经支气管针吸活检术临床应用的学习曲线

Learning curve of transbronchial needle aspiration

摘要:

目的??针对已熟练掌握支气管镜操作技能的呼吸内科医师，通过评估经支气管针吸活检术（TBNA）的穿刺时间和穿刺阳性率，探讨TBNA的学习曲线规律。方法?选取2013年5月-2014年8月在该院支气管镜室最初连续开展的60例行TBNA检查患者的病例资料。按TBNA操作先后顺序依次分为4组（A、B、C和D），每组15例设为一操作学习阶段，每例均由同一位医师操作完成TBNA检查。比较各阶段的平均穿刺时间、穿刺阳性率及穿刺并发症。结果?各组病例在性别、年龄等方面差异无统计学意义（P >0.05）。A组（15.2±2.0）min和B组（14.7±2.2）min穿刺时间均长于C组（8.3±1.6）min和D组（7.6±1.3）min，且差异有统计学意义（P <0.05），但A组和B组之间及C组和D组之间穿刺时间差异无统计学意义（P >0.05）；A组（26.7%）和B组（33.3%）穿刺阳性率均低于C组（80.0%）和D组（80.0%），且差异有统计学意义（P <0.05），但A组和B组之间及C组和D组之间穿刺阳性率差异无统计学意义（P >0.05）；各组穿刺误入血管，穿刺后引起的穿刺点黏膜出血、气胸、纵隔血肿、纵隔出血及纵隔感染等并发症均无明显差异。结论?对已熟练掌握支气管镜操作技能的呼吸内科医师，经支气管针吸活检术的学习曲线大约为30例。

Abstract:

Objective?To explore the learning curve of transbronchial needle aspiration by evaluating the procedure time and the positive rate for respiratory physicians who have already mastered the bronchoscopy.?Methods?Clinical data of 60 patients who received TBNA procedure from May 2013 to August 2014 were retrospectively analyzed. The patients were divided into four groups (A, B, C, D) according to the time sequence of receiving the TBNA procedure, 15 patients in each group were set as a learning stage. The patients were received TBNA by the same doctor. The average time in each stage of puncture, positive rate, and puncture complications were compared among each groups.?Results?There did not show any significant differences in gender, age, etc. (P > 0.05) among the four groups. Puncture time in group A (15.2 ± 2.0) min and in group B (14.7 ± 2.2) min were significantly longer than that in group C (8.3 ± 1.6) min and in group D (7.6 ± 1.3) min (P < 0.05). In terms of the positive rate after the puncture, group A (26.7%) and group B (33.3%) were significantly lower than group C (80.0%) and group D (80.0%) (P < 0.05). There were no significantly different between group A and group B, and group C and group D in terms of puncture time and positive rate. Complications in each group was similar to intravascular puncture, after-puncture bleeding, pneumothorax, mediastinal hematoma, mediastinal bleeding and mediastinal infection did not show significant differences.?Conclusion?The learning curve of transbronchial needle aspiration for respiratory physicians who have mastered the bronchoscopy is around 30 cases.