PBL結(jié)合可視喉鏡在麻醉學(xué)氣管插管術(shù)教學(xué)中的應(yīng)用

謝海輝 張曙 何炳華

摘 要：目的 探討適合實(shí)習(xí)醫(yī)師學(xué)習(xí)氣管插管術(shù)的教學(xué)方法，使學(xué)生在短時(shí)間內(nèi)掌握氣管插管術(shù)。方法 選擇2017年1月1日～12月31日同期進(jìn)入東莞市人民醫(yī)院麻醉科輪轉(zhuǎn)培訓(xùn)的實(shí)習(xí)醫(yī)師38人，采用隨機(jī)數(shù)字表法隨機(jī)分為C組和G組，各19人，C組學(xué)員采用傳統(tǒng)教學(xué)模式培養(yǎng)，G組學(xué)員采用PBL教學(xué)模式。記錄首次插管成功率、首次插管成功所需時(shí)間、導(dǎo)管誤入食道的發(fā)生率、總體插管成功率以及總體并發(fā)癥等，并進(jìn)行理論考核及滿意度調(diào)查。結(jié)果 G組學(xué)員首次插管成功率及總體插管成功率均高于C組（97.89% vs 78.07%，100.00% vs 85.79%），且無氣管導(dǎo)管誤入食道病例，差異均有統(tǒng)計(jì)學(xué)意義（P<0.05），兩組首次插管成功所用時(shí)間比較[（53.66±8.33）s vs （58.32±7.61）s]，差異無統(tǒng)計(jì)學(xué)意義（P>0.05）；G組學(xué)員的插管相關(guān)并發(fā)癥發(fā)生率為8.77%，低于C組的22.11%，對PBL教學(xué)模式的滿意率為78.95%，高于C組的36.84%，差異均有統(tǒng)計(jì)學(xué)意義（P<0.05）。G組學(xué)員的理論考核成績高于C組[（92.45±5.32）分vs（84.27±4.97）分] ，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。結(jié)論 PBL結(jié)合可視喉鏡進(jìn)行氣管插管術(shù)的教學(xué)模式，可使實(shí)習(xí)醫(yī)師在短時(shí)間內(nèi)掌握氣管插管術(shù)的相關(guān)解剖知識及操作要點(diǎn)，在提高非困難氣管插管成功率的同時(shí)減少相關(guān)并發(fā)癥，有利于保障醫(yī)療安全。

關(guān)鍵詞：實(shí)習(xí)醫(yī)師；麻醉學(xué)；氣管插管術(shù)；PBL；可視喉鏡

中圖分類號：G642 文獻(xiàn)標(biāo)識碼：B DOI：10.3969/j.issn.1006-1959.2018.23.004

文章編號：1006-1959（2018）23-0013-03

Abstract：Objective To explore the teaching method of tracheal intubation for intern，enabling students to master tracheal intubation in a short period of time.Methods From January 1st to December 31th， 2017， 38 intern doctors who entered the Department of Anesthesiology of Dongguan people's Hospital for rotation training were selected，the method of random digital table was used to divide them randomly into group C and group G， each with 19 person，group C adopted traditional teaching mode， group G adopted PBL teaching mode.The success rate of the first intubation， the time required for the first intubation， the incidence of misentry of the catheter into the esophagus， the overall success rate of intubation and the overall complications were recorded and theory examination and the satisfaction degree investigation were carried.Results The success rate of first intubation and total intubation in group G was higher than that in group C （97.89% vs 78.07%， 100.00% vs 85.79%）. And there was no trachea tube straying into the esophagus，the difference was statistically significant （P<0.05）.There was no significant difference in the time of successful intubation between the two groups [（53.66±8.33） s vs （58.32±7.61） s]，the difference was not statistically significant （P>0.05）.The incidence of intubation related complications in group G was 8.77%， which was lower than that in group C 22.11%. The satisfaction rate of PBL teaching model was 78.95%， which was higher than that in group C 36.84%，the difference was statistically significant （P<0.05）.The score of theoretical examination in group G was higher than that in group C [（92.45±5.32） vs （84.27±4.97）]，the difference was statistically significant （P< 0.05）.Conclusion The teaching mode of tracheal intubation by PBL combined with visual laryngoscope can make the intern master the anatomical knowledge and the key points of operation in a short time.So that to improve the success rate of non-difficult tracheal intubation and reduce the related complications， it is helpful to ensure medical safety.

Key words：Interns；Anesthesiology；Tracheal intubation PBL；Visual laryngoscope

實(shí)習(xí)醫(yī)師在麻醉科進(jìn)行輪轉(zhuǎn)學(xué)習(xí)是實(shí)習(xí)培訓(xùn)的重要組成部分，其中氣管插管術(shù)是培訓(xùn)的重點(diǎn)內(nèi)容之一。但因院校有限的實(shí)習(xí)保障、畢業(yè)生的研究生升學(xué)壓力及工作壓力常常導(dǎo)致實(shí)習(xí)質(zhì)量不佳。如何讓學(xué)生在短時(shí)間內(nèi)掌握氣管插管術(shù)相關(guān)理論知識和臨床操作技能，值得教育者關(guān)注。“基于問題的學(xué)習(xí)”（problem-based learning，PBL）是一種新型的教學(xué)方法，由加拿大教授 Barrows在1969年所提出并試行，該教學(xué)模式以學(xué)生為中心，有別于傳統(tǒng)醫(yī)學(xué)教育中“教師主動-學(xué)生被動”的方式，有利于調(diào)動學(xué)生的學(xué)習(xí)主動性和積極性，將理論知識和臨床應(yīng)用緊密結(jié)合，因而為醫(yī)學(xué)界教育者廣泛采納應(yīng)用[1-3]。……