Samkoff J S, Jacques C H
Keystone Peer Review Organization, Pennsylvania Medical Society, Harrisburg.
Acad Med. 1991 Nov;66(11):687-93. doi: 10.1097/00001888-199111000-00013.
Possible effects of sleep deprivation and fatigue on the performance and well-being of residents have received little scientific examination until recently. This article is a review of the studies on this topic published since 1970. All those studies that dealt with residents' moods and attitudes demonstrated deleterious effects of sleep deprivation and fatigue. The implications of this finding for patient care deserve exploration. Residents' acuity on performance tests requiring prolonged vigilance tended to deteriorate with acute sleep loss, while their performances on most brief psychomotor tests measuring manual dexterity, reaction times, and short-term recall were not adversely affected. The data presently available suggest that sleep-deprived or fatigued house officers can compensate for sleep loss in crises or other novel situations. However, sleep-deprived residents may be more prone to errors on routine, repetitive tasks and tasks that require sustained vigilance, which form a substantial portion of residents' workload. The authors concur with the recommendation of the Executive Council of the Association of American Medical Colleges that the total working hours for residents should not exceed 80 hours per week averaged over four weeks.
直到最近，睡眠剥夺和疲劳对住院医师工作表现及健康可能产生的影响才受到很少的科学研究。本文是对1970年以来发表的关于该主题研究的综述。所有涉及住院医师情绪和态度的研究都表明了睡眠剥夺和疲劳的有害影响。这一发现对患者护理的意义值得探讨。在需要长时间保持警觉的绩效测试中，住院医师的敏锐度往往会随着急性睡眠缺失而下降，而在大多数测量手部灵活性、反应时间和短期记忆的简短心理运动测试中，他们的表现并未受到不利影响。目前可得的数据表明，睡眠不足或疲劳的住院医师在危机或其他新情况下能够弥补睡眠缺失。然而，睡眠不足的住院医师在日常重复性任务以及需要持续警觉的任务上可能更容易出错，而这些任务在住院医师的工作量中占了很大一部分。作者赞同美国医学院协会执行委员会的建议，即住院医师的总工作时长平均四周内不应超过每周80小时。
