基于人体工程学的人工心肺机改造及其对灌注师工作负荷视觉模拟评分的影响

Modification of the heart-lung machine based on ergonomics and its effect on visual analogue score of perfusionists'workload

目的探讨基于人体工程学的人工心肺机(HLM)改造及评价其临床应用。方法2022年1月1日对本中心4台StockertV型HLM基于人体工程学特点进行个性化改造并投入使用,回顾性分析在2021年1月至2022年7月期间南方医科大学南方医院心脏外科共899台心肺转流(CPB)手术资料,按改造前后分为对照组(n=531)和改良组(n=368),于每台手术结束后使用视觉模拟评分量表(VAS)评估并记录灌注师在身体负荷、精神负荷、信息获取负荷及沟通需求负荷水平(分值由0分至10分,分值越低表示负荷程度越低),比较两组4个维度的VAS评分,使用机器学习XGBoost法对其进行重要度排序分析改造后对4个维度的影响程度。结果两组患者人口学资料、手术类型、CPB时间、主动脉阻断时间等比较无统计学差异(均P>0.05),VAS评分比较发现改良组在身体负荷[4.40(3.40,5.80)分vs.6.20(4.20,7.70)分],精神负荷[4.00(2.80,4.90)分vs.5.70(3.50,7.40)分]、信息获取负荷[4.80(3.00,5.70)分vs.6.10(4.00,7.30)分]、沟通需求负荷[4.50(3.30,5.60)分vs.6.20(4.20,7.70)分]均显著低于对照组(均P<0.05),XGBoost法分析重要度排序依次为沟通需求负荷、信息获取负荷、精神负荷、身体负荷,CPB相关轻微不良事件的发生率也较对照组低。结论基于人体工程学改造HLM有利于改善灌注师术中沟通、提升信息获取能力,减轻精神及身体负荷,值得临床推广。

Objective To investigate the modification of heart-lung machine(HLM)based on ergonomics and evaluate its clinical application.Methods On January 1,2022,four HLM(Stockert V)were personalized modified based on ergonomic design and put into use in our center.The data of 899 cardiac surgeries under cardiopulmonary bypass in Department of Cardiac Surgery,Nan⁃fang Hospital,Southern Medical University from January 2021 to July 2022 were retrospectively analyzed.Cases were divided into Con⁃trol group(n=531)and Modified group(n=368)according to the application of the modified HLM or not.Subjective feelings of the physical load,mental load,information demand load and communication demand load were assessed with the Visual Analogue Scale(scores ranged from 0 to 10,where 0 indicated the least severe and 10 indicated the most severe)after each surgery.The VAS scores of the four dimensions were compared between the two groups and the importance of them was ranked by XGBoost method.Results There was no significant difference in demographic data,type of surgery,cardiopulmonary bypass time,aortic cross-clamp time between the two groups(all P>0.05).The VAS score of the Modified group showed that the physical load 4.40(3.40,5.80)vs.6.20(4.20,7.70),men⁃tal load 4.00(2.80,4.90)vs.5.70(3.50,7.40),information demand load 4.80(3.00,5.70)vs.6.10(4.00,7.30),communication de⁃mand load 4.50(3.30,5.60)vs.6.20(4.20,7.70)were significantly lower than those of the Control group(all P<0.05).The order of importance by XGBoost analysis was communication demand load,information demand load,mental load,physical load respectively.Conclusion The ergonomic modification of the heart-lung machine is beneficial to improve the intraoperative communication,improve the ability of information acquisition,and reduce the mental and physical load of perfusionists,which is worthy of clinical promotion.