情景模拟教学在成人未预料困难气道培训中的作用研究

A study of the effect of mannequin training on management of unanticipated difficult airway

目的 探讨情景模拟训练对培养麻醉科住院医师处理未预料困难气道能力的作用.方法 将30名麻醉科高年住院医师随机分为两组(E,T),每组各15人.使用高仿真模拟人设计无法插管可以通气(can't intubate can oxygenate,CI)和无法插管无法通气(can't intubate can't oxygenate,CICO)两种未预料困难气道的模拟情景.E组分别在理论培训前和培训后第2、4、6个月进行情景模拟训练,T组则于理论培训后当日和培训后第2、6个月进行相同的情景模拟训练.对照标准操作流程,依据事先制定的评价指标对两组受训者的表现予以记录.应用SPSS 23.0,使用t检验、M-W检验和x2检验对两组间数据差异进行比较.结果 在CI测试中,培训当日T组置入双管喉罩或经可插管喉罩的成功率高于E组(87％vs.55％,P=0.037);随着时间推移和后期情景模拟训练,该能力保持稳定没有降低.两组受训者接受理论培训的先后差异,未对情景模拟训练中低氧血症发生次数和低氧血症持续时间造成显著影响.在CICO测试中,T组经环甲膜切开置管的各项指标与E组比较,均有显著提高(P<0.05);随时间推移,T组切开环甲膜的耗时逐渐增加,置管成功率逐渐下降,而E组这种技术衰退并不明显.结论 情景模拟训练可显著提高麻醉科住院医师面对未预料困难气道时采取正确应对措施的能力,显著缩短受培训者对急症气道处理的反应时间.应当以2个月或更短时间为间隔进行重复的情景模拟训练,让住院医师保持对急症气道的应急处理能力.

Objective This study on a medium-fidelity simulator (SimMan , Laerdal Medical Corpo-ration,Wappingers Falls, NY, USA) examined the management of unanticipated difficult airway by residents of anesthesiology and the effect of training in this context.Methods 30 residents of anesthesiology were devided into two groups (T and E). There were two scenarios investigated:'can't intubate, can oxygenate'(CI) and'can't intubate, can't oxygenate'(CICO). The E group was trained by scene simulation in the second, fourth, sixth month respectively before and after the training, and the T group received the same situation simulation training on the same day after the theoretical training and in the second, sixth month after the training. In con-trast to standard operating procedures, the performance of two groups of trainees was recorded on the basis of pre established evaluation criteria. Data differences between the two groups were analyzed using SPSS 23.0,t test, M-W test andx2 test.ResultIn CI, success rate of placement of astandard and intubating laryngeal mask air-way were high in T group (87％ vs. 55％ ,P=0.037). This was sustained over time. There was no difference in duration and incidence of desaturation between two groups. In CICO, there was a more structured approach following training in T group (P<0.05), which wasn't sustained over time. But this was sustained over 6 months in E group.ConclusionSituational simulation training can significantly improve the anesthesiology residents' ability to take proper response measures to the unexpected difficult airway, and significantly shorten the training time for emergency airway treatment. Repeated situational simulation training should be conducted at intervals of 2 months or less, allowing residents to maintain emergency response to the emergency airway.