不同临床场景气道教学效果比较及相关因素分析  

Comparison of airway teaching effect in different clinical scenarios and analysis of related factors

作　　者：金魁 戴佳原[1] 尹路 付阳阳[1] 于珊珊 张丽利 徐军[1] 于学忠[1] Jin Kui;Dai Jia-yuan;Yin Lu;Fu Yang-yang;Yu Shan-shan;Zhang Li-li;Xu Jun;Yu Xue-zhong(Department of Emergency Medicine,Peking Union Medical College Hospital,Peking Union Medical College,Chinese Academy of Medical Sciences,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 [2]中国科技大学第一附属医院(安徽省立医院)急诊医学科,安徽合肥236000

出　　处：《中国急救医学》2020年第8期724-728,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：目的本研究基于中国急诊专科医联体急诊核心课程气道版块,评估气道管理课程中不同临床场景的教学效果,并按步骤分析不同场景下参训人员存在的不足,为课程和教学方式、方法的改善提供依据.方法根据培训前后效果对比的对照研究,纳入参与培训学员80名,参考急诊气道共识2016版,按照中国急诊专科医联体核心课程气道版块教学方案进行培训;模拟三种临床场景:心肺复苏气道建立、低氧血症不伴困难气道、困难气道但低氧可被常规氧疗纠正.分别代表临床常见的需要建立气道的三种场景,培训中使用气道模拟人和临床常用气道建立所需的相关设备.将整个人工气道建立过程分为插管前评估、器物人员准备、插管后管理三个环节,记录三种临床场景下的参训人员正确率,并且评估不同类型参训人员对于气道流程教学的教学效果.结果共纳入参训人员80名,气道培训对提高参训人员气道管理流程正确率有明显效果(培训前和培训后72.7%vs.90.9%,P<0.01).超过90%培训后均能够在模拟设备上2次尝试内完成直视下经口气管插管,且插管所需要的时间可在培训后明显减少.所有参训人员培训前对于气道规范管理均存在不足,而不同临床场景、不同气道管理环节的正确率不同,场景①中判断气道种类、评估氧合情况、正确预氧合正确率最低.场景②中预治疗和药物诱导肌松的正确率最低.而场景③正确的插管设备选择和插管过程的正确率最低.此外,场景①和③中的预氧合和选择插管设备、过程环节虽然正确率较低,但培训后能够被很好纠正(场景①:培训前和培训后51.3%vs.97.5%,P<0.01),而场景②中的肌松诱导环节在培训后仍然较难纠正(培训前和培训后45.0%vs.50.0%,P=0.56).结论气道模拟培训能够提高参训人员对标准气道管理流程的掌握.对于不同临床场景应当进行具有针对性的培训,�Objective Based on the emergency airway core course of Peking Union Medical College emergency departments,the teaching effect of different elinical scenarios in the course of airway management were evaluated in order to improve the curriculum and teaching methods.Methods The effect before training and after training was compared.80 members participated in this comparative study,based on the emergency airway guidelines 2016 and emergency airway core course of Peking Union Medical College emergency departments.Three elinical scenarios were used to evaluate the effects of airway education:airway during cardiac arrest,airway with hypoxemia but not difficult airway,and difficult airway.Airway simulators and equipment were used to stimulate airway management in clinical situation of emergency departments,and the whole process was divided into pre-evaluation,preparation of staff and equipment,and post-management.The details of each process were recorded before training and after training and were compared to evaluate the efficacy of airway education.Results Airway education significantly improve the rate of successful airway management protocol(before training vs.after training 70.8%vs.90.8%,P<0.01).More than 90%students can successfully intubate after two attempts and the time needed to intubate was significantly decreased.Before training,all the participants had deficiencies in standardized management of airway,but the accuracy of airway management was different in different clinical scenarios and different airway management.Judgment of airway type,the evaluation of hypoxemia,and preoxygenation had the highest rate of failure in scenario one,the induction of sedation and paralyze drug use was most commonly seen in scenario two,for scenario three the right equipment chosen was the most common failure during airway management.In addition,in scenario one and three the failure can be corrected after education(scenario one before training Vs.after training,51.3%vs.97.5%,P<0.01).However,in scenario two,use of sedation and p

关 键 词：气道 困难气道 教学 模拟课程 

分 类 号：R-4[医药卫生] C975[经济管理—劳动经济]