床旁超声心动图于围术期麻醉管理的培训探索

Investigation of point-of-care transthoracic echocardiography education in perioperative anesthetic management

目的针对床旁经胸超声心动图(POC-TTE)在围术期应用的需求及培训方法、效果进行初步研究。方法北京协和医院麻醉科于2013年在全科40位主治医师及以上职称的麻醉医生中开展两轮经胸超声心动图(TTE)培训;2014年,在心脏内科专业医师指导下对6位有经食道超声心动图(TEE)临床经验的麻醉医师进行了TTE师资培训。2015年,以发放问卷的形式对POC-TTE潜在学员进行问卷调查,并基于调查结果在2015—2017年连续3年开设围术期TTE教学活动。采用理论讲解与模拟器练习相结合,并辅以低血压诊疗思路讲解等方式,并对不同教学方法的学习成果进行考核。结果 95位学员中,有15位(15.8%)调查对象表示所在医院有开展围术期POC-TTE检查的基础,有14位(14.7%)在此前有过基本的超声学及影像学基础知识;80位(84.2%)对TTE的围术期应用尚缺乏基本的认知。3年间,共计举办POC-TTE培训4次,培训学员83人。48%的学员认为需加强操作机会;39%的学员认为要加强超声心动图基础知识的培训;另外有22.5%的学员认为应该增加培训频率,定期开展并定期考核。结论北京协和医院麻醉科开展的POC-TTE实践包括理论基础、模拟演练以及重症临床思路教学模式有助于围术期POC-TTE在麻醉领域的开展。进一步开展围术期POC-TTE教学对于麻醉管理及患者安全均可能产生积极的影响。

Objective To investigate the need,methods and effects training on perioperative point-of-care transthoracic echocardiography（ POC-TTE） in anesthesiologists. Methods In 2013,forty anesthetic attendings of Pecking Union Medical College Hospital（ PUMCH） had two rounds of transthoracic echocardiography（ TTE）training. In the following year,six anesthetic attendings from PUMCH experienced in intraoperative transesophageal（ TEE） were trained by cardiologists as TTE instructors. In 2015,we conducted a survey about basic TTE education prevalence and need. Based on the results of the survey,POC-TTE workshops were hosted from 2015 to 2017. The didactic lecture,simulation practice,as well as hypotension differential diagnosis were included in those workshops. Different teaching methods were tested for their effectiveness. Results A total of 95 surveyswere collected. Fifteen（ 15. 8 %） participants reported their hospital had the resources for perioperative P OCTTE exams; fourteen（ 14. 7 %） reported basic knowledge about ultrasound or other images techniques. Eighty（ 84. 2%） acknowledged a lack of understanding about perioperative TTE. Four rounds of POC-TTE workshops were hosted by the anesthesia department of P UMCH and a total of 83 trainees participated. Sixty three participants finished all training and testing sessions. Forty eight percent of the participants voiced the need for more hand-practice opportunities,39 % suggested that training covering more basic ultrasound knowledge,22. 5 % suggested more frequent training and testing. Conclusions These training methods may increas the prevalence and acceptance of perioperative P OC-TTE application. It＇s learning outcome has positive impact on patients＇ prognosis.