积极情绪对青年医师白内障超声乳化手术学习的影响

The effect of positive emotion on residents’ learning performance of phacoemulsification

目的：探讨在白内障超声乳化手术的学习中，积极情绪对学员手术掌握程度、并发症的发生及术后效果的影响。方法以2009年7月至2010年3月参加北京大学眼科中心的白内障超声乳化手术（以下简称超声乳化手术）的理论和实践技能培训的12名学员为研究对象。将12名学员随机分为实验组和对照组。对照组采用传统的理论讲解、观摩手术、动物实验和分阶段临床实践的方案进行学习；实验组在传统培训方案的基础上，着重对学员实施积极情绪的培养，以提高其手术中预防和处理并发症的心理适应能力及促进其对手术技能的掌握。培训结束后对实验组学员的心理干预效果、两组学员的手术并发症的发生及手术术后效果进行评估。对比分析两组学员的心理问卷得分、术后效果及手术常见并发症的发生率。结果两组学员经过培训后，都能够掌握超声乳化手术的基础理论知识及手术基本操作步骤，经过分阶段临床实践后，均具备独立完成超声乳化手术的能力。经过心理干预后，实验组学员的情感平衡量表与焦虑自评量表得分较干预前显著提高（P〈0.05）；前60例手术中各类并发症的发生例数实验组学员均少于对照组学员，其中切口并发症及前囊膜撕裂2项，两组的差异具有统计学意义（P〈0.01）；实验组手术后1周裸眼视力及最佳矫正视力均好于对照组，差异具有统计学意义（P〈0.01）；两组学员的有效超声乳化手术时间及超声能量，对照组学员小于实验组学员，其差异有统计学意义（P〈0.01）。结论积极情绪有利于缩短白内障超声乳化手术技术的学习过程、减少手术并发症的发生及改善手术效果。

Objective To investigate the effect of positive emotions on operative skills and the related complications of phacoemulsication cataract surgeries at an early learning stage. Methods From Jun 2009 to Mar 2010,12 fellow students who took part in cataract surgery training program were divided into two groups （experimental group and control group）. The training course included attending lectures （theoretical study）, observing surgery, animal experiments and clinical practices, respectively. The 6 students in control group followed the classic training course while the other six in experimental group （were trained with the advanced course which laid emphasis on cultivating positive emotions. We use affect balance scale（ABS）and self-rating anxiety scale（SAS）to evaluate the effect of psychological inter-vention. Then ABS and SAS scores, the rates of major complications and surgical outcomes of the first 60 cases were recorded and compared. The data analyzed included peroperative and postoperative complications,the effective phaco time and the energy of the surgeries, postoperative visual acuity （1 week） and best corrected visual acuity （ BCVA） （1 week）. Results With the learning of lectures,＆amp;nbsp;observing surgery and animal experiments,all fellow students mastered the basic operating principles. After the clinical practices, all of them could complete the phacoemulsication cataract surgery independently. Significant differences were found between the 2 groups concerning to incision complication and CCC failure （P〈0. 05）. Posterior capsula rupture of experimental group was lower than that of control group, but didn’t reach significance （P〉0. 05）. Postoperative visual acuity and BCVA of experimental group was significantly better than control group （ P〈 0. 01,P〈0. 01）. Conclusions Phacoemulsification could be a safe procedure when learning step by step. Positive emotions are beneficial to shorten the learning curve of the surgery and facilitate the successful transition to phacoemul-sification.