危重病例库的建立及其在麻醉教学中的应用

The establishment and application of case database of critical illness in anethesia teaching program

目的建立危重病例库并探索危重病例讨论在临床麻醉教学中的应用效果及对学生临床思维能力的影响。方法采用foxtable软件构建危重病例数据库，以ASAⅢ-Ⅴ级麻醉病例作为纳入标准，并遵循术前评估一术中管理一术后恢复的诊疗流程录入相关临床信息。采用学生问卷调查危重病例讨论教学的实施效果，并分别在本科实习医生、住院医生及研究生中对比危重病例教学与传统教学应用后病例分析题考试成绩的差异，数据分析采用t检验。结果危重病例数据库体现了真实性、层次性及前沿性的特点。调查显示，危重病例教学有助于加强理论与临床实践联系、有助于提高表达能力、有助于活跃课堂气氛并增加团结。与传统教学相比，接受危重病例教学的研究生与住院医生考试中病例分析题成绩明显高于前者，而在本科实习生中，两种教学未能体现出明显差异。结论危重病例库的建立及其在教学中的应用有效促进了麻醉住院医生及研究生的临床思维能力的提高。

Objective To establish case database of critical illness and explore the effect of critical case-based learning in the anesthesia teaching program as well as its influence on clinical thinking ability of students. Methods Case database of critical illness was built with foxtable software and ASA Ⅲ-Ⅴ patients undergoing anesthesia were included in the case database. Patients＇ information were recorded according to the sequence of pre-operative evaluation,intra-operative management and post-operative recovery. We designed a student questionnaire to investigate the effect of critical case-based learning. And we also compared the effect of critical case-based learning and traditional teaching on undergraduate interns, residents, and graduate students by scores of case analysis test. Data analysis used t test. Results The critical cases database is characterized by authenticity, hierarchy and forwardness. Survey result of questionnaire shows that the proportions of students who believe critical case-based learning helps to strengthen the links of theory and clinical practice, to improve expression skills, and to promote active classroom atmosphere, solidarity and cooperation are 80%, 71.6% and 68.3% respectively. Compared with those who received traditional teaching, the residents and graduate students who received critical case-based learning get significantly higher scores in case analysis test.However, the difference of scores between undergraduate interns receiving traditional teaching or critical case-based learning has no significance. Conclusion The establishment of critical cases database and its application in anesthesia teaching program have effectively improved clinical thinking ability of anesthesia residents and graduate students.