Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, United Kingdom.
Ann Surg. 2012 Feb;255(2):222-7. doi: 10.1097/SLA.0b013e3182306c99.
To investigate the effect of modafinil 200 mg on the performance of a cohort of healthy male doctors after 1 night of supervised sleep deprivation.
Sleep-deprived and fatigued doctors pose a safety risk to themselves and their patients. Yet, because of the around-the-clock nature of medical practice, doctors frequently care for patients after periods of extended wakefulness or during circadian troughs. Studies suggest that a group of substances may be capable of safely and effectively reversing the effects of fatigue. However, little work has been done to investigate their role within our profession.
We conducted a parallel, double-blind, randomized, and placebo-controlled study to investigate the effect of pharmacological enhancement on performance doctors. Thirty-nine healthy male resident doctors received either lactose placebo (n = 19) or modafinil 200 mg (n = 20) after 1 night of sleep deprivation. A selection of CANTAB neuropsychological tests was used to assess higher cognitive function. Clinical psychomotor performance was assessed using the Minimally Invasive Surgical Trainer Virtual Reality. Assessments were carried out between 6.00 AM and approximately 8.00 AM.
Modafinil improved performance on tests of higher cognitive function; participants in the modafinil group worked more efficiently when solving working memory (F1,38 = 5.24, P = 0.028) and planning (F1,38 = 4.34, P = 0.04) problems, were less-impulsive decision makers (F1,37 = 6.76, P = 0.01), and were more able to flexibly redirect their attention (F1,38 = 4.64, P = 0.038). In contrast, no improvement was seen in tests of clinical psychomotor performance.
Our results suggest that fatigued doctors might benefit from pharmacological enhancement in situations that require efficient information processing, flexible thinking, and decision making under time pressure. However, no improvement is likely to be seen in the performance of basic procedural tasks.
研究莫达非尼 200mg 对经过一夜监督性睡眠剥夺后的一组健康男医生的表现的影响。
睡眠剥夺和疲劳的医生对自己和患者都存在安全风险。然而，由于医疗实践的 24 小时性质，医生经常在长时间清醒或昼夜节律低谷期间照顾患者。研究表明，一组物质可能能够安全有效地逆转疲劳的影响。但是，在我们的职业中，很少有研究探讨它们的作用。
我们进行了一项平行、双盲、随机、安慰剂对照研究，以研究药物增强对医生表现的影响。39 名健康的男性住院医生在一夜睡眠剥夺后接受乳糖安慰剂（n = 19）或莫达非尼 200mg（n = 20）治疗。使用一系列 CANTAB 神经心理学测试来评估高级认知功能。使用微创外科训练虚拟现实评估临床精神运动表现。评估在上午 6.00 至 8.00 之间进行。
莫达非尼改善了高级认知功能测试的表现；莫达非尼组的参与者在解决工作记忆（F1,38 = 5.24，P = 0.028）和规划（F1,38 = 4.34，P = 0.04）问题时效率更高，冲动决策的可能性更小（F1,37 = 6.76，P = 0.01），并且能够更灵活地转移注意力（F1,38 = 4.64，P = 0.038）。相比之下，临床精神运动表现测试未见改善。
我们的结果表明，在需要高效信息处理、灵活思维和在时间压力下做出决策的情况下，疲劳的医生可能会受益于药物增强。然而，在基本程序任务的表现上不太可能看到改善。
