支气管内窥镜训练系统在电子软镜插管教学中的应用

Application of the bronchoscope training system in the teaching of electronic flexible endoscope-guided intubation

目的评估支气管内窥镜训练系统在电子软镜插管教学中的效果,并拟合在该系统上行软镜操作的学习曲线,为软镜训练设置合理的学习终点提供理论依据。方法选取我院2019-01/2020-03期间轮转的30名麻醉专业住院医师规范化培训学员(简称“住培学员”)采用随机数字表法,分为试验组和对照组,每组15名。两组学员均先进行电子软镜插管的理论知识培训,随后对照组学员观摩带教老师对患者实施电子软镜插管5例,并在带教老师指导下,完成5例全麻非困难气道患者的电子软镜插管。试验组学员则在带教老师的指导下,使用支气管内窥镜训练系统完成30次软镜模拟训练,记录每次训练的操作时间,拟合学习曲线。完成培训后,2组学员均采用模拟人头进行5次(N1、N2、N3、N4、N5)软镜操作考核,比较2组学员的操作时间及熟练度评分。结果与对照组比较,试验组学员操作时间短,熟练度评分高,差异有统计学意义(P<0.05);对照组学员自N2次考核后操作时间随着操作次数增加而减少(P<0.05),与N1比较,N3、N4、N5熟练度评分高(P<0.05),与N2、N3比较,N4、N5熟练度评分高(P<0.05)。试验组学员在支气管内窥镜训练系统上模拟软镜操作26(23,27)次后,操作时间基本稳定在90(82,101)s,达到专业级水平。结论使用支气管内窥镜训练系统对麻醉专业住培学员行电子软镜插管训练,安全、高效,且训练26次后可达到学习目标。

Objective To evaluate the effect of the bronchoscope training system in the teaching of electronic flexible endoscope intubation,and fit the learning curve of the flexible endoscope operation on the system,which could provide a theoretical basis for setting a reasonable learning end point for flexible endoscope training.Methods There were 30 anesthesia residents in our hospital during the period from January 2019 to March 2020 enrolled as the study by the random number table method,which were divided into the experimental group(n=15)and the control group(n=15).The residents in the two groups were first trained in the theoretical knowledge of electronic flexible endoscope intubation,then the control group members was taught by the teacher about 5 cases of the implementation of electronic flexible endoscope intubation on patients by watching.Afterwards,they completed the electronic flexible endoscope intubation of 5 cases of patients with non-difficulty airway in general anesthesia status under the guidance of the teacher.The residents in the experimental group used the bronchoscope training system to complete 30 times of flexible endoscope simulation training with the guidance of the teacher,the operating time of each training was recorded,and the learning curve was fitted.After the training,the two groups of residents performed 5 times(N1,N2,N3,N4,N5)of flexible endoscope operation assessment respectively by using the simulated human heads.The operation time and proficiency score of the two groups were compared.Results Compared with the control group,the residents in the experimental group had shorter operating time and higher proficiency scores,with the statistically significant difference(P<0.05);the operating time of the residents in the control group decreased with the increase in the number of operations after N2 assessments(P<0.05).Compared with N1,the proficiency scores of N3,N4 and N5 were higher(P<0.05).Compared with N2 and N3,the proficiency scores of N4,N5 were higher(P<0.05).After the residents in the experimental group simulated the flexible endoscope operation 26(23,27)times on the bronchoscope training system,the operation time was basically stable at 90 s(82 s,101 s),which had been reaching the professional level.Conclusion It is safe and efficient to use the bronchoscope training system to train anesthesia residents for electronic flexible endoscope intubation,and the learning goal can be achieved after 26 times of training.