超声引导下两种平面外穿刺技术的应用
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摘要
目的在模拟教学培训的基础上,对超声引导下两种平面外穿刺技术,即"45°角进针"法和"动态扫描"法进行比较。方法招募50名在北京协和医院麻醉科轮转或进修的志愿者医师参加模拟培训和操作。记录"45°角进针"法和"动态扫描"法的穿刺时间、穿刺过程中调整进针方向的次数、一次穿刺成功的例数、穿刺成功时超声图像中可见针尖的例数。志愿者医师分别对两种方法的穿刺难度、安全性以及完成穿刺的自信心进行评分、选择临床实际穿刺时会应用的方法并对参加培训的收获程度进行评价。结果两种方法穿刺时间及穿刺成功时可见针尖的比率差异无统计学意义。与"45°角进针"法比较,"动态扫描"法穿刺过程中调整进针方向的次数明显减少,一次穿刺成功率明显增高,所得穿刺难度评分及安全性评分明显降低(P<0.05或P<0.01)。志愿者医师对利用两种方法完成穿刺的自信心评分差异无统计学意义。20名(40%)志愿者医师表示临床穿刺会选用"动态扫描"法、8名(16%)选用"45°角进针"法,22名(44%)选择"两种方法都会用"。所有志愿者均认为该培训令他们"非常有收获"或"有收获"。结论与"45°角进针"法相比,"动态扫描"法一次穿刺成功率更高,穿刺难度更低,安全性更高。将两种方法结合在一起应用可能是一种值得尝试的新方法。
Objective To compare simulated training of "45°tilting insertion"and the"dynamic scan"needling under B ultrasound.Methods Fifty volunteer residents and visiting physicians worked in the anesthesiology department in Peking Union Medical College Hospital were recruited to attend the simulated needling training.The insertion time,insertion attempts until success,numbers of success while advancing the needle and numbers of needle tip visible upon success were recorded.The degree of difficulty and safety of the techniques,the confidence of performing the techniques,the clinical usefulness of the techniques and the training effect were evaluated among the volunteers.Results There were no differences in the insertion time,numbers of successful insertion while advancing the needle and numbers of needle tip visible upon success between the two techniques.Compared with"45° tilting insertion"technique,"dynamic scan"resulted in less needle redirection times and a higher first-attempt successful rate,and got higher scores in terms of difficulty and safety(P<0.05 or P <0.01).The confidence scores of performing the two technique were similar.20(40%)volunteers chose to use"dynamic scan",8(16%)chose to use"45° tilting insertion"and 22(44%)chose to use both technique in their clinical work.100% of them considered the training was greatly helpful or helpful.Conclusion The technique of"dynamic scan"produced a higher first-attempt successful rate and was easier and safer than"45°angle insertion".The combination of the two techniques might be a new technique that is worth trying.
Objective To compare simulated training of "45°tilting insertion"and the"dynamic scan"needling under B ultrasound.Methods Fifty volunteer residents and visiting physicians worked in the anesthesiology department in Peking Union Medical College Hospital were recruited to attend the simulated needling training.The insertion time,insertion attempts until success,numbers of success while advancing the needle and numbers of needle tip visible upon success were recorded.The degree of difficulty and safety of the techniques,the confidence of performing the techniques,the clinical usefulness of the techniques and the training effect were evaluated among the volunteers.Results There were no differences in the insertion time,numbers of successful insertion while advancing the needle and numbers of needle tip visible upon success between the two techniques.Compared with"45° tilting insertion"technique,"dynamic scan"resulted in less needle redirection times and a higher first-attempt successful rate,and got higher scores in terms of difficulty and safety(P<0.05 or P <0.01).The confidence scores of performing the two technique were similar.20(40%)volunteers chose to use"dynamic scan",8(16%)chose to use"45° tilting insertion"and 22(44%)chose to use both technique in their clinical work.100% of them considered the training was greatly helpful or helpful.Conclusion The technique of"dynamic scan"produced a higher first-attempt successful rate and was easier and safer than"45°angle insertion".The combination of the two techniques might be a new technique that is worth trying.
引文
[1]Troianos CA,Hartman GS,Glas KE,et al.Special articles:guidelines for performing ultrasound guided vascular cannulation:recommendations of the American Society of Echocardiography and the Society Of Cardiovascular Anesthesiologists.Anesth Analg,2012,114(1):46-72.
[2]Stone MB,Moon C,Sutijono D,et al.Needle tip visualization during ultrasound-guided vascular access:short-axis vs long-axis approach.Am J Emerg Med,2010,28(3):343-347.
[3]Blaivas M,Brannam L,Fernandez E.Short-axis versus longaxis approaches for teaching ultrasound-guided vascular access on a new inanimate model.Acad Emerg Med,2003,10:1307-1311.
