醫師的睡眠剝奪與疲累之探討

Sleep Deprivation and Fatigue in Clinicians

劉玲伶(Ling-Ling Liu) ； 蔡明翰(Ming-Han Tsai) ； 吳彥林(Yen-Lin Wu)

《北市醫學雜誌》 3卷3期 (2006/03) Pp. 194-200

https://doi.org/10.6200/TCMJ.2006.3.3.01

摘要

由於工作時間過長致使睡眠不足和生理時鐘的混亂，很久以來一直造成醫療界的困擾。這些現象被稱為醫療界的阿基里斯的足踝(the Achilles' heel)，在訓練階段的住院醫師身上最嚴重，但是這現象也擴及至主治醫師與護理人員。本文主要針對醫師睡眠剝奪與疲累的相關文獻，做系統性的回顧。睡眠不足和未有足夠休息的時間會增加疲累感，降低警覺性與認知執行的能力。在過去的30年間，有許多研究的確發現疲倦會造成種種的情緒低落，包括沮喪、焦慮、困惑、憤怒，以及車禍的危險性增加。「睡眠剝奪」對工作上的影響，就如同是「酒精中毒」一般。而連續24小時不眠的狀態下執行能力會降低，就如同血中含有0.1%的酒精濃度般低落，也相當於人吐氣酒測時酒精濃度達0.55毫克。這時的酒精濃度，駕駛人將被處以危害公共安全罪。目前大部分的報告都只發現睡眠不足會造成部分行為能力的疏失，但是仍然無法證明，睡眠不足會造成整體上醫療執行能力的障礙。因為醫療工作是需要24小時的全天性服務，但是只有限制醫師工作的總時數，並不能完全改善醫師的睡眠剝奪與疲倦的狀況。唯有根據已知的睡眠生理循環時鐘，與每個人的身體狀況，去調整合適工作時間表，和增加工作的效益，才會有明顯的效果。

關鍵字

醫師 ； 睡眠剝奪 ； 疲累

並列摘要

Sleep loss due to extended work hours and circadian disruption has long been a concern in medicine. It has been called the Achilles' heel of the medical profession. The problem is most severe for residents in training but extends to experienced physicians and nurses. In this article, we reviewed current studies and proposed policies concerning physicians' sleep loss and fatigue. Sleep loss and inadequate recovery leads to increased fatigue, decreased alertness and impaired performance in a variety of cognitive psychomotor tests. Over the past 30 years, many studies have provided unequivocal evidence that mood is worsened by fatigue, as indicated by increased scores on measures of depression, anxiety, confusion, and anger, and increased the risk of motor vehicle crashes in sleep-Sleep loss due to extended work hours and circadian disruption has long been a concern in medicine. It has been called the Achilles' heel of the medical profession. The problem is most severe for residents in training but extends to experienced physicians and nurses. In this article, we reviewed current studies and proposed policies concerning physicians' sleep loss and fatigue. Sleep loss and inadequate recovery leads to increased fatigue, decreased alertness and impaired performance in a variety of cognitive psychomotor tests. Over the past 30 years, many studies have provided unequivocal evidence that mood is worsened by fatigue, as indicated by increased scores on measures of depression, anxiety, confusion, and anger, and increased the risk of motor vehicle crashes in sleep-deprived physicians. In fact, the effect of sleep deprivation on a task that involves tracking has been shown to be equivalent to the effect of alcohol intoxication; in one study, performance of such a task after 24 hours of sustained wakefulness was equivalent to the performance with a blood alcohol concentration of 0.10 percent. Studies of simulated driving have had similar results. Despite many anecdotes about errors that were attributed to fatigue, no study has proved that fatigue on the part of health care personnel causes errors that harm patients. The problem of fatigue-related risks in medicine will not resolve simply by reducing physicians' working hours. A comprehensive strategy should include devises optimal work schedules, and increases efficiency in performing work duties.

並列關鍵字

physicians ； sleep deprivation ； fatigue