中国麻醉医生超声引导下椎管内穿刺技术的临床应用与培训需求调查

A survey of the clinical application and training requirements of ultrasound-guided intraspinal puncture for Chinese anesthesiologists

目的 调研中国麻醉医生对于超声引导椎管内穿刺技术的认知、临床应用与培训需求。方法 调查对象为我国麻醉科临床医生,采用自主设计的调查问卷,调查时间为2023年10月~11月,通过微信平台发送调查问卷。问卷主要分为3部分,一般人口学信息、椎管内穿刺的应用情况、超声引导下椎管内穿刺的应用情况和对超声引导下椎管内穿刺技术的培训需求。采用有序Logistic回归分析影响因素。结果 共回收1 001份问卷,有效问卷回收率为94.2%(942/1 001)。所有调查对象对于超声引导下技术的了解程度分别为3.21±1.03,在临床中对超声引导下技术的应用情况为2.43±1.25(P<0.01)。有序Logistic回归分析显示,主任医师(OR=0.312,95%CI 0.117~0.829,P=0.019)、男性(OR=0.658,95%CI 0.511~0.846,P=0.001)、中部地区(OR=0.690,95%CI 0.523~0.911,P=0.009)和椎管内麻醉比例<20%(OR=0.426,95%CI 0.200~0.905,P=0.026)与对超声引导下椎管内穿刺的了解情况呈明显负相关。调查人员认为,超声引导下椎管内穿刺目前在临床开展的主要困难是对技术不熟悉(83.9%)和设备问题(54.6%)。超声引导下椎管内穿刺的主要技术难点是寻找正确切面(69.6%)、识别解剖结构(69.2%)和超声成像质量差(63.0%)。未来更希望接受的超声引导下椎管内穿刺培训形式是模拟教学(87.4%)和基于病例的临床实践指导(90.0%)。结论 我国麻醉医生对于超声引导下椎管内穿刺技术的了解和应用情况仍有较大提升空间,未来可对我国麻醉医生开展更多超声引导下椎管内穿刺的针对性培训。

Objective To investigate the knowledge,clinical application and training needs of Chinese anesthesiologists for ultrasound-guided intrathecal puncture technique.Methods The survey objects were anesthesiology clinicians in China.The questionnaire was designed by ourselves,and the survey time was from October to November 2023.Questionnaires were sent through wechat platform.The questionnaire was divided into three parts:general demographic information,application of intraspinal puncture,application of intraspinal puncture under ultrasound guidance,and training needs for intraspinal puncture under ultrasound guidance.The influencing factors were analyzed by ordered Logistic regression.Results A total of 1001 questionnaires were collected with a valid ratio was 94.2%(942/1001).The respondents’knowledge of ultrasound-guided intrathecal puncture was 3.21±1.03,while the clinical application level was 2.43±1.25(P<0.01).According to ordinal logistic regression analysis,senior doctor(OR=0.312,95%CI 0.117-0.829,P=0.019),male(OR=0.658,95%CI 0.511~0.846,P=0.001),central region(OR=0.690,95%CI 0.523-0.911,P=0.009)and percentage of neuraxial anesthesia less than 20%(OR=0.426,95%CI 0.200-0.905,P=0.026)were significantly negatively correlated with the knowledge of ultrasound-guided intrathecal puncture technique.The main obstacle for the clinical application was unfamiliarity of the technique(83.9%)and the equipment(54.6%).The key technical challenges were finding the correct ultrasound views(69.6%),recognizing anatomical structures(69.2%)and poor ultrasound imaging(63.0%).The preferred training methods were simulation training(87.4%)and clinical instruction based on cases(90.0%).Conclusion There is still room for improvement in the understanding and clinical application of ultrasound-guided intrathecal puncture technique for the Chinese anesthesiologists.In the future,more training on ultrasound-guided intrathecal puncture technique could be provided according to our survey.