Department of Otolaryngology, Head and Neck Surgery, Hyogo Prefectural Amagasaki General Medical Center, 6608550 Higashinaniwachou 2-17-77, Hyogo Prefecture, Japan.
Department of Otolaryngology, Head and Neck Surgery, Hyogo Prefectural Amagasaki General Medical Center, 6608550 Higashinaniwachou 2-17-77, Hyogo Prefecture, Japan.
Int J Psychophysiol. 2023 Mar;185:19-26. doi: 10.1016/j.ijpsycho.2023.01.008. Epub 2023 Jan 17.
A previous study examining clinical subacute pain models under different methodological conditions showed that pain-induced mental fatigue can be associated with decreased initial pupil size (INIT)/shortened constriction latency (LAT) in the pupillary light reflex (PLR). We aimed to investigate the potential of INIT/LAT as objective indicators reflecting mental fatigue under the same methodological conditions. We recruited 118 patients planning to undergo three types of representative otolaryngological head and neck surgery procedures. We used the numerical rating scale (NRS) to assess subjective pain intensity and two mental fatigue-related mood categories of the Profile of Mood States, as well as INIT and LAT measurements (1) in the afternoon one day before surgery (pre1-surgery), (2) in the morning of the day of surgery (pre2-surgery), and (3) in the morning of the day following surgery (post-surgery). We assessed time point-dependent changes using one- or two-way analysis of variance, as well as responses of PLR parameters to mental fatigue using linear mixed-effects models (LMMs). As a result, NRS scores, the two mood categories, as well as LAT and INIT, showed significant time point-dependent changes. In post-hoc analyses, only INIT showed significant changes between the two pre-surgery time points. Thus, INIT values fluctuated even under pain-free conditions due to differences in the time of the day. LMMs demonstrated decreased INIT/shortened LAT related to mental fatigue. All surgical groups showed similar associations between mental fatigue and INIT/LAT findings. As each parameter has advantages and disadvantages, it is recommended to use both INIT and LAT as the indicators.
先前的研究检查了不同方法学条件下的临床亚急性疼痛模型，结果表明，疼痛引起的精神疲劳可与瞳孔光反射（PLR）中的初始瞳孔大小（INIT）减小/收缩潜伏期（LAT）缩短相关。我们旨在研究在相同方法学条件下，INIT/LAT 作为反映精神疲劳的客观指标的潜力。我们招募了计划接受三种典型耳鼻喉头颈外科手术的 118 名患者。我们使用数字评分量表（NRS）评估主观疼痛强度和心境状态剖面图的两种与精神疲劳相关的情绪类别，以及 INIT 和 LAT 测量值（1）在手术前一天下午（术前 1），（2）在手术当天早上（术前 2），以及（3）在手术后的第二天早上。我们使用单向或双向方差分析评估时间点依赖性变化，以及使用线性混合效应模型（LMMs）评估 PLR 参数对精神疲劳的反应。结果，NRS 评分、两种情绪类别以及 LAT 和 INIT 均显示出显著的时间依赖性变化。在事后分析中，只有 INIT 在两个术前时间点之间显示出显著变化。因此，即使在无痛条件下，INIT 值也会因一天中的时间不同而波动。LMM 显示与精神疲劳相关的 INIT/缩短 LAT。所有手术组均显示精神疲劳与 INIT/LAT 结果之间存在相似的关联。由于每个参数都有其优点和缺点，因此建议同时使用 INIT 和 LAT 作为指标。
