虚拟现实模拟装置和模拟气道在麻醉科纤支镜插管培训中的应用比较  

Comparison of training in department of anesthesiology for flexible fibreoptic intubation with ap- plication of virtual reality simulator and high-fidelity manikin

作　　者：姜柏林[1] 鞠辉[1] 姚兰[1] 冯艺[1] 赵莹[1] 王岚[2] 

机构地区：[1]北京大学人民医院麻醉科,100044 [2]北京大学人民医院心内科,100044

出　　处：《中华医学教育探索杂志》2016年第3期291-295,共5页Chinese Journal of Medical Education Research

基　　金：北京大学人民医院教育教学研究课题（RD-Edu201419,RD-Edu-201606）;2014年度北京大学医学部教育教学研究课题

摘　　要：目的对比模拟气道和虚拟现实模拟装置（virtualrealitysimulator，VRS）应用于纤支镜插管培训的效率和效果。方法在北京大学人民医院接受住院医师一阶段培训，且无纤支镜插管经验的46名麻醉学住院医师被纳入本研究；随机分为VRS组（s组，n=23）和模拟人组（M组，n=23）。S组在VRS上进行25次纤支镜置入气道的模拟训练，M组在模拟人上完成同样25次训练。两组均于模拟人上进行5次操作考核。记录各组模拟训练中每次纤支镜操作时间，通过SPSS20．0拟合学习曲线；应用重复测量方差分析及t检验对比两组考核中的操作时间、纤支镜操作能力评分及两组培训前后的信心评分。结果据曲线拟合参数，s组需19（15，26）次训练达学习曲线的稳定段，M组需24（19，31）次。s组及M组学员考核中的操作时间[（13．7±6．6）S和（11．9±4．1）s]、操作能力评分[（3．9±0．4）和（3．7±0.3）】差异无统计学意义。2组学员培训后信心均得到提升[s组：（1．8±0．5）vs．（3．9±0．6），t=10．928，P=0．000；M组：（2．0±0．7）V8．（3．9±0．5），t=15．306，P=0．000]；而组间比较差异无统计学意义。结论VRS较模拟人在教学效率上更具优势，但经充分培训后，两者的教学效果并无显著差异。相关培训应综合考虑经济成本、时间成本因素，采取切合的教学手段与形式。Objective To compare the efficacy and efficiency of simulation-based training of flexi- ble fibreoptic intubation in novices with virtual reality simulator. Methods A total of 46 anaesthesia residents in their first stage of training in anaesthesiology with no experience in flexible fibreoptic intuba- tion at Peking University People＇s Hospital were enrolled in the study, and were divided into 2 groups randomly, which were virtual reality simulator group （group S, n=23） and manikin group （group M, n=23）. The group S was then trained for 25 times on simulator, while the group M did the same processes on manikin. After training, participants in both groups had their performance assessed with the fibrescope eval- uated through the oral route using a simulation manikin, who were instructed to attempt to advance the fibrescope 5 consecutive times to view the carina in the shortest amount of time. The time required to viewthe carina of each practice during training in both groups were recorded as pooled data to construct group learning curves with the application of SPSS 20.0. By using repeated measures analysis of variance and T- test, the procedure time and global rating scale （GRS） of fibreoptic bronchoscope manipulation ability were compared between groups, so did the participant＇s confidence between before and after the training both within-subjects and between-subjects. Results The plateaus in the learning curves were achieved after 19 （15, 26） practice sessions in group S and 24 （19, 31） in group M, respectively. There was no significant difference in the procedure time [（13.7 ± 6.6） s and （11.9 ± 4.1） s] and GRS [（3.9±0.4） vs. （3.7 ±0.3）] between groups. There were significant increases in participant＇s confidences in both groups after training [group S： （1.8± 0.5） vs. （3.9 ±.6）, t=10.928, P=0.000; group Mi （2.0± 0.7） vs. （3.9± 0.5）, t=15.306, P= 0.000], but there was no significant difference between groups. Conclusion The simulation-based tra

关 键 词：住院医师规范化培训 模拟训练 纤支镜插管 虚拟现实模拟装置 学习曲线 

分 类 号：R614[医药卫生—麻醉学]