Institute for Systems Engineering and Computers - Technology and Science (INESC TEC), Porto, Portugal; Faculty of Engineering, University of Porto, Portugal.
Institute for Systems Engineering and Computers - Technology and Science (INESC TEC), Porto, Portugal; Faculty of Engineering, University of Porto, Portugal.
Int J Med Inform. 2019 Sep;129:60-68. doi: 10.1016/j.ijmedinf.2019.05.028. Epub 2019 May 31.
It is known that excessive levels of occupational stress affect professionals' technical and non-technical skills and surgeons are no exception. However, very few studies address this problem in neurosurgeons. A system for monitoring cardiovascular strain and autonomic imbalance during intracranial aneurysm procedures is proposed in order to obtain overall cardiac measures from those procedures. Additionally, this study also allows to detect stressful events and compare their impact with the surgeon's own appraisal. Linear and nonlinear heart rate variability (HRV) features were extracted from surgeon's electrocardiogram (ECG) signal using wearable ECG monitors and mobile technology during 10 intracranial aneurysm surgeries with two surgeons. Stress appraisal and cognitive workload were assessed using self-report measures. Findings suggest that the surgeon associated to the main role during the clipping can be exposed to high levels of stress, especially if a rupture occurs (pNN20 = 0%), while the assistant surgeon tends to experience mental fatigue. Cognitive workload scores of one of the surgeons were negatively correlated with AVNN, SDNN, pNN20, pNN50, 1 V, 2 L V, SD2 and CVI measures. Cognitive workload was positively related with stress appraisal, suggesting that more mentally demanding procedures are also assessed as more stressful. Finally, pNN20 seems to better mirror behavior during stress moments than pNN50. Additionally, a sympathovagal excitation occurs in one of the professionals after changing to main role. The present methodology shows potential for the identification of harmful events. This work may be of importance for the design of effective interventions in order to reduce surgeons stress levels. Furthermore, this approach can be applied to other professions.
已知职业压力过大影响专业人员的技术和非技术技能，外科医生也不例外。然而，很少有研究关注神经外科医生的这个问题。提出了一种监测颅内动脉瘤手术中心血管紧张和自主失衡的系统，以便从这些手术中获得整体心脏指标。此外，这项研究还可以检测应激事件，并比较其与外科医生自身评估的影响。使用可穿戴心电图监测器和移动技术，从两位外科医生的 10 例颅内动脉瘤手术中的心电图（ECG）信号中提取线性和非线性心率变异性（HRV）特征。使用自我报告的措施评估压力评估和认知工作量。研究结果表明，在夹闭过程中担任主要角色的外科医生可能会承受高强度的压力，尤其是在发生破裂时（pNN20=0%），而助理外科医生则容易出现精神疲劳。其中一位外科医生的认知工作量评分与 AVNN、SDNN、pNN20、pNN50、1V、2L V、SD2 和 CVI 指标呈负相关。认知工作量与压力评估呈正相关，这表明更具挑战性的认知任务也被评估为更具压力。最后，pNN20 似乎比 pNN50 更好地反映压力时刻的行为。此外，在一位专业人员转换为主角后，会出现交感神经兴奋。本方法显示出识别有害事件的潜力。这一工作对于设计有效的干预措施以降低外科医生的压力水平可能具有重要意义。此外，这种方法可以应用于其他职业。
