重症超声专项培训在重症医学教学中的作用  

Application of critical care ultrasound special training in critical care medical education

作　　者：王慧[1] 何伟[2] 丁欣[3] 王小亭[3] 段军[1] Wang Hui;He Wei;Ding Xin;Wang Xiaoting;Duan Jun(Department of Intensive Care Unit,China-Japan Friendship Hospital,Beijing 100029,China;Department of Intensive Care Unit,Beijing Tongren Hospital,CMU,Beijing 100005,China;Department of Intensive Care Unit,Peking Union Medical College Hospital,Beijing 100005,China)

机构地区：[1]中日友好医院重症医学科,北京100029 [2]首都医科大学附属北京同仁医院重症医学科,北京100005 [3]北京协和医院重症医学科,北京100005

出　　处：《中国中西医结合急救杂志》2023年第4期471-475,共5页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：北京市医药卫生住院医师规范化培训质量提高项目(2021072)。

摘　　要：目的评估重症超声专项培训在重症医学教学中的应用效果。方法采用观察性研究方法。选择中日友好医院2020年3月至2021年9月重症医学专业的80名进修医师作为研究对象,教学方案实施的重点为重症超声的使用、重症超声的基础知识和基本切面获取、标准切面的识别、异常超声图像的解读和分析以及临床病例的整合分析。通过柯氏4级模型评估培训前后学员的满意度、理论考试和操作考核成绩,以及将超声用于临床的综合应用能力、超声培训对临床结果的影响。结果学员对于课程整体的满意程度(包括同意或非常同意)在90%以上。所有学员在经过超声专修培训后理论考试、异常图像解读和操作技能考核成绩均有明显提高〔理论考试(分):76(68,80)比52(48,60),异常图像解读(分):68(64,76)比40(28,44),操作技能考核(分):36(32,42)比8(0,13),均P<0.05〕,学员的超声实际应用能力亦有明显提高〔病例考核成绩(分):72(64,80)比40(28,44),病例分析成绩(分):20(16,23)比11(7,15),图像解读成绩(分)13(11,14))比7(0,11),均P<0.05〕。总共230次床旁超声检查后,87次检查得出了新的诊断,77次检查确认了之前的诊断,并将治疗进行了更改,使用后对于整体临床决策的影响达到71.3%(164/230)。重症心脏超声的使用率最高〔41.7%(96/230)〕,其次是肺部超声〔29.1%(67/230)〕,颅脑超声使用率最低〔4.8%(11/230)〕。心脏超声应用后,左室舒张功能不全和急性右室功能障碍的诊断率明显提高〔分别为28.1%(27/96)和13.5%(13/96)〕。结论重症超声专项培训在重症医学教学中表现出了良好的教学效果。Objective To explore the application of critical care ultrasound special training in critical care medicine.Methods An observational study method was conducted.A total of 80 trainees from March 2020 to September 2021 in China-Japan Friendship Hospital were selected.The implementation of the teaching program focused on the use of critical care ultrasound,the acquisition of basic knowledge and basic section of critical care ultrasound,the recognition of standard section,the interpretation and analysis of abnormal ultrasound images,and the integrated analysis of clinical cases.The degree of satisfaction,the performance of theoretical and operational assessment,the comprehensive application ability of ultrasound in clinical application and the influence of ultrasound training on clinical outcomes were assessed by the Kirkpatrick Level 4 Model before and after training.Results Students'satisfaction with the course(including agree or strongly agree)was above 90%.After the ultrasound training,all the students had significantly improved their results,including theoretical examination,abnormal image interpretation and operational skills examination,and their practical ultrasonic application ability has significantly improved[theoretical examination:76(68,80)vs.52(48,60),abnormal image interpretation score:68(64,76)vs.40(28,44),operation skill test score:36(32,42)vs.8(0,13),all P<0.05],the students'practical application ability of ultrasound was also significantly improved[case assessment score:72(64,80)vs.40(28,44),case analysis score:20(16,23)vs.11(7,15),image interpretation score:13(11,14)vs.7(0,11),all P<0.05].Out of a total of 230 bedside ultrasounds,87 resulted in a new diagnosis,77 confirmed a previous diagnosis,and treatment changes were made,resulting in a 71.3%impact on overall clinical decision making(164/230).The use rate of severe cardiac ultrasound was the highest[41.7%(96/230)],followed by lung ultrasound[29.1%(67/230)],and brain ultrasound was the lowest[4.8%(11/230)].The diagnosis rates of left ventricular

关 键 词：重症医学 重症超声 专项培训 

分 类 号：R459.7[医药卫生—急诊医学]