模拟培训在超声引导区域麻醉教学中的应用

Application of simulation-based training in the ultrasound-guided regional anesthesia teaching program

目的探讨模拟培训在超声引导区域麻醉教学中的应用效果。方法将2019年11月至2020年10月在北京大学附属第一医院进行住院医师规范化培训的30名麻醉科学员分为试验组和对照组,每组15名学员。试验组采用传统教学联合模拟培训,对照组采用传统教学方式。教学效果评价包括理论考核、解剖绘图评分、模特超声图像获取及解剖结构识别的熟练度评分、单纯神经识别评分和猪肉模型超声引导下靶区穿刺。主要观察指标是猪肉模型靶区穿刺时间。考核评分等组间比较采用t检验或秩和检验。结果试验组学员猪肉模型靶区穿刺时间短于对照组[188.0(53.5)秒比219.0(70.5)秒],试验组学员错误累积评分总和低于对照组[5.5(4.5)分比10.0(8.5)分],其差异均具有统计学意义(P值分别为0.006和0.001)。试验组学员解剖绘图、超声图像获取及解剖结构识别熟练度和单纯神经识别评分均高于对照组[(33.8±5.4)分比(28.5±6.1)分,(37.8±5.9)分比(24.5±7.4)分,(7.1±1.9)分比(4.6±2.3)分],其差异均具有统计学意义(均P<0.05)。结论模拟培训有助于提高麻醉科学员超声引导区域麻醉的技巧和能力。

Objective To evaluate the effectiveness of simulation-based training in the ultrasound-guided regional anesthesia teaching program.Methods This prospective assessor-blind randomly controlled trial was conducted in the hospital from November 2019 to October 2020.Thirty anesthesia trainees from clinical rotation program of anesthesiology residence training project were randomly divided into workshop group(WG)or the control group(CG)for pre-technical procedure training on UGRA.Following didactic lectures,simulation-based workshops were performed only for the WG.All trainees were assessed by written examination,ultrasound scanning and anatomy recognition in human body and ultrasound-guided target injections into pork mass.The scores of examination,drawing anatomy,the sonographic proficiency,nerve recognition and the time taken to perform the injections as well as the errors were all recorded and analyzed.Difference of measurement data was compared by t-test or rank-sum test.Results The simulation-based training program significantly decreases the time taken for target injections in the WG as compared with that in the CG[188.0(53.5)s vs.219.0(70.5)s,P=0.006].The total errors score was lower in WG than in CG[5.5(4.5)vs.10.0(8.5),P=0.001].The drawing anatomy score(33.8±5.4 vs.28.5±6.1),sonographic proficiency score(37.8±5.9 vs.24.5±7.4)and the nerve recognition score(7.1±1.9 vs.4.6±2.3)were all higher in the WG than that in the CG(all P<0.05).Conclusions For anesthesia trainees,the simulation-based training program can improve the UGRA skills and support the building of clinical competence.