超声预定位提高住培生CVC技术改善焦虑的研究

The Study of Pre-procedure Ultrasound on Improving CVC Skill and Alleviating Anxiety Among Residents

目的本研究拟探讨超声预定位法对提高重症医学科住培学员中心静脉置管(central venous catheterization,CVC)操作水平及缓解术前焦虑自评量表(self-rating anxiety scale,SAS)评分的效果。方法纳入西安交通大学第一附属医院重症医学科无CVC置管经验的住培学员100名,随机分成对照组(n=50名,利用传统体表解剖标志确定CVC穿刺点)和超声预定位组(n=50名,利用超声预定位法确定CVC穿刺点),比较两组学员CVC置管时间、试穿刺次数、求助上级医师率、并发症发生率及置管前焦虑评分。结果超声预定位方法可以显著缩短住培学员CVC置管时间(5.12±2.94)分钟vs.(3.50±1.81)分钟,P<0.05,减少试穿次数(1.80±0.73)次vs.(1.32±0.59)次,P<0.05,降低上级医师求助率(78%vs.52%,P<0.05),同时改善焦虑SAS评分(22.00±7.04)分vs.(17.18±5.23)分,P<0.05。结论使用超声预定位法进行CVC置管,可以提升住培学员中心静脉置管术的操作水平,降低学员术前焦虑SAS评分,具有较好的教学效果。

Objective To explore whether the pre-procedure ultrasound method can improve the skill of central venous catheterization(CVC)and alleviating self-rating anxiety scale(SAS)among ICU residents.Methods A total of 100 ICU residents without experience of CVC from the First Affiliated Hospital of Xi’an Jiaotong University were recruited to this study and randomly divided into two groups:control group(n=50,the insert site of CVC was confirmed by traditional landmark),pre-procedure ultrasound group(n=50,the insert site of CVC was confirmed by the guide of pre-procedure ultrasound method).The demographic data,insertion time,attempt cannulation rate,rate of seeking help for physicians,complication rate and self-rating anxiety scale(SAS)of the two groups were recorded and compared.Results There was no difference in demographic data,including age,gender,training years and education information between two groups.The attempt cannulation rate(1.80±0.73)times vs.(1.32±0.59)times,P<0.05,insertion time(5.12±2.94)mins vs.(3.50±1.81)mins,P<0.05 and rate of seeking help for physicians(78%vs.52%,P<0.05)in pre-procedure ultrasound group were significantly lower than that in control group,P<0.05.Furthermore,the SAS in pre-procedure ultrasound group were remarkably lower than that in control group(22.00±7.04)scores vs.(17.18±5.23)scores,P<0.05.Conclusion The pre-procedure ultrasound method can significantly improve the CVC skill of ICU residents and alleviate the anxiety score,which is helpful to train resident to enhance clinical skill.