鍵喚醒回路的失活,而行為覺(jué)醒只需要喚醒系統(tǒng)的激活[13]。全身麻醉蘇醒和自然睡眠的覺(jué)醒有很多相似之處,而VTA和PBN在全身麻醉和睡眠-覺(jué)醒中均起到重要作用,因此,我們推測(cè)VTA和PBN在丙泊酚全身麻醉的誘導(dǎo)和蘇醒兩個(gè)階段中,可能由不同的神經(jīng)通路所調(diào)控。
此外,VTA多巴胺能神經(jīng)元在解剖定位和功能意義上都具有高度異質(zhì)性[21-22]。投射到PBN和伏隔核的VTA多巴胺能神經(jīng)元是兩個(gè)非重疊神經(jīng)元的隊(duì)列,大多數(shù)投射到PBN的VTA神經(jīng)元多數(shù)位于尾側(cè)VTA[15]。有研究通過(guò)化學(xué)遺傳學(xué)和光遺傳學(xué)激活或抑制VTA投射至伏隔核的多巴胺能神經(jīng)環(huán)路,能夠調(diào)節(jié)七氟醚麻醉的誘導(dǎo)和蘇醒[10]。有趣的是,本研究通過(guò)光遺傳學(xué)特異性激活VTA投射至PBN中的多巴胺能通路發(fā)現(xiàn)丙泊酚麻醉誘導(dǎo)時(shí)間并無(wú)統(tǒng)計(jì)學(xué)差異,而麻醉蘇醒時(shí)間縮短,表明VTADA-PBN通路只調(diào)控了丙泊酚麻醉的蘇醒階段。因此,我們推測(cè)VTA中兩組非重疊的DA神經(jīng)元群體可能在調(diào)控全身麻醉中均起到關(guān)鍵作用,但這兩組多巴胺神經(jīng)元在調(diào)控麻醉誘導(dǎo)和蘇醒兩個(gè)階段中所參與的神經(jīng)通路可能有所差異。
本研究將光纖陶瓷插芯置入上游核團(tuán)VTA中,光激活多巴胺能神經(jīng)元胞體,能夠縮短丙泊酚麻醉蘇醒時(shí)間。而課題組先前研究將光纖陶瓷插芯置入下游核團(tuán)PBN中,光激活或抑制VTA投射至PBN中的多巴胺神經(jīng)末梢,發(fā)現(xiàn)這一通路能夠調(diào)控丙泊酚麻醉蘇醒階段,光激活VTADA-PBN通路,丙泊酚麻醉蘇醒時(shí)間縮短;光抑制VTADA-PBN通路,丙泊酚麻醉蘇醒時(shí)間延長(zhǎng)[23]。其他研究表明無(wú)論光刺激神經(jīng)元胞體或直接刺激神經(jīng)元軸突末梢,均會(huì)對(duì)神經(jīng)環(huán)路起到直接調(diào)控作用[24]。
總之,我們通過(guò)光遺傳學(xué)技術(shù)結(jié)合c-Fos蛋白染色和在體腦電記錄發(fā)現(xiàn),激活VTADA-PBN通路能夠縮短丙泊酚麻醉蘇醒時(shí)間,表明VTADA-PBN通路在丙泊酚麻醉蘇醒階段可能發(fā)揮關(guān)鍵作用。
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(責(zé)任編輯:編輯唐慧)