Doleman B, Blackwell J, Karangizi A, Butt W, Bhalla A, Lund J N, Williams J P
Division of Medical Sciences and Graduate Entry Medicine, Royal Derby Hospital, University of Nottingham, Derby, UK.
Acta Anaesthesiol Scand. 2016 Aug;60(7):910-6. doi: 10.1111/aas.12716. Epub 2016 Mar 4.
The aims of this study were to determine if patient ASA grade was associated with increased stress in anaesthetists with a subsequent effect on non-technical skills.
Stress was measured using a validated objective (heart rate variability or heart rate) and subjective tool. We studied eight consultant anaesthetists at baseline (rest) and during 16 episodes of intubation with an ASA 1 or 2 patient vs. an ASA 3 or 4 patient. The primary outcome for the study was objective and subjective stress between both patient groups. Secondary outcomes were non-technical skill ratings and the association between stress measurements.
ASA 3 or 4 patients were associated with increases in objective stress when compared to baseline (mean 4.6 vs. 6.7; P = 0.004). However, ASA 1 or 2 patients were not associated with increases in stress when compared to baseline (mean 4.6 vs. 4.7; P = 1). There was no significant difference in subjective stress between the groups (P = 0.18). Objective stress negatively affected situational awareness (P = 0.03) and decision-making (P = 0.03); however, these did not decline to a clinically significant threshold. Heart rate variability (r = 0.60; P = 0.002) better correlated with subjective stress when compared to heart rate (r = 0.30; P = 0.15). Agreement between raters for Anaesthetic Non-Technical Skills (ANTS) scores was acceptable (ICC = 0.51; P = 0.003).
This study suggests that higher patient ASA grade can increase stress in anaesthetists, which may impair non-technical skills.
本研究旨在确定患者的美国麻醉医师协会（ASA）分级是否与麻醉医生压力增加相关，进而对非技术技能产生影响。
使用经过验证的客观工具（心率变异性或心率）和主观工具测量压力。我们在基线（休息时）以及为ASA 1或2级患者与ASA 3或4级患者进行16次插管过程中，对8名麻醉科顾问医生进行了研究。该研究的主要结果是两组患者之间的客观和主观压力。次要结果是非技术技能评分以及压力测量之间的关联。
与基线相比，ASA 3或4级患者与客观压力增加相关（平均值4.6对6.7；P = 0.004）。然而，与基线相比，ASA 1或2级患者与压力增加无关（平均值4.6对4.7；P = 1）。两组之间的主观压力无显著差异（P = 0.18）。客观压力对情景意识（P = 0.03）和决策（P = 0.03）有负面影响；然而，这些并未降至具有临床意义的阈值。与心率（r = 0.30；P = 0.15）相比，心率变异性（r = 0.60；P = 0.002）与主观压力的相关性更好。麻醉非技术技能（ANTS）评分的评估者之间的一致性是可接受的（组内相关系数ICC = 0.51；P = 0.003）。
本研究表明，患者较高的ASA分级会增加麻醉医生的压力，这可能会损害非技术技能。
