光斑法和直视法对Bonfils纤维光导硬镜气管插管学习曲线及并发症的影响

Learning curve and complications of bonfils intubating fiberoptic: comparison of transillumination technique and direct vision technique

摘要:

目的   比较光斑法和直视法两种技术用于Bonfils纤维光导硬镜气管插管的学习曲线和气管插管并发症的影响。方法   前瞻性随机对照研究，住院医师学员10人，性别不限，年龄25～35岁，取得医师资格≤2年，没有纤维光导硬镜的使用经验，采用随机数字表法分为两组（n =5）：光斑法组（A组）和直视法组（B组）。选取择期全麻手术患者为操作对象。学员使用Bonfils纤维光导硬镜进行气管插管操作。记录每位学员首个50例患者气管插管操作的气管插管次数、插管时间（s）、插管成功率（%）；通过累积和（CUSUM）的方法建立学习曲线；记录气管插管相关并发症的发生情况。结果   两组学员性别、年龄和受教育程度差异均无统计学意义；两组平均插管次数、3次插管成功率及插管时间比较差异无统计学意义。A组掌握气管插管技术应进行的最少操作例数为40例，B组为35例，B组学习曲线优于A组（P <0.05）；A组患者气管插管相关并发症发生率高于B组（P <0.05）。结论   采用直视法技术时Bonfils纤维光导硬镜的学习曲线优于光斑法，并且气管插管并发症少，直视法技术更适于初学者的学习训练。

Abstract:

Objective To evaluate the effect of two endotracheal intubation methods for bonfils intubating fiberoptic on the learning curve and complications associated with intubation. Methods Ten resident trainees aged 25～35 years, not limited to gender, qualified as a doctor less than or equal to 2 years, have none experience on bonfils intubating fiberoptic, were randomly assigned into two groups (n = 5): transillumination group (group A) or direct vision group (group B). Patients undergoing elective surgery under general anesthesia were selected. Endotracheal intubation using transillumination method (group A) or direct vision method (group B) with bonfils intubating fiberoptic. Fifty tracheal intubations were performed by each trainee. Attempts, intubation time (S), success rate (%) were recorded; establish the learning curve for trainees using the Cumulative Summation (CUSUM) method. The incidence of complications associated with intubations was recorded during perioperative period. Results There was no significant difference among gender, age, education level in the two groups. For the time of intubation, success rate and attempts, there were no significant difference. Group A required approximately 40 cases of attempts to complete the learning curve, 35 cases for group B. The learning curve of group B was better than group A (P < 0.05). Patients in group A got a higher incidence of intubation complications (P < 0.05). Conclusion Learning curve of bonfils intubating fiberoptic using direct vision method is better than the transillumination method, with fewer complications, suitable for novice to learn and training.