Budden Aaron, Song Sophia, Henry Amanda, Wakefield Claire E, Abbott Jason
Gynaecological Research and Clinical Evaluation (GRACE) Group, Royal Hospital for Women, Sydney, Australia.
School of Clinical Medicine, UNSW, Sydney, Australia.
Surg Pract Sci. 2023 May 25;13:100174. doi: 10.1016/j.sipas.2023.100174. eCollection 2023 Jun.
While a degree of stress facilitates learning and task performance, excessive stress in surgeons may lead to poor patient outcomes, with maladaptive stress as a risk factor for surgeon burnout or self-harm through mechanisms including substance abuse, and suicide. We aim to systematically review publications investigating how measures of surgeons' acute biological stress change during surgery.
Medline, Embase, Cochrane library, and The United States, Australian, and European clinical trials registries were searched using the terms stress; surgeon; cortisol; skin conductance; and heart rate. Studies had to report at least one measure of biological stress related to surgery or simulated surgical exercise and have been published between January 1996 to June 2022.
Twenty-eight studies with a total of 433 participants met inclusion criteria with cortisol, heart rate, heart rate variability, and electrodermal activity being reported. Salivary cortisol was measured in four studies with conflicting directional changes reported. Mean heart rate increased in nine studies (by 6-22 beats/minute), however the impact of the physical work of surgery was not reported. Heart rate variability, as measured by low-frequency to high-frequency ratio, was significantly increased in three of six studies. One study measured electrodermal activity reporting significant increase in skin conductance in a simulation setting.
While some biological measures appear able to detect changes in acute stress in surgeons (particularly heart rate), appropriate measures of stress during non-stressful and stressful surgery are yet to be fully identified. Importantly, there are no current pathways for identifying surgeons at risk of burnout or self-harm and this is a critical unmet research need.
一定程度的压力有助于学习和任务表现，但外科医生承受的过度压力可能导致患者预后不良，适应不良的压力是外科医生职业倦怠或通过药物滥用和自杀等机制进行自我伤害的风险因素。我们旨在系统回顾研究外科医生急性生物应激指标在手术过程中如何变化的出版物。
使用“应激”“外科医生”“皮质醇”“皮肤电传导”和“心率”等术语检索了医学文献数据库（Medline）、荷兰医学文摘数据库（Embase）、考克兰图书馆以及美国、澳大利亚和欧洲的临床试验注册库。研究必须报告至少一项与手术或模拟手术练习相关的生物应激指标，且发表时间在1996年1月至2022年6月之间。
28项研究共433名参与者符合纳入标准，报告了皮质醇、心率、心率变异性和皮肤电活动。四项研究测量了唾液皮质醇，报告的方向变化相互矛盾。九项研究中平均心率增加（增加6 - 22次/分钟），但未报告手术体力工作的影响。六项研究中有三项研究测量的低频与高频比值所反映的心率变异性显著增加。一项研究测量了皮肤电活动，报告在模拟环境中皮肤电传导显著增加。
虽然一些生物指标似乎能够检测外科医生急性应激的变化（特别是心率），但在非应激和应激手术期间的适当应激指标尚未完全确定。重要的是，目前没有识别有职业倦怠或自我伤害风险的外科医生的途径，这是一项关键的未满足的研究需求。
