Department of General, Vascular and Thoracic Surgery, Charité-Campus Benjamin Franklin, Berlin, Germany.
Surgery. 2010 Feb;147(2):246-54. doi: 10.1016/j.surg.2009.08.007.
Despite recent work hour restrictions, 24-hour calls remain an important part of patient care. The aim of this study was to assess the impact of 24-hour night calls on the psychomotor and cognitive skills of surgeons with a virtual surgery simulator (VSS) and psychometric tests. We hypothesized that sleep loss impairs surgical skills and concentration performance.
Seventeen surgery residents (test group) and 13 medical students (reference group) performed a 5-day training program on the VSS. The test group was then assessed during a night call on 4 test points (8 am and 4 pm on the on-call day, 8 am on the postcall day, and 8 am on the recovery day) to assess the effects of sleep loss on these surgery residents. The reference group performed the same tests but without a night call.
The training resulted in a homogenous performance level for both groups. The average time for the test group was 26 minutes. The analysis between rested and sleep-deprived participants (6.5 +/- 0.9 vs 2.9 +/- 1.4 hours of night sleep) in the on-call part showed no performance differences. No impairment was found for the VSS and the cognitive tests within the test group between the start of the working day and the start of the postcall day after the night of relative sleep loss. The subgroup analysis showed no significant differences regarding the amount of night sleep and laparoscopic experience.
No performance impairment was found for surgeons with a VSS and standardized cognitive tests after a night of relative sleep loss. Although there is no doubt that sleep deprivation ultimately impairs human functioning, typical surgical skills do not necessarily deteriorate with a limited amount of sleep loss under clinical conditions.
尽管最近对工作时间进行了限制，但 24 小时值班仍然是患者护理的重要组成部分。本研究旨在使用虚拟手术模拟器（VSS）和心理测量测试评估 24 小时夜间值班对外科医生的精神运动和认知技能的影响。我们假设睡眠不足会损害手术技能和注意力表现。
17 名外科住院医师（实验组）和 13 名医学生（对照组）在 VSS 上进行了为期 5 天的培训计划。然后，在夜间值班的 4 个测试点（值班日的上午 8 点和下午 4 点、值班后日的上午 8 点和恢复日的上午 8 点）对实验组进行评估，以评估睡眠不足对这些外科住院医师的影响。对照组进行了相同的测试，但没有夜间值班。
培训使两组的表现水平均达到了同质化。实验组的平均时间为 26 分钟。在值班部分，对休息和睡眠不足的参与者（6.5 +/- 0.9 与 2.9 +/- 1.4 小时夜间睡眠）进行分析，结果显示无表现差异。在实验组中，在经历了一夜相对睡眠不足后的值班日和值班后日的工作开始时，VSS 和认知测试均未发现工作表现受损。亚组分析显示，夜间睡眠时间和腹腔镜经验的差异无统计学意义。
在经历了一夜相对睡眠不足后，外科医生使用 VSS 和标准化认知测试并未发现表现受损。尽管毫无疑问，睡眠剥夺最终会损害人类的功能，但在临床条件下，典型的手术技能不一定会因有限的睡眠不足而恶化。
