可视喉镜气管插管模拟培训效果及分析  

The effect of simulation training of endotracheal intubation under videolaryngoscope and the analysis of key points

作　　者：戴佳原[1] 尹路 付阳阳[1] 金魁 朱华栋[1] 于学忠[1] 徐军[1] Dai Jia-yuan;Yin Lu;Fu Yang-yang;Jin Kui;Zhu Hua-dong;Yu Xue-zhong;Xu Jun(Department of Emergency,Peking Union Medical College Hospital,CAMS&PUMC,Beijing 100730,China)

机构地区：[1]中国医学科学院北京协和医学院北京协和医院急诊科,北京100730

出　　处：《中国急救医学》2020年第6期489-493,共5页Chinese Journal of Critical Care Medicine

基　　金：中国医学科学院医学与健康科技创新工程项目(2017-12M-1-009)。

摘　　要：目的调查急诊可视喉镜辅助气管插管应用现状;观察对急诊医生进行可视喉镜辅助气管插管模拟培训的效果并对培训重点进行分析总结.方法选取急诊医生120人给予可视喉镜辅助气管插管培训,按培训方法不同,随机分为模拟培训组与非模拟培训组,每组各60人.培训前后问卷调查.培训后每名急诊医生独立完成一次模拟可视喉镜辅助气管插管,全程记录.对两组医生问卷调查结果进行自身前后对照及组间比较分析;对两组医生模拟操作表现,即一次气管插管成功率,包括暴露声门成功率、气管插管总时间、暴露声门时间及导管插入时间进行比较分析.结果模拟培训组与非模拟培训组在性别、年龄、职称及直接喉镜气管插管经验方面差异无统计学意义.绝大多数医生所在急诊科配备可视喉镜,模拟培训组和非模拟培训组差异无统计学意义(91.7%vs.83.3%,P>0.05).但实际临床工作中,模拟培训组与非模拟培训组急诊医生使用可视喉镜辅助气管插管意愿不强且差异无统计学意义(43.3%vs.50.0%,P>0.05).模拟培训组与非模拟培训组急诊医生不愿使用可视喉镜的主要原因均为可视喉镜下不易置入导管且两组差异无统计学意义(70.6%vs.70.0%,P>0.05).其他少见原因有个人经验习惯和暴露声门不满意,两组间差异无统计学意义(17.6%vs.16.7%,11.8%vs.13.3%,均P>0.05).培训后模拟培训组与非模拟培训组使用可视喉镜辅助气管插管的意愿均明显升高,且模拟培训组较非模拟培训组提升更为明显(95.0%vs.83.3%,P<0.05).在模拟可视喉镜辅助气管插管表现中,两组医生均能全部成功暴露声门,但模拟培训组一次气管插管成功率要高于非模拟培训组(93.3%vs.58.3%,P<0.05).模拟培训组中气管插管总时间及导管置入时间均短于非模拟培训组[s:22(19,24)vs.34.5(24,41.75),14.5(13,17)vs.29(18,35),均P<0.05],暴露声门时间两组差异无统计学意义[s:7(6Objective To investigate the application of emergency videolaryngoscope assisted endotracheal intubation(ETI),and to observe the effect of videolary ngoscope assisted endotracheal intubation simulation training for emergency doctors in order to analyze and summarize the training key points.Methods According to the different teaching methods,120 emergency physicians were randomly divided into simulation training group and non-simulation training group,60 docloars in each goup.Questionndires were perforned before and after the tmaining,Afher the training.each emergeney doetor independently completed a simulated videolaryngoscope asised endotracheal intubation and the whole process was reorded.The results of the qustionaire in the two groups of doctors were compared before and afer the training and were also compared between the thu groups.The itubating success rate on the first atempt including the suecess rate of gottis exposure,total intubation time,glotis exposure time and catheter insertion time were compared and analyzed betwen the thwo grmoups.Results There was no difference in gender,age,title and directed laryngoscope assisted endotracheal intubation experience between the sinulation training group and the non-simulation tmaining group.Most of the doctors in the emergency departments were equipped with videlaryngoecope,and there was no signifeant diference between the simulation tmining group and the ron-simulation training group(91.7%vs.83.3%,P>0.05).But the wllingnes of emergeney phyeicians using videolaryngoscope tw assist endotrncheal intubation in elinical practice was not strong in both simulation training group and the non-simulation training group,and no signifcant dfference existed betwee the to groups(43.3%vs.50.0%,P>0.05).The emergeney physicins in both simulaion training group and the non-simulation training group were reluctant to use the videolaryngoseope,which was atributed mainly to the dificuly in intubuting,and mo significant difeence existed between the two goups(70.6%vs.70.0%,P>0.05).Oth

关 键 词：可视喉镜 气管插管 模拟培训 气道 教学 

分 类 号：R-4[医药卫生] C975[经济管理—劳动经济]