韧性是否与麻醉专业人员的应激反应相关？一项基于前瞻性模拟的研究

摘要(中文译文)

麻醉学是一个压力很高的专业，从业者职业倦怠发生率较高。心理弹性（resilience）被定义为面对逆境时积极适应的动态过程，可能作为一种保护性因素发挥作用。然而，心理弹性与急性应激反应之间的关系仍知之甚少。本研究旨在检验以下假设：在标准化麻醉危机模拟中，较高的心理弹性水平与减弱的生理和心理应激反应相关。研究对象包括麻醉科医师、麻醉科住院医师、麻醉护士和麻醉护士学生。心理弹性采用Connor-Davidson心理弹性量表（CD-RISC 10，范围0-40）进行测量。参与者接受高仿真小儿喉痉挛模拟。分析了对急性应激的生理反应（心率变异性）和心理反应（自我报告的应激）。共纳入34名专业人员。心理弹性评分中位数为29 [27-32]，范围为18至34。心理弹性与急性应激的生理反应（p = 0.085）或心理反应（p = 0.621）之间未发现显著关联。心理弹性与年龄、工作年限或专业角色无关。心理弹性评分与其他研究报告的评分相当。心理弹性与急性应激反应之间未观察到显著关联。这些发现与将心理弹性概念化为长期适应过程而非对压力的即时反应的理论框架相一致。因此，直接测量心理弹性可能比依赖可观察的应激反应更适合识别处于社会心理风险中的专业人员。未来需要采用纵向设计和更大样本的研究来阐明这些关系。

Abstract

Anesthesiology is a stressful specialty characterized by high rates of burnout among its practitioners. Resilience, defined as a dynamic process of positive adaptation in the face of adversity, may serve as a protective factor. However, the relationship between resilience and the acute stress response remains poorly understood. This study aimed to test the hypothesis that higher resilience levels would be associated with attenuated physiological and psychological stress responses during a standardized anesthetic crisis simulation. Participants included anesthesiologists, anesthesiology residents, nurse anesthetists, and nurse anesthetist students. Resilience was measured using the Connor-Davidson Resilience Scale (CD-RISC 10, range 0-40). Participants underwent a high-fidelity pediatric laryngospasm simulation. Physiological (heart rate variability) and psychological (self-reported stress) responses to acute stress were analyzed. Thirty-four professionals were included. The median resilience score was 29 [27 -32], ranging from 18 to 34. No significant association was found between resilience and physiological (p = 0.085) or psychological (p = 0.621) responses to acute stress. Resilience was not related to age, years of experience, or professional role. Resilience scores were comparable to those reported in other studies. No significant association was observed between resilience and the acute stress response. These findings are consistent with theoretical frameworks that conceptualize resilience as a long-term adaptation process rather than an immediate reaction to stress. Direct measurement of resilience may therefore be more appropriate than relying on observable stress responses to identify professionals at psychosocial risk. Future studies using longitudinal designs and larger samples are needed to clarify these relationships.

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