手绘画图导航引导经支气管镜肺活检的学习曲线分析  

Analysis of Learning Curve Hand-Drawn Mapping Navigation Guided Transbronchial Lung Biopsy

作　　者：苏柱泉[1] 饶婉媛 樊明粤 钟长镐[1] 李红佳 孙岩 李时悦[1] SU Zhuquan;RAO Wanyuan;FAN Mingyue;ZHONG Changhao;LI Hongjia;SUN Yan;LI Shiyue(Department of Pulmonary and Critical Care Medicine,the First Affiliated Hospital of Guangzhou Medical University/Guangzhou Institute of Respiratory Health/State Key Laboratory of Respiratory Disease,Guangzhou Guangdong 510120,China)

机构地区：[1]广州医科大学附属第一医院呼吸与危重症医学科/广州呼吸健康研究院/呼吸疾病国家重点实验室,广东广州510120

出　　处：《中国继续医学教育》2023年第22期91-96,共6页China Continuing Medical Education

基　　金：国家自然科学基金青年基金项目(81900032)。

摘　　要：目的 探讨手绘画图导航引导经支气管镜肺活检的学习曲线。方法 纳入2022年6—10月于广州医科大学附属第一医院呼吸内镜中心进修且具备常规支气管镜操作经验的12名进修医师作为研究对象,分为超声对照组(单纯超声)和手绘画图组(画图导航+超声),各6名。采用累积和分析法(cumulative sum analysis,CUSUM)的方法对6名位进修医师分别完成15次手绘画图导航引导经支气管镜肺活检操作的学习曲线进行分析,对CUSUM曲线进行曲线拟合。结果12名进修医师共对126例肺外周结节患者进行活检操作(超声对照组36例,手绘画图组90例),两组患者的性别、年龄、病灶部位、病灶大小、操作成功率和术中并发症发生率差异无统计学意义(P>0.05)。与超声对照组相比,手绘画图组操作者的信心评分更高[(3.20±0.69)分vs.(2.86±0.80)分,P=0.019],气管镜操作时间更短[(363.89±117.64) s vs.(470.64±91.44) s,(P<0.001)]。经气管镜活检时间变化趋势图显示随画图导航操作例数的增加而呈下降趋势。学习曲线(系数R2为0.741)拟合模型显示,经过约8例画图导航引导气道镜操作后,操作时间CUSUM值穿过0点,分为学习提升阶段和熟练掌握阶段。与提升阶段相比,熟练阶段的操作时间明显缩短[(278.33±57.07) s vs.(461.67±89.14) s,(P<0.001)],画图时间减少[(3.35±1.50)s vs.(4.38±1.83) s,(P=0.004)],自信心评分明显增加[(3.40±0.61)分vs.(2.98±0.72)分,(P=0.003)]。结论 建立学习曲线指导画图支气管导航引导经支气管镜肺活检的技能培训安全、可行、有效,经过理论和操作培训以及8次实践操作后进入熟练掌握期,学员可独立熟练完成该项临床操作。Objective To explore the learning curve of bronchoscopic lung biopsy guided by hand-drawn mapping navigation for peripheral pulmonary nodules.Methods A total of 12 trainee doctors with bronchoscopy experience were enrolled in the study from June to October 2022.They were divided into the control group(ultrasound)and the mapping group(mapping navigation+ultrasound).The cumulative sum analysis(CUSUM)method was used to analyze the learning curve of 6 continuing physicians who completed 15 hand drawn navigation guided bronchoscopic lung biopsy operations,and the CUSUM curve was fitted.Results A total of 126 patients with peripheral pulmonary nodules underwent biopsy by 12 training physicians(36 cases in ultrasound group and 90 cases in mapping group).There were no significant differences in gender,age,lesion location,lesion size,operation success rate and intraoperative complications between these two groups(P>0.05).The operator confidence score was higher[(3.20±0.69)points vs.(2.86±0.80)points,(P=0.019)],and the operation time was shorter in the mapping group[(363.89±117.64)s vs.(470.64±91.44)s,(P<0.001)]compared with ultrasound group.The time curve demonstrated a downward trend with the increase of the number of drawn navigation procedures.The fitting model of learning curve(R2=0.741)showed that after 8 cases of mapping navigation guided airway bronchoscopy,the CUSUM value of operating time passed the 0 point,which could be divided into learning stage and proficient stage.In proficient stage,the operation time was significantly shortened[(363.89±117.64)s vs.(470.64±91.44 s),(P<0.001)],the drawing time was reduced[(3.35±1.50)s vs.(4.38±1.83)s,(P=0.004)],as well as the self-confidence score was markedly increased[(3.40±0.61)points vs.(2.98±0.72)points,(P=0.003)],compared with the learning stage.Conclusions It is safe,feasible and effective to establish a learning curve to guide the operation training of transbronchoscopic lung biopsy by hand-drawn mapping navigation.After theoretical,operational training an

关 键 词：画图导航 支气管镜 肺结节 肺活检 教学培训 学习曲线 

分 类 号：G726[文化科学—成人教育学]