一项关于内分泌手术中心率变异性的前瞻性研究：手术培训增加了顾问的精神压力。

A prospective study of heart rate variability in endocrine surgery: surgical training increases consultant's mental strain.

机构信息

University of Sydney, Endocrine Surgical Unit, Sydney, NSW, Australia.

出版信息

J Surg Educ. 2012 Jul-Aug;69(4):453-8. doi: 10.1016/j.jsurg.2012.04.002.

DOI:10.1016/j.jsurg.2012.04.002

PMID:22677581

Abstract

BACKGROUND

The aim of this study was to determine whether instructing surgical trainees in technically demanding procedures causes alterations in heart rate variability (HRV) and mental strain in supervising surgeons.

METHODS

A prospective study of HRV in two consultant surgeons and three endocrine surgical fellows undertaking 50 total thyroidectomy procedures was performed. Fellows and consultant surgeons performed 50 lobectomies as primary operator and 50 as assistants in a cross-over design. HRV was measured during dissection around the recurrent laryngeal nerve. The overall heart rate, time, and frequency domain parameters of HRV, specifically the low frequency/high frequency (LF/HF) ratio, which was used as a measure of cardiac and mental stress, were correlated with the surgical role, particularly teaching surgical fellows at critical points.

RESULTS

HRV data were collected between October 2009 and March 2010. There was no statistically significant difference in the mean heart rate for either group of participants regardless of role. Energy expenditure was greater for fellows when operating (p = 0.03). Fellows demonstrated a higher LF/HF ratio when acting as the primary operator (p = 0.02). All time domain parameters of HRV increased when attending surgeons were operating, denoting more cardiac relaxation. Similarly, the LF/HF ratio was significantly greater for attending surgeons when teaching (p = 0.05), suggesting an increase in mental strain.

CONCLUSIONS

The teaching of complex but common endocrine surgical procedures is associated with a measurable increase in mental strain of consultant surgeons, as determined by HRV. Fellows demonstrated increased levels of stress when acting as primary operators.

摘要

背景

本研究旨在确定在指导外科受训者进行技术要求高的手术时，是否会改变监督外科医生的心率变异性（HRV）和精神压力。

方法

对 2 名顾问外科医生和 3 名内分泌外科研究员进行了前瞻性 HRV 研究，他们共进行了 50 例全甲状腺切除术。研究员和顾问外科医生以交叉设计的方式分别作为主要操作者和助手完成 50 例肺叶切除术和 50 例肺叶切除术。在喉返神经周围解剖时测量 HRV。总体心率、时间和频域 HRV 参数，特别是作为心脏和精神压力测量的低频/高频（LF/HF）比值，与手术角色相关，特别是在关键节点教授外科研究员。

结果

HRV 数据于 2009 年 10 月至 2010 年 3 月收集。无论角色如何，两组参与者的平均心率均无统计学差异。研究员在操作时的能量消耗更高（p=0.03）。研究员作为主要操作者时 LF/HF 比值更高（p=0.02）。当主治外科医生操作时，所有 HRV 时域参数均增加，表明心脏放松度更高。同样，当主治外科医生进行教学时，LF/HF 比值显著更高（p=0.05），表明精神压力增加。