颈内静脉穿刺超声定位教学作用分析

Analysis of the role of ultrasound location teaching in internal jugular vein puncture

目的评估住院医师规范化培训中超声辅助颈内静脉穿刺教学的应用效果。方法28名在麻醉科规范化培训的非麻醉专业住院医师,在经过颈内静脉穿刺理论培训和模型上操作培训后,每位住院医师分别使用解剖定位法和超声定位法实施颈内静脉穿刺各1例。记录并比较两种方法首次穿刺置管成功率、总穿刺置管成功率、总穿刺置管所用时间、并发症发生率,以及问卷调查住院医师对教学的满意度和操作前的自信度。结果与解剖定位法比较,超声定位法首次穿刺置管成功率及总成功率均较高(均P<0.05);超声定位从开始定位到穿刺置管成功用时(10.2±1.1)min,解剖定位法用时(11.1±1.3)min,二者比较差异无统计学意义。解剖定位法有6例出现局部血肿,明显高于超声定位法(P<0.05)。问卷评分调查显示,住院医师对超声辅助定位下的颈内静脉穿刺置管教学方法满意度和操作自信度评分均高于解剖定位法(均P<0.05)。结论颈内静脉穿刺超声定位置管较传统解剖定位法更加安全、有效。颈内静脉穿刺超声定位教学规培住院医师满意度高,可在住院医师规范化培训中推广。

ObjectiveTo evaluate the effect of ultrasound-assisted teaching of internal jugular vein puncture instandardized training of resident physicians.MethodsTwenty-eight non-anesthesiology residents who were trained inanesthesiology department,after theoretical training and model operations of internal jugular vein puncture,underwent punctureprocedure with the method of anatomic localization and ultrasonic localization.The success rate of the first puncture,the successrate and the time of puncture procedure,the incidence of complications and the students’satisfaction with teaching,and theconfidence score before operation were recorded.ResultsCompared with the method of anatomic localization,the method ofultrasonic localization has higher success rate of first puncture catheterization and total success rate(both P<0.05).There was nosignificant difference in the time of successful puncture between the method of ultrasonic localization and anatomic localization[(10.2±1.1)min vs.(11.1±1.3)min].There were 6 cases of hematoma in the method of anatomic localization,which wassignificantly higher than that in the method of ultrasonic localization(P<0.05).Questionnaire survey showed that the scores ofteaching satisfaction and operation confidence score of internal jugular vein puncture under ultrasound-assisted localization werehigher than those of anatomical localization(both P<0.05).ConclusionThe teaching of ultrasonic localization in internaljugular vein puncture is safer and more effective than the traditional anatomic location teaching method,and the satisfaction ofresidents is high,which can be promoted in the standardized training of residents.