可视化超声技术提高蛛网膜下腔穿刺教学质量的探索

Application of visualized ultrasonic technique in improving the quality of subarachnoid puncture teaching

目的探讨可视化超声技术在蛛网膜下腔穿刺教学中的应用和效果。方法选取2017-09/2018-12期间在我院麻醉科进行医师规范化培训的住院医师20名,均未对患者实施过蛛网膜下腔穿刺,随机分为盲探组(n=10)和超声组(n=10),选取拟实施下肢骨科手术的患者200例,年龄18~55岁,体质量指数(BMI)21~26kg/m^2,ASA分级Ⅰ或Ⅱ级,随机分配到上述2组进行蛛网膜下腔穿刺,每组100例患者,各组中每名住院医师随机分配10例患者进行蛛网膜下腔穿刺。盲探组中住院医师通过脊柱解剖进行定位后盲探穿刺,超声组中住院医师在超声引导定位后进行穿刺。记录2组住院医师穿刺定位准确率、穿刺时间、穿刺次数、进针深度、首次穿刺成功率,并统计术中疼痛、术后腰疼及神经刺激征象发生率。穿刺结束后2组住院医师对解剖知识掌握度、操作难度、操作自信心、学习积极性、教学效果进行评价和评分。结果与盲探组比较,超声组中住院医师穿刺定位准确率和首次穿刺成功率均增高(P<0.05),穿刺时间、穿刺次数、术中疼痛和术后腰疼发生率均明显降低(P<0.05),2组住院医师穿刺进针深度及神经刺激征象组间比较差异无统计学意义。超声组中住院医师对相关教学评分明显优于盲探组(P<0.05)。结论在可视化超声技术的引导下,可以明显提高初学者蛛网膜下腔穿刺的成功率,有效减少穿刺相关并发症,学生的操作自信心和学习积极性显著增强,有利于提升临床教学效果。

Objective To investigate the application and effect of visualized ultrasonic technique in teaching subarachnoid puncture.Methods Twenty residents under standardized training in the department of anesthesiology in the First Affiliated Hospital of Army Medical University from September 2017 to December 2018,whom had not performed subarachnoid puncture,were included and randomly divided into blind detection group ( n =10) and ultrasound group ( n =10).Two hundred cases of patients with lower extremity orthopedic surgery,aged 18 to 55 years,with body mass index 21-26 kg/m^2,American Society of Anesthesiologists physical status Ⅰ or Ⅱ,were randomly assigned to the above two groups for subarachnoid puncture averagely.Every 10 patients were randomly assigned to one of ten residents for subarachnoid puncture.In the blind detection group,residents performed puncture operation without ultrasound guided localization.In the ultrasonic group,residents performed puncture operation after ultrasound guided localization.The puncture time,number of puncture,the needle depth,the success rate of first puncture,accuracy of localization,intraoperative pain,postoperative lumbago,and the incidence of nerve stimulation signs were recorded.After the puncture has been carried out,the proficiency of anatomical knowledge,operation difficulty,self-confidence of operation,learning motivation,teaching effect were evaluated and graded by residents of both groups.Results Compared with blind detection group,the success rate of first puncture and accuracy of localization were increased in ultrasound group ( P <0.05),the puncture time,number of puncture,intraoperative pain,postoperative lumbago were significantly lower ( P <0.05).There were no significantly differences in the depth of the needle and the nerve stimulation signs between two groups.The scores of teaching in the ultrasound group was significantly higher than that in the blind detection group ( P <0.05).Conclusion Under the guidance of visualized ultrasonic technique,the success rate of subarachnoid puncture can be significantly improved for beginners,and puncture related complications can be effectively reduced.Students' operational confidence and learning enthusiasm are significantly enhanced,which is conducive to improve clinical teaching effect.