Ellman Peter I, Kron Irving L, Alvis Jeffrey S, Tache-Leon Carlos, Maxey Thomas S, Reece T Brett, Peeler Benjamin B, Kern John A, Tribble Curtis G
Department of Cardiovascular Surgery, University of Virginia, Charlottesville, Virginia, USA.
Ann Thorac Surg. 2005 Jul;80(1):60-4; discussion 64-5. doi: 10.1016/j.athoracsur.2005.01.034.
There is an increasing trend toward work hour restrictions for doctors world wide. These reforms have been inspired, in part, by the assertion by some that the fatigued physician is more prone to making errors. Interestingly, there is very little in the way of objective data with regard to the effects of sleep deprivation on patient outcomes. We have recently studied this in attending surgeons. The present study focused on thoracic surgical residents. Our hypothesis was that acute sleep deprivation would not lead to an increase in operative times or complications.
A retrospective review of all cases performed by thoracic surgical residents at the University of Virginia from January 1994 to March of 2004 was done. Complication rates of cases performed by "sleep deprived" (SD) residents were compared with cases done when the residents were "not sleep deprived" (NSD). A resident was deemed sleep deprived if he or she performed a case the previous evening that started between 10 pm and 5 am or ended between the hours of 11 pm and 7:30 am.
A total of 7,323 cases were recorded in the STS database over the 10-year period examined. Two hundred and twenty-nine of these cases (3%) were performed by SD residents. Mortality rates for coronary artery bypass operations showed no significant differences (2.1% [SD = 3 of 141 patients] vs 3.1% (NSD = 143 of 4452 patients), p = 0.63). A comparison of operative, neurologic, renal, infectious, and pulmonary complications as well as cardiopulmonary bypass times, cross-clamp times, the use of blood products, and length of stay also demonstrated no significant differences between groups.
Acute sleep deprivation in thoracic surgical residents does not affect operative efficiency, morbidity, or mortality in cardiac surgical operations.
全球范围内对医生工作时间限制的趋势日益增强。这些改革部分是受到一些人的断言的启发，即疲劳的医生更容易犯错。有趣的是，关于睡眠剥夺对患者预后影响的客观数据非常少。我们最近在主治外科医生中对此进行了研究。本研究聚焦于胸外科住院医师。我们的假设是急性睡眠剥夺不会导致手术时间增加或并发症增多。
对1994年1月至2004年3月弗吉尼亚大学胸外科住院医师所做的所有病例进行回顾性研究。将“睡眠剥夺”（SD）住院医师所做病例的并发症发生率与住院医师“未睡眠剥夺”（NSD）时所做病例进行比较。如果一名住院医师在前一晚进行了一台于晚上10点至凌晨5点开始或晚上11点至早上7:30结束的手术，则被视为睡眠剥夺。
在研究的10年期间，STS数据库中共记录了7323例病例。其中229例（3%）由睡眠剥夺的住院医师完成。冠状动脉搭桥手术的死亡率无显著差异（2.1%[141例患者中有3例SD]对3.1%[4452例患者中有143例NSD]，p = 0.63）。对手术、神经、肾脏、感染和肺部并发症以及体外循环时间、交叉夹闭时间、血液制品使用情况和住院时间的比较也显示两组之间无显著差异。
胸外科住院医师的急性睡眠剥夺不会影响心脏外科手术的手术效率、发病率或死亡率。
