Alobid Isam, de Pablo Juan, Mullol Joaquim, Centellas Silvia, Parramon Gemma, Carrasco Javier, Armario Antonio, Bernal-Sprekelsen Manuel
Rhinology Unit and Smell Clinic, Department of Otorhinolaryngology, Universitat de Barcelona, Villarroel 170, Barcelona 08036, Spain.
Arch Otolaryngol Head Neck Surg. 2011 May;137(5):487-92. doi: 10.1001/archoto.2011.60.
To compare psychophysiological responses among novice surgeons during performance of endoscopic sinus surgery (ESS).
Randomized study.
Academic institution.
Fifteen novice surgeons.
The psychophysiological effects of performing ESS were assessed among 15 novice surgeons at 30 minutes before (T - 30), at the beginning of (T0), at 15 minutes (T15), and 45 minutes (T45) during, and at 30 minutes after (T + 30) surgery. Participants were randomized to perform ESS with a computer-assisted surgery system, to perform ESS without a computer-assisted surgery system, or to be evaluated on a nonsurgical day (control day). Measured were the State-Trait Anxiety Inventory score, Visual Analog Anxiety Scale score, heart rate, blood pressure, and plasma cortisol and prolactin levels.
Anxiety as measured by the State-Trait Anxiety Inventory score was not modified by the experimental conditions. The mean (SEM) Visual Analog Anxiety Scale score increased (P < .05) during ESS at T0 (2.45 [0.32]), T15 (3.46 [0.50]), and T45 (3.17 [0.46]) compared with the control day (1.19 [0.19], 1.32 [0.26], and 1.20 [0.19], respectively). The mean (SEM) systolic blood pressure (in millimeters of mercury) increased (P < .05) during ESS at T0 (127 [2]), T15 (126 [3]), and T45 (125 [2]) compared with the control day (120 [3], 119 [4], and 116 [3], respectively). The mean (SEM) heart rate (in beats per minute) increased during ESS but was significant only at T15 (73 [4]) compared with the control day (64 [3]). The mean (SEM) plasma cortisol level (in micrograms per deciliter) increased 29% above baseline during performance of ESS and reached a maximum peak at T45 (12.6 [1.2]) compared with the control day (9.7 [1.1]), while prolactin levels did not change. The Visual Analog Anxiety Scale score, heart rate, blood pressure, and endocrine biomarkers of stress were not significantly modified during performance of ESS with a computer-assisted surgery system.
This study demonstrates for the first time that cardiovascular and anxiety changes during performance of ESS are not associated with increased levels of prototypical endocrine stress hormones.
比较新手外科医生在内镜鼻窦手术（ESS）操作过程中的心理生理反应。
随机研究。
学术机构。
15名新手外科医生。
在手术前30分钟（T - 30）、手术开始时（T0）、手术过程中15分钟（T15）和45分钟（T45）以及手术后30分钟（T + 30），对15名新手外科医生进行ESS操作时的心理生理效应进行评估。参与者被随机分为使用计算机辅助手术系统进行ESS、不使用计算机辅助手术系统进行ESS或在非手术日（对照日）接受评估。测量的指标包括状态-特质焦虑量表得分、视觉模拟焦虑量表得分、心率、血压以及血浆皮质醇和催乳素水平。
状态-特质焦虑量表得分所测量的焦虑并未因实验条件而改变。与对照日（分别为1.19 [0.19]、1.32 [0.26]和1.20 [0.19]）相比，在ESS过程中，T0（2.45 [0.32]）、T15（3.46 [0.50]）和T45（3.17 [0.46]）时视觉模拟焦虑量表得分升高（P <.05）。与对照日（分别为120 [3]、119 [4]和116 [3]）相比，在ESS过程中，T0（127 [2]）、T15（126 [3]）和T45（125 [2]）时平均（SEM）收缩压（毫米汞柱）升高（P <.05）。在ESS过程中心率平均（SEM）（每分钟心跳次数）升高，但仅在T15（73 [4]）时与对照日（64 [3]）相比有显著差异。在ESS操作过程中，血浆皮质醇水平平均（SEM）（微克/分升）比基线升高29%，并在T45（12.6 [1.2]）时达到最高峰值，与对照日（9.7 [1.1]）相比，而催乳素水平未发生变化。使用计算机辅助手术系统进行ESS操作过程中，视觉模拟焦虑量表得分、心率、血压和应激内分泌生物标志物均未发生显著改变。
本研究首次表明，ESS操作过程中的心血管和焦虑变化与典型内分泌应激激素水平升高无关。
