Sturm Lana, Dawson Drew, Vaughan Richard, Hewett Peter, Hill Andrew G, Graham John C, Maddern Guy J
Australian Safety and Efficacy Register of New Interventional Procedures – Surgical, Royal Australasian College of Surgeons, Australia.
ANZ J Surg. 2011 Jul-Aug;81(7-8):502-9. doi: 10.1111/j.1445-2197.2010.05642.x.
Sleep deprivation and disturbances in circadian rhythms generally lead to poor performance, but is there a link in surgery? This review aimed to determine whether fatigue has an impact on surgeon performance or surgical outcomes.
Studies were identified by searching EMBASE, CINAHL, PubMed, The Cochrane Library, Current Contents and clinical trials databases. Inclusion of relevant studies was by application of a predetermined protocol and independent assessment by two reviewers. Each included study was critically appraised for its study quality according to the methods used for Cochrane Reviews. Data from included studies were extracted by one researcher using standardized data extraction tables developed a priori and checked by a second researcher.
From 823 potentially relevant studies, a total of 16 studies were included in this review: two randomized controlled trials, five non-randomized comparative studies and nine case series. Of five studies that directly measure clinical performance, three studies reported no significant difference as a result of sleep deprivation, while two studies found increases in complications or errors. Eleven studies assessed psychomotor skill performance using a variety of simulation-based methods when a participant was rested and/or fatigued. Two randomized controlled trials reported no significant differences, while the nine remaining studies reported mixed results. Surgical residents with less surgical training/experience appeared to be more affected than more senior residents.
There is little evidence, as yet, to inform the issue of the effect of fatigue on surgical performance.
睡眠剥夺和昼夜节律紊乱通常会导致表现不佳，但手术中是否存在关联呢？本综述旨在确定疲劳是否会对外科医生的表现或手术结果产生影响。
通过检索EMBASE、CINAHL、PubMed、Cochrane图书馆、现刊目次和临床试验数据库来识别研究。纳入相关研究需遵循预定方案并由两名评审员进行独立评估。根据Cochrane综述所使用的方法，对每项纳入研究的质量进行严格评估。纳入研究的数据由一名研究人员使用事先制定的标准化数据提取表进行提取，并由另一名研究人员进行核对。
在823项可能相关的研究中，本综述共纳入16项研究：两项随机对照试验、五项非随机对照研究和九项病例系列研究。在五项直接测量临床操作表现的研究中，三项研究报告称睡眠剥夺没有显著差异，而两项研究发现并发症或错误有所增加。十一项研究在参与者休息和/或疲劳时，使用各种基于模拟的方法评估心理运动技能表现。两项随机对照试验报告无显著差异，而其余九项研究结果不一。手术培训/经验较少的住院医师似乎比资深住院医师更容易受到影响。
目前几乎没有证据能说明疲劳对外科手术表现的影响这一问题。
