超声技能提升对急诊科住院医师能力提高的影响  

Effect of ultrasound skill improvement on the ability of emergency residents

作　　者：卢骁[1] 应岚 郑忠骏 蒋守银[1] 徐善祥[1] Lu Xiao;Ying Lan;Zheng Zhongjun;Jiang Shouyin;Xu Shanxiang(Emergencypartment,the Second Affliated HospitalofZhejiang UniversitySchoolfMedicine,Key Laboratoryf The Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province,Zhejiang Province Clinical Research Center for Emergency and Critical Care Medicine,Hangzhou 310009,Zhejiang,China)

机构地区：[1]浙江大学医学院附属第二医院急诊医学中心/浙江省严重创伤与烧伤诊治重点实验室/浙江省急危重症临床医学研究中心,浙江杭州310009

出　　处：《中国毕业后医学教育》2022年第4期362-365,共4页Chinese Journal of Graduate Medical Education

摘　　要：目的探索适合无危重症超声操作经验的急诊科住院医师床边危重症超声高效学习方案,提高急诊科住院医师对危重症超声掌握的能力。方法对无危重症超声操作背景的急诊科住院医师进行30天的“住院医师主导的超声岗位培训”,每天由1名住院医师在早查房前对10位入住ICU治疗的重症患者进行危重症超声评估(肺部超声评分及下腔静脉宽度、变异度评估),并进行记录及开具医嘱;早查房期间由已熟练掌握危重症超声技术的急诊科主治医师对评估准确率进行评价并记录。结果住院医师进行床边超声第5次评估时间较首次评估时间明显缩短,差异有统计学意义(P<0.05)。住院医师进行床边肺部超声准确率由第1次27.3%上升到第3次38.2%,第5次78.2%;下腔静脉宽度及变异评估准确率由第1次34.5%上升到第3次50.9%,第5次85.5%。两项评估准确率提高差异有统计学意义(P<0.01)。结论在急诊监护室设置住院医师主导的超声岗位,能显著提高急诊科住院医师危重症超声掌握能力及熟练度,是一种较好的短时间提高无相关经验的急诊住院医师对危重症超声掌握的培训方案。Objective To explore the effective learning scheme of emergency physicians’bedside critical ultrasound suitable for the experience of non-critical ultrasound operation,and to improve the ability of emergency doctors to master critical ultrasound.Methods The emergency physicians with no critical ultrasound operating background were trained in 30 days of"ultrasound class",and 10 critically ill patients were assessed daily by a physician before the early examination of the room(lung ultrasound score and lower cavity vein width,variability assessment),and the medical advice was recorded and prescribed.Results The time for the 5 th evaluation of bedside ultrasound was significantly shorter(P<0.05).The accuracy of physicians performing bedside lung ultrasound(LUS)increased from 27.3%in the first session to 38.2%in the third and 78.2%in the fifth).The accuracy assessment of the venous width and variability of the lower cavity increased from 34.5%to 50.9%in the third and 85.5%in the fifth.Both assessment accuracy gains were statistically significant(P<0.01).Conclusion Setting up"ultrasound class"in emergency ward can significantly improve the ability and proficiency of emergency physicians in critical care ultrasound,which is a offective traning teaching program for improving emergency physicians without relevant experience in a short period of time,and for further educating doctors and residents to master critical ultrasound.

关 键 词：超声 急诊医学 住院医师 肺部超声评分 下腔静脉变异 

分 类 号：G40-034[文化科学—教育学原理] R4[文化科学—教育学]