在手术室影响声学和语音清晰度的因素：手术室大小很重要
本公众号每天分享一篇最新一期Anesthesia & Analgesia等SCI杂志的摘要翻译，敬请关注并提出宝贵意见
Factors Affecting Acoustics and Speech Intelligibility in the Operating Room: Size Matters
背景与目的
卫生保健设施的噪音自1960年以来有所增加，是工作人员和患者不满的重要来源，也是患者安全的风险因素。有效沟通至关重要的手术室（ORs）特别嘈杂。语音清晰度受噪声，房间结构和声学影响。例如，声音反射时间（RT60）随着房间大小而增加，这可能会对清晰度造成负面影响，而房间本体被假设为具有相反的效果。我们通过调查我们机构的手术室的房间建设和声学来探索这些关系。
方 法
我们在手术室不使用的时候对其进行研究。 测量房间尺寸以计算房间体积（VR）。 通过估算大小并将项目分配为5个类别来估算房间内容体积，以获得调整后的房间容积（VC）。通过播放来自扬声器的扫描音和记录每个房间3个位置的脉冲响应（即，产生的声场）进行心理声学分析。录音用于计算6个心理声学指标的清
晰度。使用VR和VC作为预测变量进行多元线性回归，每个清晰度指数作为结果变量。
结 果
共研究了40个手术室。 外科手术室的特点是施工程度大，表面光洁度不均匀，尺寸从71.2到196.4立方米（平均VR = 131.1 [34.2]立方米）。 在VR和VC之间观察到微不足道的相关性（Pearson相关= 0.223，P = .166）。 多重线性回归模型拟合，并且对于每个清晰度指数，VR的β系数是非常显着的，并且对于RT60（R2 = 0.666，F（2,37）= 39.9，P <0.0001）是最好的。 对于Dmax（辅音发音衰减小于15％的最大距离），VR和VCβ系数均显着。 对于RT60和Dmax，控制VC后，部分相关分别为0.825（P <0.0001）和0.718（P <0.0001），而在控制VR后，部分相关性分别为-0.322（P = .169）和0.381 （P <0.05）。
结 论
我们的研究结果表明，OR的大小和容积可以预测语音清晰度的一系列心理声学指标。具体来说，增加OR大小与较差的语音清晰度相关，而增加的OR容积与改善的语音清晰度相关。该研究提供了有价值的描述性数据和识别可能受益于声学修饰物（例如，吸声板）的现有OR的测方法。此外，它表明在手术室设计过程中应考虑房间尺寸和预计的临床应用以优化声学性能。
原始文献摘要
Richard R. McNeer, MD, PhD,* Christopher L. Bennett, PhD,† Danielle Bodzin Horn, MD, et al. Factors Affecting Acoustics and Speech Intelligibility in the Operating Room: Size Matters.[J]. Anesth Analg 2017;124:1978–85
Abstract：INTRODUCTION: Noise in health care settings has increased since 1960 and represents a significant source of dissatisfaction among staff and patients and risk to patient safety. Operating rooms (ORs) in which effective communication is crucial are particularly noisy. Speech intelligibility is impacted by noise, room architecture, and acoustics. For example, sound reverberation time (RT60) increases with room size, which can negatively impact intelligibility, while room objects are hypothesized to have the opposite effect. We explored these relationships by investigating room construction and acoustics of the surgical suites at our institution.
METHODS: We studied our ORs during times of nonuse. Room dimensions were measured to calculate room volumes (VR). Room content was assessed by estimating size and assigning items into 5 volume categories to arrive at an adjusted room content volume (VC) metric. Psychoacoustic analyses were performed by playing sweep tones from a speaker and recording the impulse responses (ie, resulting sound fields) from 3 locations in each room. The recordings were used to calculate 6 psychoacoustic indices of intelligibility. Multiple linear regression was performed using VR and VC as predictor variables and each intelligibility index as an outcome variable.
RESULTS: A total of 40 ORs were studied. The surgical suites were characterized by a large degree of construction and surface finish heterogeneity and varied in size from 71.2 to 196.4 m3 (average VR = 131.1 [34.2] m3). An insignificant correlation was observed between VR and VC (Pearson correlation = 0.223, P = .166). Multiple linear regression model fits and β coefficients for VR were highly significant for each of the intelligibility indices and were best for RT60 (R2 = 0.666, F(2, 37) = 39.9, P < .0001). For Dmax (maximum distance where there is <15% loss of consonant articulation), both VR and VC β coefficients were significant. For RT60 and Dmax, after controlling for VC, partial correlations were 0.825 (P < .0001) and 0.718 (P < .0001), respectively, while after controlling for VR, partial correlations were −0.322 (P = .169) and 0.381 (P < .05), respectively.
CONCLUSIONS: Our results suggest that the size and contents of an OR can predict a range of psychoacoustic indices of speech intelligibility. Specifically, increasing OR size correlated with worse speech intelligibility, while increasing amounts of OR contents correlated with improved speech intelligibility. This study provides valuable descriptive data and a predictive method for identifying existing ORs that may benefit from acoustic modifiers (eg, sound absorption panels). Additionally, it suggests that room dimensions and projected clinical use should be considered during the design phase of OR suites to optimize acoustic performance. (Anesth Analg 2017;124:1978–85)
麻醉学文献进展分享
联系我们