Intraoperative stress in cardiac surgery: Attendings versus residents
Intraoperative stress in cardiac surgery: Attendings versus residents
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DOI：
10.1016/j.jss.2012.11.011
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发表时间：
2013-06-15
影响因子：
2.2
通讯作者：
Wahlers, Thorsten
中科院分区：
文献类型：
--
作者：
Kuhn, Elmar W.;Choi, Yeong-Hoon;Wahlers, Thorsten
背景：对外科医生来说，进行心脏手术与压力有关。我们调查了有经验的外科医生和实习生在冠状动脉搭桥术教学过程中的压力水平。方法：在109例选择性冠状动脉搭桥手术中，我们使用单导联心电图评估了有经验的外科医生(7名)和参加培训计划的住院医生(3名)的心率(HR)和交感迷走神经平衡(SVB)。作为主外科医生(n=10)和助理医生(n=9)，我们测量了静息和手术中预定时间的HR和SVB基线值。结果：所有参与者都是健康男性，平均年龄41.4+/-4.3岁。在本研究期间接受手术的患者，人口统计学和术中数据是一致的。与REST相比，外科医生和助手在整个手术过程中的平均心率和SVB较高，但HR值有显著差异(外科医生83.7+/-8.8次/分钟；助手85.4+/-12.7次/分钟，P<；0.05对62.3+/-5.1次/分钟)。参加组和住院组的HR和SVB课程相似，但在整个手术过程中，主治组的值高于作为外科医生的住院医生和在体外循环期间担任助理的住院医生。协助手术的主治医生的平均心率和SVB值高于进行手术的住院医生。结论：手术经验与降低压力水平无关。与实习医生相比，指导心脏外科教学案例可能会带来更大的压力。(C)2013 Elsevier Inc.保留所有权利。
Background: Performing cardiac surgery is associated with stress for surgeons. We investigated stress levels of experienced surgeons and trainees during coronary artery bypass graft teaching procedures.Methods: We assessed heart rate (HR) and sympathovagal balance (SVB) of experienced surgeons(attendings; n = 7) and residents enrolled in a training program(residents; n = 3) using a one-lead electrocardiogram during a total of 109 elective isolated coronary artery bypass graft procedures. We measured HR and SVB for baseline values at rest and at prespecified phases during the procedure in the role as primary surgeons (n = 10) and assistants (n = 9).Results: All participants were healthy men with a mean age of 41.4 +/- 4.3 y. For patients operated on during this study, demographic and intraoperative data were homogeneous. Compared with rest, mean HR and SVB for the whole procedure were higher for surgeons and assistants, with significant differences for HR values (surgeons, 83.7 +/- 8.8 beats/min [bpm]; assistants, 85.4 +/- 12.7 bpm, P < 0.05 versus 62.3 +/- 5.1 bpm). Courses of HR and SVB were comparable for attending and resident groups but values were higher throughout for attendings compared with residents in their role as surgeons during the total procedure, and as assistants during cardiopulmonary bypass. Mean HR and SVB values of attendings assisting the procedure were higher compared with those of residents performing the operation.Conclusions: Surgical experience is not associated with reduced stress levels. Supervising a teaching case in cardiac surgery can be linked with more stress compared with the resident performing the procedure. (C) 2013 Elsevier Inc. All rights reserved.