阶梯式消化内镜模拟训练在上消化道内镜初级培训中的应用

Upper gastrointestinal endoscopy primary training with a computer-animal-clinic Sequential train-ing model：a randomized controlled trial

目的：探讨阶梯式消化内镜模拟训练在上消化道内镜初级培训中的作用。方法2013年4月至2014年8月，参加首都医科大学附属北京友谊医院上消化道初级内镜培训班的进修医师共51名，随机分成两组，即内镜计算机模拟-动物模拟-实际操作的阶梯式训练组和模拟内镜训练组。第1周，全体学员观摩胃镜操作的同时，接受至少10 h的上消化道内镜计算机模拟训练，而阶梯式训练组在此期间接受2d活体动物（猪）的上消化道胃镜检查培训。第2周，全体学员在指导教师监督下对临床患者进行胃镜操作。比较两组胃镜操作的成功率、操作时间及患者的不适程度等指标，应用SPSS 11.5行两样本t检验或χ2检验。结果阶梯式内镜训练组（n＝26）与模拟内镜训练组学员（n＝25）相比，在插入食管成功率（81.5%vs.71.6%）、通过幽门成功率（58.5%vs.48.4%）、进入十二指肠降段成功率（47.3%vs.36.8%）、成功插入降部者的平均操作时间[（8.15±2.48） min vs.（10.44±3.02） min]及受检者的不适反应评分[（4.82±1.68）分vs.（6.53±2.85）分]等方面，表现更为理想，且组间差异有统计学意义（P〈0.05）。结论阶梯式训练方式更有助于初学者掌握上消化道内镜操作技巧，缩短教学时间，减轻患者不适反应。

Objective To discuss the value of computer-animal-clinic sequential training model in upper gastrointestinal endoscopy primary training. Methods From Apr 2013 to Aug 2014, fifty one trainee doctors were randomly assigned to two groups for a upper gastrointestinal endoscopy training： computer-animal-clinic sequential training group and computer simulator group. In the first week, both groups under-went at least 10 hours of training with a computer-based simulator, and another 2 days animal simulator training for sequential training group only. In the second week, students of both groups carried out the op-eration of endoscopic operation. The success rate, operation duration and comfort of both groups were com-pared using SPSS 11.5, t test for the average of two samples, χ2 test for the ratio of two samples. Results Differences between the computer-animal-clinic sequential training group （n=26） and computer simulator group （n=25） were significant for esophageal intubation （81.5% vs. 71.6%）, pyloric intubation （58.5% vs. 48.4%）, intubation of the descending part of the duodenum （47.3%vs. 36.8%）, procedure duration [（8.15± 2.48） min vs. （10.44 ±3.02） min] and degree of comfort [（4.82 ±1.68） vs. （6.53 ±2.85）]. The sequential training group was much better in performance than the other group in upper gastrointestinal endoscopy training （P〈0.05）. Conclusion Computer-animal-clinic sequential training model are effective in trainees＇ grasping the skills needed for upper gastrointestinal endoscopy, reducing the teaching times and alleviating the uncomfortable of patients.