规范化培训的麻醉住院医师硬膜外穿刺操作学习曲线的建立  

Establishment of the learning curve of epidural puncture operation for standardized training anesthesia residents

作　　者：邱晓晓 陈敏敏 陈培 周振锋 QIU Xiaoxiao;CHEN Minmin;CHEN Pei;ZHOU Zhenfeng(Department of Anesthesiology,Hangzhou Obstetrics and Gynecology Hospital,Hangzhou 310008,China)

机构地区：[1]杭州市妇产科医院麻醉科,浙江杭州310008

出　　处：《中国现代医生》2022年第17期200-203,共4页China Modern Doctor

基　　金：浙江省中医药科技计划项目(2020ZB194)。

摘　　要：目的 探讨规范化培训的麻醉住院医师硬膜外穿刺操作学习曲线的建立。方法 选择2017年8月~2020年6月在杭州市妇产科医院麻醉科接受规范化培训的10名住院医师进行多媒体教学及穿刺模拟培训,内容包括解剖基础,操作步骤和并发症等。培训考核通过后方可进入临床操作,每位住院医师共进行60次硬膜外穿刺操作,记录操作成功率、操作次数、操作时间、不良反应,采用CUSUM分析构建学习曲线的预测模型并确定掌握该技能所需要的最少操作例数。结果 10名住院医师硬膜外穿刺成功率、操作时间、不良反应比较,差异无统计学意义(P>0.05)。参加规范化培训的新入科的住院医师硬膜外穿刺总成功率为69.2%(415/600)。每位住院医师的失败率均超过20%(可接受失败率),但仍在30%以内(不可接受失败率)。总体学习曲线显示穿刺成功率达90%时需要经过51次操作。结论 即使经过麻醉科系统的理论及模拟培训,规范化培训的麻醉住院医师硬膜外穿刺需要多次和较长时间培训。作为麻醉医生的基本技能之一,带教老师需要长时间关注学习进度,促进规培学员安全、顺利掌握该技术。Objective To explore the establishment of the learning curve of epidural puncture for standardized training anesthesia residents. Methods Ten resident physicians who received standardized training in the Department of Anesthesiology of Hangzhou Obstetrics and Gynecology Hospital from August 2017 to June 2020 were selected. They received multimedia teaching and puncture simulation training, including anatomical basis, operating procedures, and complications. After passing the training and assessment, clinical operations can be entered. Each resident performed a total of 60 epidural punctures. The success rate, number of operations, operation time, and adverse reactions were recorded. The CUSUM analysis was used to construct a predictive model of the learning curve and determine the minimum number of operations required to master this skill. Results There were no statistically significant differences in the success rate of epidural puncture, operation time, and adverse reactions among ten residents(P>0.05).The total success rate of epidural puncture for newly admitted residents who participated in standardized training was 69.2%(415/600).The failure rate of each resident exceeded 20%(acceptable failure rate),but it was still within 30%(unacceptable failure rate).The overall learning curve showed that 51 operations were required for 90% puncture success. Conclusion Even after the theoretical and simulation training of the anesthesiology system, epidural puncture requires multiple and prolonged training for standardized trained anesthesia residents. Epidural puncture is one of the basic skills of anesthesiologists. Teachers need to pay attention to learning progress for a long time to promote trainees to safely and smoothly master the technology.

关 键 词：学习曲线 硬膜外穿刺 住院医师 规范化培训 

分 类 号：G642[文化科学—高等教育学]