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用累积和法模拟舌水肿并咽肿胀状态中两种双管喉罩的学习曲线

The Cumulative Sum Method was Used to Simulate the Learning Curve of Two Kinds of Double-tube Laryngeal Mask in the Condition of Tongue Edema and Pharyngeal Swelling

临床医学前沿 / 2021,3(3)：35-47 / 2021-07-26 363 384

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• 作者： 冯洁华¹      张俊²      潘子叶¹      张杰¹      魏宏¹      罗晓敏¹     
• 单位：

  1．华中科技大学协和深圳医院麻醉与围手术期医学科，深圳；
  2．鹏城实验室，深圳

• 关键词： I-gel；Suprume；累积和分析；学习曲线；模拟；人体模型研究
• I-gel; Suprume; Cusm Analysis; Learning curve; Simulation; Human manikin research
• 摘要： 目的：探讨在人体模型设置困难气道状态下，缺乏经验的麻醉住培医师使用不 同的双管喉罩I-gel 和Suprume 成功置入所需的尝试量，并建立相关的学习 曲线。方法：本研究是在人体模型模拟舌水肿并咽肿胀的状态下，让20 名没 有经验的麻醉住培医师用两种双管喉罩置入（120 秒内），并使用纤维支气管 镜对位。喉罩置入困难程度以及模拟的仿真程度使用10 点量表，用累积和法 生成学习曲线。结果：20 名住培医师中有18 人能够在使用Suprume 的20 次 训练中，从上面向下通过可接受的故障率边界（h0，下判决边界），尝试次数 中位数为18［95% 置信区间（CI）=16.82-19.18］； 而I-gel 有17 人能够 在20 次尝试中，从上面向下通过h0，尝试次数中位数为17（95%CI=15.65- 18.35）。Suprume 置入的总成功率显著高于I-gel（362/400 和337/400, p<0.05）。Suprume 置入难易程度中位数为5（95%CI=4.81-5.19）， 而 I-gel 中位数为7（95%CI=6.78-7.22），p<0.05。模拟的仿真性被评为中位 数6（95%CI=5.34-6.52）。结论：虽然需要类似数量的尝试来达到两种双管 喉罩的预定能力，但17 名住培医师能够获得使用I-gel 范围的目标成功，与 Suprume 的18 名相比，没有经验的麻醉住培医师发现Suprume 置入的难度低 于I-gel。在本研究中观察到，学员的个体差异在累积和模型的分析中，突出了 预先对双管喉罩置入技能模拟训练成功与否的定义至关重要。学员个人技能需 要得到持续发展，技能培训中心需要提供足够的训练次数使学员达到掌握技能 的目的，学习机会应相应调整。
• Objective: This study was to explore the number of attempts required by inexperienced anesthesiology residents to use different doubletube laryngeal mask (I-gel and Suprume) in the difficult airway setting of human manikin, and to establish the relevant learning curve. Methods: In this research, 20 inexperienced anesthesiology residents were asked to insert two kinds of double-tube laryngeal mask(LMA) in 120 seconds under the condition of tongue edema and pharyngeal swelling simulated by human manikin, and were checked by fiberoptic bronchoscope. The difficulty of inserting the LMA and simulation fidelity were evaluated by the 10-point scale, and the learning curve was generated by cumulative sum method. Results: With Suprume, 18 of the 20 residents were able to pass the acceptable failure rate boundary (h0, lower decision boundary) in 20 times with a median number of 18[95% confidence interval (CI) = 16.82-19.18] attempts. Whereas in I-gel, 17 residentswere able to pass h0 in 20 attempts, and the median number of 17 (95% CI = 15.65-18.35)attempts. Total success rate was found significantly higher with Suprume compared with I-gel (362 / 400 vs 337 / 400, respectively, p<0.05). Insertion with Suprume was considered as less difficult compared with I-gel [median of 5 (95% CI = 4.81-5.19) and 7 (95% CI = 6.78-7.22), respectively, p<0.05] . The simulation fidelity was rated as a median of 6 (95% CI = 5.34-6.52). Conclusion: Although a similar amount of attempts were required to reach the predetermined competency for both LMAs, 17 residents were able to obtain the targeted success using I-gel as compared with 18 with Suprume. Inexperienced residents found insertion via supreme less difficult than I-gel. In this study, it was observed that the individual variability in obtaining competency with the cumulative sum analysis underlines the importance of defining success a priori to simulation of the LMA placement skills. Individual skills of resident need to be developed continuously. The skills training center needs to provide enough training times to enable residents to master skills. Learning opportunities should be adjusted accordingly.
• DOI： https://doi.org/10.35534/fcm.0303006
• 引用： 冯洁华，张俊，潘子叶，等．用累积和法模拟舌水肿并咽肿胀状态中两种双管喉罩的学习曲线［J］．临床医学院前沿，2021，3（3）：35-47．