Budden Aaron K, Song Sophia, Henry Amanda, Nesbitt-Hawes Erin, Wakefield Claire E, Abbott Jason A
School of Clinical Medicine, University of New South Wales, Sydney, Australia (Drs. Budden, Song, Henry, Nesbitt-Hawes, Wakefield, and Abbott); Gynecology Research and Clinical Excellence, Royal Hospital for Women, Sydney, Australia (Drs. Budden, Song, Nesbitt-Hawes, and Abbott).
School of Clinical Medicine, University of New South Wales, Sydney, Australia (Drs. Budden, Song, Henry, Nesbitt-Hawes, Wakefield, and Abbott); Gynecology Research and Clinical Excellence, Royal Hospital for Women, Sydney, Australia (Drs. Budden, Song, Nesbitt-Hawes, and Abbott).
J Minim Invasive Gynecol. 2023 Oct;30(10):841-849. doi: 10.1016/j.jmig.2023.06.014. Epub 2023 Jun 26.
To assess changes in biological measures of acute stress in surgeons during surgery in real-world settings DESIGN: A prospective cohort study.
A tertiary teaching hospital.
8 consultant and 9 training gynecologists.
A total of, 161 elective gynecologic surgeries of 3 procedures: laparoscopic hysterectomy, laparoscopic excision of endometriosis, or hysteroscopic myomectomy.
Changes in surgeons' biological measures of acute stress while undertaking elective surgery. Salivary cortisol, mean and maximum heart rate (HR), and indices of the HR variability were recorded before and during surgery. From baseline to during surgery over the cohort, salivary cortisol decreased from 4.1 nmol/L to 3.6 nmol/L (p = .03), maximum HR increased from 101.8 beats per min (bpm) to 106.5 bpm (p <.01), root mean square of standard deviation decreased from 51.1 ms to 39.0 ms (p <.01), and standard deviation of beat-to-beat variability decreased from 73.7 to 59.8 ms (p <.01). Analysis of individual changes in stress by participant-surgery event by paired data graphs reveal inconsistent direction of change in all measures of biological stress despite stratification by surgical experience, role in surgery, level of training, or type of surgery performed.
This study measured biometric stress changes at both a group and individual level in real-world, live surgical settings. Individual changes have not previously been reported and the variable direction of stress change by participant-surgery episode identified in this study demonstrates a problematic interpretation of mean cohort findings previously reported. Results from this study suggest that either live surgery with tight environment control or surgical simulation studies may identify what, if any, biological measures of stress can predict acute stress reactions during surgery.
评估在实际手术环境中外科医生急性应激的生物学指标变化。
前瞻性队列研究。
一家三级教学医院。
8名顾问妇科医生和9名妇科住院医生。
总共161例择期妇科手术，包括3种术式：腹腔镜子宫切除术、腹腔镜子宫内膜异位症切除术或宫腔镜子宫肌瘤切除术。
择期手术期间外科医生急性应激的生物学指标变化。记录手术前和手术期间的唾液皮质醇、平均心率和最大心率（HR）以及心率变异性指标。在整个队列中，从基线到手术期间，唾液皮质醇从4.1 nmol/L降至3.6 nmol/L（p = 0.03），最大心率从每分钟101.8次（bpm）增加到106.5 bpm（p < 0.01），标准差的均方根从51.1 ms降至39.0 ms（p < 0.01），逐搏变异性标准差从73.7降至59.8 ms（p < 0.01）。通过配对数据图按参与者-手术事件分析个体应激变化，结果显示，尽管按手术经验、在手术中的角色、培训水平或所实施的手术类型进行分层，但所有生物学应激指标的变化方向并不一致。
本研究在实际的现场手术环境中测量了群体和个体水平的生物特征应激变化。此前尚未报道过个体变化情况，本研究中确定的参与者-手术事件应激变化的可变方向表明，对先前报道的队列平均结果的解释存在问题。本研究结果表明，要么进行环境控制严格的现场手术，要么进行手术模拟研究，可能会确定哪些应激生物学指标（如果有的话）可以预测手术期间的急性应激反应。
