評估使用喉頭鏡併用軟式支氣管鏡對氣管插管的學習效果

Evaluation of Learning Effectiveness in Endotracheal Intubation by the Use of a Laryngoscope in Combination with a Flexible Fiberoptic Bronchoscope

背景：插管過程中，食道插管可能造成患者死亡的嚴重合併症。對於未曾插管過的學習者插管時發生食道插管的機率更多。因此我們使用傳統的喉頭鏡葉片併上軟式支氣管鏡的新方法來教導新的學習者插管。我們使用這種新的插管教學法與傳統的插管教學法做比較。方法：我們以到本科實習的實習醫師為研究對象。每位實習醫師皆有6次的氣管插管機會。在相同主治醫師的指導下，4次是傳統的氣管插管教學方式(T)，2次則是新的教學方法(N)。實習醫師隨機分成三組，第一組採用的插管順序是TTTNN，第二組是TTNNTT及第三組是NNTTTT。我們使用插管成功失敗做為評估的結果。並以卡方檢定為統計評估的方法。結果：4年內有84位實習醫師對患者共執行504次氣管插管。使用新的氣管插管教學法有91.7％的成功率而傳統的教學法有78.9％的成功率(P < 0.05)。在教學上以新的氣管教學法開始的第三組有最高的插管成功率及較高的受教較滿意度。在85次插管失敗的原因中，82.4％是氣管插管時間超過1分鐘，15.3％是食道插管，2.3％是牙齒傷害或口腔傷害。結論：使用新的氣管插管教法，指導者可以教的比較輕鬆而學習者有較高的成功率及較好的學習效果。除此之外食道插管的發生率可以減到最低並增加氣管插管的成功率。

Background: Accidental esophageal intubation may cause lethal complications when undetected. We developed a laryngoscope, which utilizes a laryngoscope blade incorporating with a flexible fiberoptic bronchoscope for teaching new learners. We compared two teaching methods, i.e. the traditional method and the new method we contemplated, for teaching new interns. Methods: We selected new interns as our study group. Everyone had six turns, four of which for the traditional method (T) and two of which for the new method (N), to perform the procedure under the guidance of a teaching supervisor. The interns were assigned randomly to one of three groups. Group 1 used the series of TTTTNN; group 2, TTNNTT; and group 3, NNTTTT. We used success or failure of intubation as the result of our evaluation. Statistical analyses were performed by chi-square test. Results: 84 interns performed 504 endotracheal intubation trials during a period of 4 years. There was a 91.7% success rate with the new method and a 78.9% success rate with the traditional technique (P < 0.05). The group to which the new method was initially taught achieved the highest success rate of intubation and the greatest feeling of satisfaction according to a self-evaluation record. Of the failed intubations, 82.4% were due to performing the procedure in more than one minute, 15.3% due to esophageal intubation and the remaining 2.3% due to contact bleeding of teeth or oral trauma. Conclusions: By using the new teaching method, the supervisor could easily teach and assess the success of the new learners. Besides, esophageal intubation could be reduced to a minimum with subsequent increase of success rate.