快充式经鼻湿化高流量通气在非麻醉专业学员气管内插管培训中的应用

Application of transnasal humidified rapid-insufflation ventil￣atory exchange in endotracheal intubation training for non-anesthesia students

目的评价快充式经鼻湿化高流量通气(THRIVE)在非麻醉专业住院医师规范化培训(住培)学员气管内插管培训中的应用效果。方法选择20名非麻醉专业住培学员,根据全麻诱导操作时供氧方式分为面罩通气组(C组,n=10)和THRIVE组(T组,n=10)。选择择期行气管内插管全麻手术的患者60例随机分入C组和T组,诱导插管期C组采用面罩通气供氧,T组采用THRIVE供氧。记录患者声门暴露分级、总体插管成功例数、成功插管时间、并发症发生情况、SpO_(2)插管成功即刻低于入室基础值的例数。采用问卷调查评估学员对气管内插管操作的自信心、学习兴趣及带教满意度,采用麻醉科改良Mini-CEX和DOPS测评表评估学员理论与实践技能掌握度。结果与C组比较,T组学员总体插管成功率明显升高(P<0.05),成功插管时间明显延长(P<0.05),误入食管与SpO_(2)插管成功即刻低于入室基础值的发生率明显降低(P<0.05),学员操作的自信心、学习兴趣及带教满意度明显提高(P<0.05)。两组学员的Mini-CEX评分差异无统计学意义,而DOPS评分T组高于C组(P<0.05)。结论在全身麻醉气管插管诱导采用THRIVE供氧,可提高非麻醉专业住培学员气管内插管成功率,提高学员的自信心、兴趣、带教满意度及临床操作能力,有助于提升患者安全性。

Objective To evaluate the effect of transnasal humidified rapid-insufflation ventilatory exchange(THRIVE)in the training of endotracheal intubation for non-anesthesia residents during the induction and tracheal intubation period.Methods Twenty non-anesthesiology resident students were randomly divided into mask ventilation group(group C,n=10)and THRIVE group(group T,n=10)according to different the oxygen supply methods during general anesthesia induction.Sixty patients who underwent elective tracheal intubation under general anesthesia were randomly divided into these two groups.During the induction and tracheal intubation period,mask ventilation was used for oxygen supply in group C and THRIVE was used in group T.C-L classification of glottis exposure was recorded.The overall intubation asuccess rate,successful intubation time and complication were recorded.The incidence of SpO_(2)at successful intubation immediately after intubation lower than the baseline entry value was recorded.A questionnaire survey was conducted to assess the confidence,learning interest and teaching satisfaction of student.The improved Mini-CEX and DOPS evaluation form were used to evaluate the theoretical and practical skills of the two groups of students.Results Compared with group C,the C-L clasification of glottis exposure during endotracheal intubation in group T was significantly reduced(P<0.05),the success rate of overall intubation and the time of successful intubation was significantly pnolonged(P<0.05),the number of cases of accidental esophageal intubation was significantly reduced(P<0.05),the incidence of SpO_(2)at successful intubation immediately after intubation lower than the baseline entry value was also lower(P<0.05).Compared with group C,the operational confidence,learning interest and teaching satisfaction of group T were significantly higher(P<0.05).There was no statistical difference in MINI-CEX scores between the two groups,while DOPS score T group was superior to C group.Conclusion The use of THRIVE during the induction and tracheal intubation period could maintain patients SpO_(2)level,improve the success rate of endotracheal intubation,as well as the students confidence,interest,satisfaction and clinical skills with improved safety of patients.