A Prospective Study of Heart Rate Variability in Endocrine Surgery: Surgical Training Increases Consultant's Mental Strain
A Prospective Study of Heart Rate Variability in Endocrine Surgery: Surgical Training Increases Consultant's Mental Strain
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DOI：
10.1016/j.jsurg.2012.04.002
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发表时间：
2012-07-01
影响因子：
2.9
通讯作者：
Sywak, Mark S.
中科院分区：
文献类型：
--
作者：
Prichard, Ruth S.;O'Neill, Christine J.;Sywak, Mark S.
背景：本研究的目的是确定指导外科学员进行技术要求较高的手术是否会导致指导外科医生的心率变异性 (HRV) 和精神紧张发生变化。 方法：对进行 50 例甲状腺全切除手术的两名外科医生顾问和三名内分泌外科研究员进行了 HRV 前瞻性研究。在交叉设计中，研究员和顾问外科医生作为主要操作者进行了 50 例肺叶切除术，并作为助理进行了 50 例肺叶切除术。在解剖喉返神经周围时测量 HRV。 HRV 的总体心率、时间和频域参数，特别是用作心脏和精神压力测量的低频/高频 (LF/HF) 比值，与手术角色相关，特别是在关键点指导外科医师。 结果：HRV 数据收集于 2009 年 10 月至 2010 年 3 月期间。无论角色如何，两组参与者的平均心率均无统计学显着差异。研究员在操作时的能量消耗更大 (p = 0.03)。研究员在担任主要操作员时表现出较高的 LF/HF 比 (p = 0.02)。当主治外科医生进行手术时，HRV 的所有时域参数均增加，表明心脏松弛程度增加。同样，主治外科医生在教学时的 LF/HF 比率显着较高 (p = 0.05)，表明精神紧张有所增加。 结论：根据 HRV 确定，复杂但常见的内分泌外科手术的教学与顾问外科医生精神紧张的可测量增加有关。研究员在担任主要操作员时表现出更大的压力。 U Surg 69：453-458。 (C) 2012 年外科项目主任协会。由爱思唯尔公司出版。保留所有权利。）
BACKGROUND: The aim of this study was to determine whether instructing surgical trainees in technically demanding procedures causes alterations in heart rate variability (HRV) and mental strain in supervising surgeons.METHODS: A prospective study of HRV in two consultant surgeons and three endocrine surgical fellows undertaking 50 total thyroidectomy procedures was performed. Fellows and consultant surgeons performed 50 lobectomies as primary operator and 50 as assistants in a cross-over design. HRV was measured during dissection around the recurrent laryngeal nerve. The overall heart rate, time, and frequency domain parameters of HRV, specifically the low frequency/high frequency (LF/HF) ratio, which was used as a measure of cardiac and mental stress, were correlated with the surgical role, particularly teaching surgical fellows at critical points.RESULTS: HRV data were collected between October 2009 and March 2010. There was no statistically significant difference in the mean heart rate for either group of participants regardless of role. Energy expenditure was greater for fellows when operating (p = 0.03). Fellows demonstrated a higher LF/HF ratio when acting as the primary operator (p = 0.02). All time domain parameters of HRV increased when attending surgeons were operating, denoting more cardiac relaxation. Similarly, the LF/HF ratio was significantly greater for attending surgeons when teaching (p = 0.05), suggesting an increase in mental strain.CONCLUSIONS: The teaching of complex but common endocrine surgical procedures is associated with a measurable increase in mental strain of consultant surgeons, as determined by HRV. Fellows demonstrated increased levels of stress when acting as primary operators. U Surg 69:453-458. (C) 2012 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)