[论文解读] A parallel preprocessing for the optimal assignment problem based on diagonal scaling

Meisam Sharify, Stéphane Gaubert+1 more|arXiv (Cornell University)|Apr 19, 2011

Graph Theory and Algorithms被引用 1

一句话总结

本研究调查了分娩疼痛及患者自控硬膜外镇痛（PCEA）的昼夜节律变化，发现夜间疼痛强度和镇痛药物消耗量更高，不安全依恋与疼痛增加及镇痛效果降低相关。尽管昼夜节律显著影响药物起效时间和持续时间，但依恋类型并未调节昼夜效应。

ABSTRACT

Circadian variation in biological rhythms has been identified as affecting both labour pain and the pharmacological properties of analgesics. In the context of pain, there is also a growing body of evidence suggesting the importance of adult attachment. The purpose of this study was to examine whether labour pain, analgesic consumption and pharmacological effect are significantly affected by the time of day and to analyse whether this circadian variation is influenced by women's attachment style. This prospective observational study included a sample of 81 pregnant women receiving patient-controlled epidural analgesia (PCEA). Attachment was assessed with the Adult Attachment Scale - Revised. The perceived intensity of labour pain in the early stage of labour (3 cm of cervical dilatation and before the administration of PCEA) was measured using a visual analogue scale (VAS). Pain was also indirectly assessed by measuring the consumption of anaesthetics. The latency period and the duration of effect were recorded for a chronopharmacology characterisation. Pain, as assessed with the VAS, was significantly higher in the night-time group than in the daytime group. An insecure attachment style was significantly associated with greater labour pain at 3 cm of cervical dilatation (p < 0.001) and before the beginning of analgesia (p < 0.001) as well as with higher analgesic consumption and lower pharmacological efficacy (p < 0.05). The time of day was significantly associated with the pharmacological effect: the latency period was longer at night, and the duration of the pharmacological effect was longer during the daytime. The interaction between time of day and attachment style was not significant for any of the study variables. Our results provide evidence of the importance of circadian variation in studying labour pain and the pharmacological effect of labour analgesia involving epidural blockage with a PCEA regimen. Moreover, although there was no evidence that attachment style influenced the circadian variation, these data emphasise that insecure attachment patterns are a risk factor for greater labour pain and analgesic consumption, which should be considered in pain management approaches.

研究动机与目标

• 检验分娩疼痛和镇痛反应是否随昼夜变化而不同。
• 评估成人依恋类型对疼痛和药物疗效昼夜节律变化的影响。
• 描述全天不同时间段硬膜外镇痛的药代动力学和药效学特征。
• 确定依恋类型是否调节昼夜节律对疼痛和药物反应的影响。

提出的方法

• 采用前瞻性观察性研究设计，纳入81名接受PCEA的孕妇。
• 使用视觉模拟量表（VAS）在宫颈扩张3 cm时测量分娩疼痛。
• 记录镇痛药物消耗量、药物起效时间及药效持续时间。
• 使用修订版成人依恋量表评估依恋类型。
• 分析昼夜时间与依恋类型对疼痛和药物反应的交互作用。
• 应用统计模型检验昼夜节律、依恋类型与疼痛/镇痛结局之间的关联。

实验结果

研究问题

• RQ1 昼夜是否显著影响早期分娩阶段的主观疼痛强度？
• RQ2 不安全依恋类型是否与更高分娩疼痛或更高镇痛药物消耗量显著相关？
• RQ3 昼夜时间如何影响硬膜外镇痛起效时间和持续时间？
• RQ4 依恋类型是否调节昼夜节律对疼痛或药物反应的影响？
• RQ5 昼夜节律与依恋类型在药物疗效上是否存在显著交互作用？

主要发现

• 与白天相比，夜间分娩的主观疼痛强度显著更高（p < 0.001）。
• 不安全依恋类型与3 cm扩张时疼痛程度更高（p < 0.001）以及镇痛前疼痛更高（p < 0.001）显著相关。
• 具有不安全依恋的女性镇痛药物消耗量更多，且药效更低（p < 0.05）。
• 夜间镇痛起效时间更长，而药效持续时间在白天更长（p < 0.05）。
• 昼夜时间与依恋类型在任一结果变量上均未发现显著交互作用。
• 昼夜节律显著影响药物反应，且独立于依恋类型。