Husby T, Torgersen J, Flaatten H
Department of Anaesthesiology and Intensive Care Medicine, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway.
Acta Anaesthesiol Scand. 2014 Feb;58(2):177-84. doi: 10.1111/aas.12220. Epub 2013 Nov 6.
The work hours of Norwegian physicians are under scrutiny because of an increased public focus on patient safety. Ample international research indicate harmful effects of doctor fatigue based on studies on physicians working long weeks and on-call shifts of more than 30 consecutive hours. There is a lack of research on effects relevant for short or intermediate length of work weeks and call shifts. This study intended to study cognitive effects of short or intermediate duration in-hospital calls.
Eighteen anaesthesiology residents working on-call at an operation ward or an intensive care unit at Haukeland University Hospital were invited to participate. Schedules were adapted to allow for two additional experimental shifts. Participants were subjected to Cambridge Neuropsychological Test Automated Battery cognitive testing in a rested state and on three occasions after call. Amount of sleep and self-assessed sleepiness were recorded.
Ten residents completed all four tests during 10 months. Reaction time was longer post-call. It was significantly increased only after the 18 h night call, by 21.1 and 20.5 ms for simple and five-choice reaction time, respectively. Executive function was not significantly altered post-call. Visual memory was improved post-call. Karolinska Sleepiness Score was increased by 3.3 (long day), 2.1 (short night) and 2.5 (long night) points post-call.
Reaction times were increased after 18 h night calls and non-significant increases in reaction times were apparent after the other on-call shifts. Self reported sleepiness was increased post-call. We were not able to conclude whether executive function or memory was negatively affected post-call.
由于公众对患者安全的关注度不断提高，挪威医生的工作时长受到了审视。大量国际研究表明，基于对长时间工作和连续30多个小时值班的医生的研究，医生疲劳会产生有害影响。目前缺乏关于短或中等时长工作周和值班对相关影响的研究。本研究旨在探讨短或中等时长的院内值班的认知影响。
邀请了18名在豪克兰大学医院手术病房或重症监护病房值班的麻醉科住院医师参与。调整排班以允许增加两个额外的实验班次。参与者在休息状态下以及值班后的三个时间点接受剑桥神经心理测试自动成套测验的认知测试。记录睡眠时间和自我评估的困倦程度。
10名住院医师在10个月内完成了所有四项测试。值班后反应时间延长。仅在18小时夜间值班后显著增加，简单反应时间和五项选择反应时间分别增加了21.1毫秒和20.5毫秒。值班后执行功能没有显著改变。值班后视觉记忆得到改善。值班后卡罗林斯卡困倦评分分别增加了3.3分（长日班）、2.1分（短夜班）和2.5分（长夜班）。
18小时夜间值班后反应时间增加，其他值班班次后反应时间也有不显著的增加。值班后自我报告的困倦程度增加。我们无法得出值班后执行功能或记忆是否受到负面影响的结论。
