Fischer J E, Calame A, Dettling A C, Zeier H, Fanconi S
Department of Neonatology and Pediatric Intensive Care, University Children's Hospital, Zurich, Switzerland.
Crit Care Med. 2000 Sep;28(9):3281-8. doi: 10.1097/00003246-200009000-00027.
Critical care is a working environment with frequent exposure to stressful events. High levels of psychological stress have been associated with increased prevalence of burnout. Psychological distress acts as a potent trigger of cortisol secretions. We attempted to objectify endocrine stress reactivity.
Observational cohort study during two 12-day periods in successive years.
A tertiary multidisciplinary neonatal and pediatric intensive care unit (33 beds).
One hundred and twelve nurses and 27 physicians (94% accrual rate).
Cortisol determined from salivary samples collected every 2 hrs and after stressful events. Participants recorded the subjective perception of stress with every sample. Endocrine reactions were defined as transient surges in cortisol of >50% and 2.5 nmol/L over the baseline.
During 7,145 working hours, we observed 474 (12.5%) endocrine reactions from 3,781 samples. The mean cortisol increase amounted to 10.6 nmol/L (219%). The mean occurrence rate of endocrine reactions per subject and sample was 0.159 (range, 0-0.43). Although the mean raw cortisol levels were lower in experienced team members (>3 yrs of intensive care vs. <3 yrs, 4.1 vs. 4.95 nmol/L, p < .001), professional experience failed to attenuate the frequency and magnitude of endocrine reactions, except for the subgroup of nurses and physicians with >8 yrs of intensive care experience. A high proportion (71.3%) of endocrine reactions occurred without conscious perception of stress. Unawareness of stress was higher in intensive care nurses (75.1%) than in intermediate care nurses (51.8%, p < .01).
Stress-related cortisol surges occur frequently in neonatal and pediatric critical care staff. Cortisol increases are independent of subjective stress perception. Professional experience does not abate the endocrine stress reactivity.
重症监护是一个经常接触应激事件的工作环境。高水平的心理压力与职业倦怠患病率增加有关。心理困扰是皮质醇分泌的有力触发因素。我们试图客观化内分泌应激反应性。
连续两年进行的两个为期12天的观察性队列研究。
一家三级多学科新生儿和儿科重症监护病房（33张床位）。
112名护士和27名医生（参与率94%）。
每2小时以及在应激事件后采集唾液样本测定皮质醇。参与者对每个样本记录应激的主观感受。内分泌反应定义为皮质醇较基线水平瞬时升高>50%且升高2.5 nmol/L。
在7145个工作小时内，我们从3781个样本中观察到474次（12.5%）内分泌反应。皮质醇平均升高10.6 nmol/L（219%）。每个研究对象和样本的内分泌反应平均发生率为0.159（范围0 - 0.43）。尽管经验丰富的团队成员（重症监护经验>3年与<3年相比，分别为4.1与4.95 nmol/L，p <.001）的皮质醇原始平均水平较低，但职业经验未能减弱内分泌反应的频率和幅度，除了重症监护经验>8年的护士和医生亚组。71.3%的内分泌反应发生时没有对应激的自觉感受。重症监护护士对应激无觉察的比例（75.1%）高于中级护理护士（51.8%，p <.01）。
新生儿和儿科重症监护工作人员中与应激相关的皮质醇激增频繁发生。皮质醇升高与主观应激感受无关。职业经验并不能减轻内分泌应激反应性。
