脑死亡判定标准与技术规范培训分析:经颅多普勒超声确认试验

Analysis on the training effect of criteria and practical guidance for determination of brain death: transcranial Doppler

目的对脑死亡经颅多普勒超声（TCD）确认试验培训效果进行分析,以改进和完善脑死亡判定标准与技术规范培训。方法采用理论培训、模拟技能培训、床旁技能培训和考核后培训的方式对106名学员进行TCD确认试验培训与考核。单因素和多因素后退法Logistic回归分析筛查学员性别、年龄、专科类别、专业岗位、专业技术职称和医院级别对试卷考核错误率的影响。结果 106名学员中30~49岁占77.36%（82/106）,主要来自三级甲等医院（96.23%,102/106）的神经内科（64.15%,68/106）和超声科（19.81%,21/106）,其中医师占77.36%（82/106）,高级和中级职称分别占32.08%（34/106）和46.23%（49/106）。6项知识点考核总错误率为7.26%（149/2052）,由高至低依次为参数设置9.43%（10/106）、检查部位8.73%（37/424）、血管识别8.67%（43/496）、结果判定7.41%（55/742）、设备要求1.89%（2/106）和注意事项1.12%（2/178）。单因素和多因素Logistic回归分析显示,专科类别（OR=1.313,95%CI：1.072~1.610;P=0.009）和医院级别（OR=2.943,95%CI：1.623~5.338;P=0.000）是导致试卷考核错误率高的独立危险因素。结论不同受训学员对知识点的掌握程度存在差异,学员基本特征影响培训效果,应依据重点和难点不断改进培训方案,以使更多的学员能够胜任脑死亡判定工作。

ObjectiveTo analyze the training effects of transcranial Doppler（TCD） for brain deathdetermination conducted by Brain Injury Evaluation Quality Control Centre of National Health and FamilyPlanning Commission to optimize the training program and improve the training effects.MethodsA totalof 106 trainees received theoretical training, simulation skill training, bedside skill training and test analysison TCD confirmatory test for brain death determination. The composition of trainees was analyzed and theerror rates of 6 knowledge points were calculated. Univariate and multivariate backward Logistic regressionanalyses were used to analyze the influence of factors including sex, age, specialty, professional category,professional qualification and hospital level on the error rates.ResultsThe trainees including 42 malesand 64 females, came from 69 hospitals. Trainees of 30-49 years old occupied 77.36%（82/106）. In thetrainees, 96.23%（102/106） were from third grade, grade A hospitals, and most of them were fromDepartment of Neurology（64.15%, 68/106） and Ultrasound（19.81%, 21/106）. There were 82 clinicians（77.36%）. Thirty four（32.08%） trainees had senior certificate and 49（46.23%） had intermediate certificate.Total error rate of 6 knowledge points was 7.26%（149/2052）. Of the 6 knowledge points, the error rate ofparameter setting was the highest（9.43%, 10/106）, followed by checking position（8.73%, 37/424）, arteryrecognition（8.67%, 43/496）, result determination（7.41%, 55/742）, equipment（1.89%, 2/106） and pitfalls（1.12%, 2/178）. Univariate and multivariate Logistic regression analyses showed that specialty（OR = 1.313,95% CI： 1.072-1.610; P = 0.009） and hospital level（OR = 2.943, 95% CI： 1.623-5.338; P = 0.000） wereindependent risk factors associated with high error rates.ConclusionsAmong the trainees, degree ofmastering the knowledge points is different, and the characteristics of trainees influence the training effect.The training program should be optimized according to key and difficult points to make more and moretrainees qualifying for TCD confirmatory test in brain death determination.