摘要
目的应用小型猪血流动力学模型研究加强和提高麻醉住院医生对临床血流动力学变化理解及处理能力的可行性。方法选用实验用小型猪8只，麻醉后监测心电图、脉搏血氧饱和度（SpO2）、呼气末二氧化碳分压（PetCO2）、有创动脉压（ABP）、中心静脉压（CVP）、每搏量（SV）、每搏量变异度（SVV）及肺动脉压（PAP）。（1）分别经动脉抽血、颈静脉注入空气、静脉给予15％KCl及0．75％布比卡因，当相应数据出现明显变化时再行救治、观察恢复并记录相关数据。学员于此阶段作观察。（2）右颈内静脉鞘管置入成功后，学员接受Swan-Ganz导管放置技术的学习；利用超声仪引导学员接受可视下动脉置管技术的学习；记录学习前后操作得分。结果（1）处理前后血流动力学参数（ABP、CVP、SV、SVV、PAP）、SpO2、PetCO2变化差异均有统计学意义（均P〈0．05或均P〈0．01），心电图出现相应特征性表现，提示急性失血模型、急性空气肺栓塞模型、高血钾及布比卡因毒性模型建立成功。学习评价量表显示：81．3％的学生认为通过学习对血流动力学的变化理解有提高，78．2％认为对处理能力有帮助，71．9％认为学习班有作用。（2）结果显示学习后Swan—Ganz操作技能有改善（P〈0．05）；超声引导可视下动脉置管技术改善差异无统计学意义（P〉0．05）。结论小型猪血流动力学模型作为一种教学辅助方式提高年轻麻醉医生对临床血流动力学变化理解及处理能力具有可行件。
Objective To investigate the feasibility of training anesthesiologists with hemodynamic models of miniature pigs. Methods Eight miniature experimental pigs were chosen; ECG, SpO2, PetCO：, ABP, CVP, SV, SVV and PAP were monitored after anesthesia. The research was divided into two parts. Part one： the blood of pig was taken from its artery, air was injected into its body throught jugular vein, 15% KC1 and 0. 75% bupivacaine were given by peripheral vein respectively. The resuscitation would not be implemented unless the monitoring data changes were significantly and were recorded. Trainees looked on only during that time. Part two： Trainees were trained for placement of Swan-Ganz catheter after the sheath had been success- fully intubated into pig＇s right jugular vein. Trainees were trained for placement of femoral artery guided by ultrasound. Scores related to trainees＇ performance were written down. Results （ 1 ） Monitoring data （ABP, SV, SVV, CVP, PetCO2, PAP, SpO2, ECG） changes were significantly（ P 〈0. 05 or P 〈 0. 01 ）, which indicated that the models had been successfully established. The evaluation scale displays： 81.3% of trainees thought this research improved their under- tanding of hemodynamic changes; 78.2% thought that it helped them know how to deal with these circumstances; 71.9% thought this training was meaningful. （2） It was improved for students＇ skill to place Swan-Ganz catheter （P 〈 0. 05 ）, whereas the skill for placement of artery catheter by ultrasound was not significantly improved （ P 〉 0. 05 ）. Conelusion It was feasible to use a hemodynamic model of miniature pigs as an assisted teaching method to improve resident anesthesiologists＇ ability to understand and cope with clinical hemodynamic changes.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2013年第41期3302-3305,共4页
National Medical Journal of China
关键词
小型猪
血流动力学模型
麻醉
住院医师的培养
Miniature pigs
Hemodynamic model
Anesthesia
Education of resident anesthesiologists
