TCCC教学中环甲膜切开术培训的初步尝试  

A Preliminary Attempt in the Training of Cricothyrotomy in TCCC Teaching

作　　者：李爽[1] 桂莉[1] 郭子剑[1] 刘晶晶[1] 王毅欣[1] 黄燕[1] 陈楚琳 朱思悦 LI Shuang;GUI Li;GUO Zijian;LIU Jingjing;WANGS Yixin;HUANG Yan;CHEN Chulin;ZHU Siyue(Department of Emergency Nursing,School of Nursing,Naval Medical University,Shanghai 200433,China)

机构地区：[1]第二军医大学护理学院,上海200433

出　　处：《解放军护理杂志》2018年第17期73-76,共4页Nursing Journal of Chinese People's Liberation Army

摘　　要：目的探讨在战术战伤救治(tactical combat casualty care,TCCC)中引入环甲膜切开术培训,以提升军校医学生在演习中应对急性气道梗阻的战伤救治能力。方法采用"理论授课+技能示范+分组练习"教学模式对参加"联卫-2017"演习的425名军医大学毕业学员进行环甲膜切开术培训;通过专家小组会议方法制定模拟案例,以随机抽取模拟案例方式对学员进行技能考核,并对部分学员进行针对教学评价的访谈。结果环甲膜切开术考核学员合格率为95.2%,伤情判断正确率为81.0%,但操作完全正确率仅为9.5%。其中操作中存在的主要问题为环甲膜定位不准确、穿刺及扩皮时手法和方向错误等。质性访谈结果显示,学员均认为有必要学习环甲膜切开技术,评价教学模式便于迅速掌握技能,贴近实战;建议理论授课时播放环甲膜切开视频并增加练习时间,以利于学员充分掌握此技能。结论环甲膜切开术是TCCC战术区域必备的缓解气道梗阻的关键措施,可有效减少战场可预防性死亡;但须强化实战仿真教学,提升实践参与能力,并细化考核评分标准,以反映学员技能水平,同时聚焦薄弱操作步骤,采取针对性教学措施,以提高教学效果。Objective TCCC has been documented to produce unprecedented decreases in preventable corn bat death in military units. We aimed to introduce cricothyrotomy training to TCCC teaching, in order to enhance the combat casualty care ability of military medical students in dealing with airway obstruction. Methods We used the teaching model of ＂theoretical teaching ＋skill demonstration ＋ practice in groups＂ to deliver the cricothyrotomy simulative training for our school graduates. Skill examination was conducted by selecting the simulation case randomly. And some students were selected for qualitative interviews with teaching evaluations. Results In the descriptive statistical analysis for skill examination of cricothyroto my,we found that the qualification rate was 95.2%. The correct rate of injury judgment was 81.0% ,while that of the operation accuracy was only 9.5 %. The main problems existing in skill operation are the inaccu rate cricothyroid membrane positioning and the improper manipulation as well as operation angle. The qualitative interviews showed that the students regarded cricothyrotomy as crucial emergency measures in combat casualty care and approved of this simulative teaching model since it closed to actual combat. Be sides, they recommended to add the video teaching which can follow along with the theoretical lesson and to increase the practice time so as to facilitate to master this skill. Conclusions Cricothyrotomy is the key measure to alleviate airway obstruction in the tactical area of TCCC. We should strengthen the combat sire ulative teaching and enhance the practical ability of military medical students. Additionally,the assessment scale should be more detailed to fully assess the level of students skill. Furthermore, the teachers should focus on weak operating procedures and take effective teaching measures.

关 键 词：环甲膜切开术 战术战伤救治 培训 

分 类 号：R823[医药卫生—临床医学]