ORSIM模擬器提升規培醫師纖支鏡操作能力的實踐研究

趙柏松　吳軍　金賽芬　宋興榮

[關鍵詞] ORSIM模擬器;規培醫師;纖支鏡;實踐研究;困難氣道

[中圖分類號] R-4? ? ? ? ? [文獻標識碼] B? ? ? ? ? [文章編號] 1673-9701（2021）22-0156-05

Research on the practice of ORSIM simulator to improve the operation ability of fiberoptic bronchoscope for standardized training physicians

ZHAO Baisong? ?WU Jun? ?JIN Saifen? ?SONG Xingrong

Department of Anesthesiology，Guangzhou Women and Children′s Medical Center，Guangdong，Guangzhou? ?510623，China

[Abstract] Difficult airway refers to the difficulty of face mask ventilation or intubation by anesthesiologists who have received professional training，and improper treatment will lead to the death of patients.Previous research has confirmed that fiberoptic bronchoscope is the most effective method to deal with difficult airway，which helps to reduce the incidence of improper airway treatment.However，it is found that anesthesiologists can′t skillfully use fiberoptic bronchoscope to deal with difficult airway.The reason is that they are short of clinically practical experience，few cases of difficult airway and emergencies.Therefore，it is impossible to give enough opportunities for standardized training physicians.Optical remote sensing imagery （ORSIM） simulator is a kind of portable virtual fiberoptic bronchoscope simulator with high simulation.Standardized training physicians with ORSIM simulator can improve their operation ability of fiberoptic bronchoscope.However，there is little research on how to train anesthesiologists to use ORSIM simulator to improve their ability to cope with difficult airway.According to this，the following scientific hypothesis is put forward.Through group training，the ORSIM simulator group is more skilled than the conventional manikin group in using fiberoptic bronchoscope.Meanwhile，the former group has lower failure rate of endotracheal intubation and can deal with difficult airway more opportunely and effectively than the latter group.This project intends to explore the optimal teaching and training scheme using ORSIM simulator and incorporate specific training methods into the anesthesia training system，so as to ultimately improve the ability of training anesthesiologists to cope with difficult airway.

[Key words] ORSIM simulator; Standardized training physicians; Fiberoptic bronchoscope; Practical research; Difficult airway

困難氣道是指經過專業訓練的有五年以上臨床麻醉經驗的麻醉科醫師所經歷的面罩通氣困難或氣管插管困難的臨床情況[1]。困難氣道又分為非緊急氣道和緊急氣道。非緊急氣道：僅有困難氣管插管而無困難面罩通氣，患者能夠維持滿意的通氣和氧合，能夠允許有充分的時間考慮其它建立氣道的方法。緊急氣道：只要存在困難面罩通氣，無論是否合并困難氣管插管，均屬緊急氣道。如手術中遇到緊急型的困難氣道且處理不當，患者極易陷入缺氧狀態，必須緊急建立氣道。其中少數患者既不能插管也不能氧合，可導致氣管切開、腦損傷和死亡等嚴重后果。