基于案例学习结合情境模拟演练在恶性高热急救培训中的应用

The application of scenario simulation exercise based on case learning in the first aid training for malignant hyperthermia

目的探讨基于案例学习(case based learning,CBL)结合情境模拟演练在麻醉危机事件恶性高热(malignant hyperthermia,MH)急救培训中的应用效果。方法选取2018年9月至2023年5月北京大学第三医院麻醉科医师共45名为研究对象,采用混合区组随机的方法将其分为试验组和对照组。试验组15名医师采用CBL结合情境模拟演练,对照组30名医师采用传统讲授方式。培训后通过两组医师MH相关理论考试答题正确人数比例评价教学效果,采用t检验或χ^(2)检验进行组间比较;并通过问卷调查试验组医师对CBL结合情境模拟演练的必要性和有效性进行评价。结果试验组医师在MH快速诊断和特效药丹曲林钠规范应用2各方面答题正确的人数比例均高于对照组医师,分别为[11/15名比12名(40.0%)]和[10/15名比9名(30.0%)],其差异均具有统计学意义(均P<0.05);其他4个方面答题正确的人数比例分别为[7/15名比15名(50.0%)]、[6/15名比10名(33.3%)]、[11/15名比15名(50.0%)]和[13/15名比26名(86.7)],其差异均无统计学意义(均P>0.05)。在15名试验组医师中,15名医师均认为在MH急救培训中开展CBL结合情境模拟演练非常必要;13名医师认为培训非常有效。结论在MH急救培训中开展CBL结合情境模拟演练有助于麻醉科医师对MH快速诊断和特效药丹曲林钠规范应用,并得到医师的一致认可。

Objective To explore the application effect of case-based learning(CBL)combined with scenario simulation exercise in emergency training for malignant hyperthermia(MH)during anesthesia crisis events.Methods A total of 45 anesthesiologists from Peking University Third Hospital from September 2018 to May 2023 were selected as the study subjects.They were randomly divided into an experimental group and a control group using a mixed block randomization method.The experimental group of 15 physicians used CBL combined with scenario simulation exercise,while the control group of 30 physicians used traditional teaching methods.After training,the teaching effectiveness will be evaluated by the proportion of correct answers in two groups of MH related theoretical exams,using t-tests orχ^(2) tests for comparison between two group;and evaluate the necessity and effectiveness of CBL combined withscenario simulation exercise by conducting a questionnaire survey among the experimental group physicians.Results The proportion of physicians in the experimental group who answered correctly in the aspects of rapid diagnosis of MH and standardized application of the specific drug dantrolene sodium was higher than that of physicians in the control group,with[11/15 to 12(40.0%)]and[10/15 to 9(30.0%)],respectively,and the differences were statistically significant(all P<0.05);The proportion of people who answered correctly in the other four aspects were[7/15 to 15(50.0%)],[6/15 to 10(33.3%)],[11/15 to 15(50.0%)],and[13/15 to 26(86.7)],and the differences were not statistically significant(all P>0.05).Among the 15 physicians in the experimental group,all 15 physicians believed that it was necessary to conduct CBL combined withscenario simulation exercise in MH emergency training;13 physicians believed that the training was very effective.Conclusions CBL combined with scenario simulation exercise in MH emergency training is helpful for anesthesiologists to quickly diagnose MH and standardize the application of the specific drug dantrolene sodium,and has been unanimously recognized by physicians.