两种不同教学方法在麻醉医师经食道超声模拟教学中的比较

Comparison of two methods of transesophageal echocardiography simulation training

目的探讨对于没有心脏超声基础的麻醉医师预先进行经胸心脏超声(TTE)培训是否能够提高经食道心脏超声(TEE)模拟教学的效果。方法将84名没有心脏超声基础的麻醉专业医师随机分为两组:TTE+TEE组(TTE培训之后再进行TEE模拟器授课并练习)(n=41)和TEE组(直接进行TEE模拟器授课并练习)(n=43)。授课前和培训后均进行涵盖5个心脏超声相关知识点的笔试。1个月后对两组再次进行笔试考核。结果两组授课前笔试分数没有显著差别。TTE+TEE组解剖结构识别题目的分数显著高于TEE组(71.5%±18.3%vs 48.8%±18.3%,P<0.01)。临床应用题目的分数则显著低于TEE组(38.4%±8.7%vs 45.2%±14.2%,P<0.01),患者安全、探头操作、病理视频的分数没有显著差异。培训后4周的笔试中,TTE+TEE组麻醉医生切面识别(54.3%±21.8%vs 43.3%±21.2%,P<0.05)和解剖结构识别(43.3%±22.0%vs 34.0%±22.7%,P<0.05)的题目分数均较高。结论麻醉医师在TEE培训之前预先接受TTE培训,在短时间内能够更准确的识别TEE图像的解剖结构,且对切面和解剖结构的记忆更为深刻。

Objective To assess the impact of transthoracic echocardiography（TTE） skills training in Transesopha- geal endocardiography （TEE） trainees. Methods In this prospective randomized study, 84 anesthesiologists （ novice in echocardiography） were randomized into either TFE ＋ TEE group （n =41 ） or TEE group（n =43）. A standard- ized pretest was administered before the training. The trainees in TTE ＋ TEE group firstly learned TTE skills fol- lowed by simulation-based TEE training. And the trainees in TEE group only had simulation-based TEE training session. Comprehension in both groups was then assessed with a written posttest immediately after training and 4 weeks later. Results Pretest scores revealed similar knowledge among the trainees. The TTE group score is higher on eehocardiography anatomy after the training session （71.5% ± 18.3% vs 48.8% ± 18.3% ,P 〈0. 01 ;TTE ＋ TEE group versus TEE group, respectively）, but the score is lower in clinical applications （38.4% ± 8.7% vs 45.2% ± 14. 2% ,P 〈0. 01 ）. The two groups showed no difference in patient safety,probe manipulation and pathology scores. In a 4-week later test, TFE ＋ TEE group scored higher on both view identification and structure i- dentification questions. Conclusions After TTE training, the trainees may know better in echocardiography anato- my,and the memory of TEE views and structures lasted longer.