[4]Schafhalter-Zoppoth,McCulloch CE,Gray AT.Ultrasound visibility of needles used for regional nerve block:an in vitro study.Reg Anesth Pain Med,2004,29(5):480-488.
[5]Jijeh AM,Shaath G,Kabbani MS,et al.Ultrasound guided vascular access in pediatric cardiac critical care.J Saudi Heart Assoc,2014,26(4):199-203.
[6]Clemmesen L,Knudsen L,Sloth E,et al.Dynamic needle tip positioning-ultrasound guidance for peripheral vascular access.A randomized,controlled and blinded study in phantoms performed by ultrasound novices.Ultraschall Med,2012,33(7):E321-E325.
[7]Goh G,Tan C,Weinberg L.Dynamic ultrasound-guided,short axis,out—of-plane rasial artery cannulation:the“follow the tip”technique.Anaesth Intensive Care,2013,41(3):431-432.
[8]Quan Z,Tian M,Chi P,et al.Modified short-axis out-ofplane ultrasound versus conventional long-axis in-plane ultrasound to guide radial artery cannulation:a randomized controlled trial.Anesth Analg,2014,119(1):163-169.
[9]Tsui BC,Dillane D.Needle puncture site and a“walkdown”approach for short-axis alignment during ultrasound-guided blocks.Reg Anesth Pain Med,2006,31(6):586-587.
[10]Sethi S,Maitra S,Saini V,et al.Comparison of short-axis out-of-plane versus long-axis in-plane ultrasound-guided radial arterial cannulation in adult patients:a randomized controlled trial.J Anesth,2017,31(1):89-94.
[11]Berk D,Gurkan Y,Kus A,et al.Ultrasound-guided radial arterial cannulation:long-axis/in-plane ver-sus short-axis/out-of-plane approaches?J Clin Monit Comput,2013,27(3):319-324.
[12]Goodman BE.An evolution in student-centered teaching.Adv Physiol Educ,2016,40(3):278-282.
[13]Tolsgaard MG.Clinical skills training in undergraduate medical education using a student-centered approach.Dan Med J,2013,60(8):B4690.
[2]Stone MB,Moon C,Sutijono D,et al.Needle tip visualization during ultrasound-guided vascular access:short-axis vs long-axis approach.Am J Emerg Med,2010,28(3):343-347.
[3]Blaivas M,Brannam L,Fernandez E.Short-axis versus longaxis approaches for teaching ultrasound-guided vascular access on a new inanimate model.Acad Emerg Med,2003,10:1307-1311.
[4]Schafhalter-Zoppoth,McCulloch CE,Gray AT.Ultrasound visibility of needles used for regional nerve block:an in vitro study.Reg Anesth Pain Med,2004,29(5):480-488.
[5]Jijeh AM,Shaath G,Kabbani MS,et al.Ultrasound guided vascular access in pediatric cardiac critical care.J Saudi Heart Assoc,2014,26(4):199-203.
[6]Clemmesen L,Knudsen L,Sloth E,et al.Dynamic needle tip positioning-ultrasound guidance for peripheral vascular access.A randomized,controlled and blinded study in phantoms performed by ultrasound novices.Ultraschall Med,2012,33(7):E321-E325.
[7]Goh G,Tan C,Weinberg L.Dynamic ultrasound-guided,short axis,out—of-plane rasial artery cannulation:the“follow the tip”technique.Anaesth Intensive Care,2013,41(3):431-432.
[8]Quan Z,Tian M,Chi P,et al.Modified short-axis out-ofplane ultrasound versus conventional long-axis in-plane ultrasound to guide radial artery cannulation:a randomized controlled trial.Anesth Analg,2014,119(1):163-169.
[9]Tsui BC,Dillane D.Needle puncture site and a“walkdown”approach for short-axis alignment during ultrasound-guided blocks.Reg Anesth Pain Med,2006,31(6):586-587.
[10]Sethi S,Maitra S,Saini V,et al.Comparison of short-axis out-of-plane versus long-axis in-plane ultrasound-guided radial arterial cannulation in adult patients:a randomized controlled trial.J Anesth,2017,31(1):89-94.
[11]Berk D,Gurkan Y,Kus A,et al.Ultrasound-guided radial arterial cannulation:long-axis/in-plane ver-sus short-axis/out-of-plane approaches?J Clin Monit Comput,2013,27(3):319-324.
[12]Goodman BE.An evolution in student-centered teaching.Adv Physiol Educ,2016,40(3):278-282.
[13]Tolsgaard MG.Clinical skills training in undergraduate medical education using a student-centered approach.Dan Med J,2013,60(8):B4690.