睡眠剥夺对腹腔镜物理模拟器中产品质量和操作有效性的影响：一项随机对照试验。
The impact of sleep deprivation on product quality and procedure effectiveness in a laparoscopic physical simulator: a randomized controlled trial.
作者信息
Uchal Miroslav, Tjugum Jostein, Martinsen Egil, Qiu Xinguang, Bergamaschi Roberto
机构信息
Department of Research and Development, Forde Health System, University of Bergen, Forde 6807, Norway.
出版信息
Am J Surg. 2005 Jun;189(6):753-7. doi: 10.1016/j.amjsurg.2005.03.021.
BACKGROUND
To compare the impact of sleep deprivation after 24-hour duty (post-call) with that of 8-hour work (post-work) on product quality (PQ) and procedure effectiveness (PE) in a laparoscopic physical simulator.
METHODS
Voluntary surgeons and nurses were pretested with the Epworth Sleepiness Scale (ESS) and Minimally Invasive Surgical Trainer-Virtual Reality (MIST-VR). Surgical task was suturing perforated ulcer on a foam stomach in a physical simulator. PQ and PE were measured by accuracy error (AE), tissue damage (TD) leak rate (LR), goal- (GDA) non-goal-directed actions (NGDA), and operating time (OT), respectively. Construct validity was assessed comparing measures when surgeons and nurses performed the surgical task. Inter-rater reliability (IRR) was assessed by Kendall's tau b coefficient. An 80% power parallel block randomization design at alpha = .05 required 60 subjects.
RESULTS
Thirty-two post-call surgeons and 32 post-work surgeons were well matched for age, gender, practice duration, and ESS and MIST-VR scores. The amount of time slept in the previous 24 hours was 1.5 versus 6.5 hours (P < .05). AE (1.0 mm vs. .5 mm), TD (2.18 mm vs. 2.18 mm), LR (56.2% vs. 65.6%), GDA (33.5 vs. 32.5), NGDA (.56 vs. .31), and OT (381.0 seconds vs. 364.5 seconds) were not significantly different when 32 surgeons in the post-call arm were compared with their 32 counterparts in the post-work arm, respectively. Construct validity was shown by significant improvement in 4 outcome measures (AE 1.0 mm vs. 2.0 mm, P = .00001; GDA 32.5 vs. 39.0, P = .07, NGDA .43 vs. .96, P = .045; and OT 377.5 vs. 557.0, P = .0005) when 64 surgeons performed the task as compared to 64 nurses. Tau b for IRR was 1.0 (P < .0001) for AE, TD, LR, and OT, .75 (P = .325) for GDA, and .77 (P = .305) for NGDA.
CONCLUSIONS
Sleep deprivation had no impact on the studied outcome measures of a surgical task performed in a laparoscopic simulator.
背景
比较24小时值班后（下班后）睡眠剥夺与8小时工作后（下班后）睡眠剥夺对腹腔镜物理模拟器中产品质量（PQ）和操作效果（PE）的影响。
方法
对自愿参与的外科医生和护士进行爱泼华嗜睡量表（ESS）和虚拟现实微创外科训练器（MIST-VR）的预测试。手术任务是在物理模拟器中的泡沫胃上缝合穿孔性溃疡。分别通过准确性误差（AE）、组织损伤（TD）、渗漏率（LR）、目标导向动作（GDA）、非目标导向动作（NGDA）和手术时间（OT）来测量PQ和PE。在外科医生和护士执行手术任务时，通过比较各项测量指标来评估结构效度。通过肯德尔tau b系数评估评分者间信度（IRR）。在α = 0.05时，80%功效的平行区组随机化设计需要60名受试者。
结果
32名下班后的外科医生和32名工作后的外科医生在年龄、性别、执业时间、ESS和MIST-VR评分方面匹配良好。前24小时的睡眠时间分别为1.5小时和6.5小时（P < 0.05）。当将32名下班后组的外科医生与其32名工作后组的对应人员分别进行比较时，AE（1.0毫米对0.5毫米）、TD（2.18毫米对2.18毫米）、LR（56.2%对65.6%）、GDA（33.5对32.5）、NGDA（0.56对0.31）和OT（381.0秒对364.5秒）无显著差异。当64名外科医生与64名护士执行任务时，4项结局指标有显著改善（AE 1.0毫米对2.0毫米，P = 0.00001；GDA 32.5对39.0，P = 0.07，NGDA 0.43对0.96，P = 0.045；OT 377.5对557.0，P = 0.0005），表明具有结构效度。AE、TD、LR和OT的IRR的tau b为1.0（P < 0.0001），GDA为0.75（P = 0.325），NGDA为0.77（P = 0.305）。
结论
睡眠剥夺对腹腔镜模拟器中进行的手术任务的研究结局指标没有影响。
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