超声引导桡动脉穿刺置管学习曲线的建立

Abstract

目的 探讨新入科住院医师学习超声引导桡动脉穿刺置管并掌握该技术所需要的最少操作例数,探究学习规律,为临床麻醉学医师超声引导桡动脉穿刺置管资格准入标准的制定和技能培训提供参考依据.方法 经北京大学第三医院伦理委员会批准,自2014年5月～2014年11月,在北京大学第三医院共有9名麻醉学第一年住院医师参与该研究.9名麻醉学住院医师每人按照时间顺序操作25个连续病例,总计225例.患者年龄范围18岁～ 80岁.按照美国麻醉师协会(ASA)分级标准,相关病例为Ⅰ级或Ⅱ级,记录9名麻醉学住院医师的操作时间和穿刺置管次数.计算每一次穿刺置管操作的累积和(CUSUM)值σ.绘制个体和总体的学习曲线,根据学习曲线的函数式求得每一次操作所对应的曲线斜率K,斜率在逐渐减小的过程中开始为负值所对应的操作次数即为掌握该项技能所需要的最少操作例数.结果 9名住院医师总体学习曲线斜率K=0时所对应的穿刺置管次数为14.结论 学习曲线表明初学者学习掌握超声引导桡动脉穿刺置管大约14次就能够掌握该项操作技能,属于一种实用技能,值得在新的麻醉学住院医师技能操作学习中推广.

Objective To investigate the least practice number for novice anesthetists to learn the skill of ultrasound-guided indwelling of radial artery catheters,investigate the regular pattern of learning a new skill,so as to provide the reference basis for formulating the criterion of the qualifications to practice the ultrasound-guided indwelling of radial artery catheters and the skill training.Methods From May 2014 to November 2014,9 post-graduate-1 year residents at Peking University Third Hospital completed a 6-month anesthesia rotation.Each resident select 25 patients in chronological order,225 patients in total.To standardize the patient population,eligibility criteria of patients were those aged 18 to 80 years old and ASA class Ⅰ or Ⅱ,undergoing selective surgery.Time to perform the catheter indwelling and frequency of catheter indwelling were recorded.Cumulated the CUSUM (σ) for every attempt.Defined the respective and the overall learning curve,then use the functional equation to get the slope (K) for every attempt of indwelling.The slope is decreasing,when the slope changes into negative,the number corresponding to the changement is the minimum training experience necessary to succeed at this skill.Results The 9 residents'overall catheter indwelling frequency was 14 when the slope (K) =O.Conclusions The learning curve indicated that the minimum number of training experience necessary to succeed in grasping this skill is approximately 14.It is a favorable and useful skill,what' s more,it can be learned quickly.So it is highly recommended in the clinical work.