目的:目的是研究连续夜班对认知功能的影响,精神运动,和学术急诊医学部急诊医学居民的道德表现。
方法:这项前瞻性病例交叉研究比较了急诊医学居民的睡眠时间,主观嗜睡,认知功能,道德判断,连续5天后的精神运动技能与使用睡眠日记的夜班相比,活动监视器,和多个性能测试。配对t检验和Wilcoxon符号秩检验用于基于正态的数据分析。相关性分析采用Spearman相关检验。还进行了亚组分析以发现基于性别和居住年份的任何差异。
结果:27名急诊医学居民参加了(13名男性,48.1%)。居住年份的分布如下:第一年为44.4%,第二年25.9%,第三年为29.6%。连续上了五个夜班,总睡眠时间从338.1±67.8分钟显著下降到307.4±71.0分钟(p<0.001),而主观嗜睡得分从9.6±3.3增加到13.6±4.6。夜班和白班之间的精神运动表现和反应时间没有显着差异。然而,工作记忆下降,通过自定进度的三回考试成绩评估(中位数[IQR]517.1[471.9-546.7]与457.6[334.4-508.8];p=0.034)和干扰测试得分(445.5±59.9vs.407.2±56.8;p<0.001),以及道德判断(中位数[IQR]19[18-28]与15[11-21];p=0.010)连续夜班后。绩效指标之间没有相关性,也没有基于性别或居住年份的差异。
结论:居民晚上比白天轮班睡眠少,报告连续5个晚上后的最高嗜睡水平。尽管如此,精神运动表现和反应时间没有显着差异。然而,道德判断大幅减少,工作记忆,串行夜班后的干扰测试性能。
OBJECTIVE: The objective was to study the effect of serial night shifts on the cognitive, psychomotor, and moral performance of emergency medicine residents of an academic Emergency Medicine Department.
METHODS: This prospective case-crossover study compared emergency medicine residents\' sleep time, subjective sleepiness, cognitive function, moral judgment, and psychomotor skills after 5 consecutive days versus night shifts using sleep diaries, activity monitors, and multiple performance tests. Paired t-tests and Wilcoxon signed-rank tests were used to analyze data based on normality. Correlation analysis was done using Spearman\'s correlation test. Subgroup analysis was also performed to find any difference based on gender and year of residency.
RESULTS: Twenty-seven emergency medicine residents participated (13 males, 48.1%). The distribution across residency years was as follows: 44.4% in their first year, 25.9% in their second year, and 29.6% in their third year. Following five consecutive night shifts, total sleep duration decreased significantly from 338.1 ± 67.8 to 307.4 ± 71.0 min (p < 0.001), while subjective sleepiness scores increased from 9.6 ± 3.3 to 13.6 ± 4.6. Psychomotor performance and reaction times did not significantly differ between night and day shifts. However, working memory declined, assessed by self-paced three-back test scores (median [IQR] 517.1 [471.9-546.7] vs. 457.6 [334.4-508.8]; p = 0.034) and interference test scores (445.5 ± 59.9 vs. 407.2 ± 56.8; p < 0.001), along with moral judgment (median [IQR] 19 [18-28] vs. 15 [11-21]; p = 0.010) after serial night shifts. No correlations existed between performance measures nor differences based on gender or residency year.
CONCLUSIONS: Residents sleep less following night versus day shifts, reporting the highest sleepiness levels after 5 consecutive nights. Despite this, psychomotor performance and reaction times did not significantly differ. However, considerable reductions occurred in moral judgment, working memory, and interference test performance after serial night shifts.