心率变异性是血管外科手术中外科医生压力的动态标记。

IF 3.5 3区 医学 Q1 SURGERY BJS Open Pub Date : 2024-09-03 DOI:10.1093/bjsopen/zrae097
Calvin D De Louche, Manish Mandal, Lee Fernandes, Jason Lawson, Colin D Bicknell, Anna L Pouncey
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引用次数: 0

摘要

背景介绍外科医生在进行手术时会经历较高的压力水平。急性压力与认知负荷过重有关,会导致手术效果恶化。慢性压力对外科医生的健康构成重大风险。识别术中压力可能有助于制定预防策略,减轻外科医生的压力,从而改善患者的预后。本研究旨在评估使用心率变异性作为血管手术中压力标志物的可行性:共有 11 名资深外科医生在进行三种不同的血管外科手术时接受了评估。心率变异性指标(低频与高频比值和正常-正常间期的标准偏差)是在预定的手术表现点从单导联心电图描记中确定的。状态-特质焦虑量表-6 是一种经过验证的压力工具,用于评估外科医生报告的压力。此外,还收集了手术难度的主观报告。单因素方差分析比较了关键绩效点与基线的心率变异性。皮尔逊系数评估了心率变异性与主观压力之间的相关性:收集了六例颈动脉内膜切除术、六例开放式腹主动脉瘤修补术和五例下肢搭桥术的数据。在所有手术的关键执行点都观察到了心率变异指标,表明压力明显增大。执行同一手术的不同外科医生的压力峰值是一致的。心率变异指标与主观状态-特质焦虑量表-6 压力报告之间存在明显相关性(r = 0.768,P = 结论:心率变异性可能是评估血管手术中术中压力和认知负荷的一种可行方法,可用于评估手术室干预措施(如超时)是否能减轻手术困难区域的压力。
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Heart rate variability as a dynamic marker of surgeons' stress during vascular surgery.

Background: A surgeon experiences elevated stress levels when operating. Acute stress is linked to cognitive overload, worsening surgical performance. Chronic stress poses a significant risk to a surgeon's health. Identifying intraoperative stress may allow for preventative strategies that reduce surgeons' stress and subsequently improve patient outcomes. The aim of this study was to assess the feasibility of using heart rate variability as a marker of stress during vascular surgery.

Methods: A total of 11 senior surgeons were evaluated performing three different vascular surgery procedures. Heart rate variability metrics (low-frequency to high-frequency ratio and standard deviation of the normal-normal interval) were determined from single-lead ECG traces at predetermined procedural performance points. State-Trait Anxiety Inventory-6, a validated stress tool, was used to assess surgeon-reported stress. Subjective reports of procedural difficulty were also collected. One-way ANOVA compared heart rate variability at key performance points with baseline. Pearson's coefficient assessed correlation between heart rate variability and subjective stress.

Results: Data were collected for six carotid endarterectomies, six open abdominal aortic aneurysm repairs, and five lower limb bypasses. Heart rate variability metrics indicating markedly greater stress were observed at key performance points across all procedures. Peaks in stress were consistent across different surgeons performing the same procedure. A significant correlation was observed between heart rate variability metrics and subjective State-Trait Anxiety Inventory-6 stress reports (r = 0.768, P =<0.001). The most difficult procedural steps reported corresponded with heart rate variability metrics displaying the greatest stress.

Conclusion: Heart rate variability may be a viable approach to assess intraoperative stress and cognitive load during vascular surgery and could be used to evaluate whether a theatre intervention (for example timeout) could reduce stress in areas of surgical difficulty.

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来源期刊
BJS Open
BJS Open SURGERY-
CiteScore
6.00
自引率
3.20%
发文量
144
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