Evaluation of tracheal intubation: A retrospective study of skill acquisition by medical students in the operating theater
Evaluation of tracheal intubation: A retrospective study of skill acquisition by medical students in the operating theater
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DOI：
10.1016/j.jfma.2013.07.019
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发表时间：
2015-09-01
影响因子：
3.2
通讯作者：
Lin, Chen-Jung
中科院分区：
文献类型：
--
作者：
Chao, Anne;Chou, Wei-Han;Lin, Chen-Jung
背景/目的：气管插管是一种关键的挽救生命的侵入性手术。医学生在麻醉科实习时，一般都要掌握在手术室进行气管插管的技巧。方法：回顾性分析2011年1月至2012年6月在我科完成3-4周轮岗的94名医学生的日志。结果：94名医学生共完成934例气管插管。插管成功率为76.7%。在调整年龄、体重指数、Mallampati分级和分级、美国麻醉学会（阿萨）评分和手术类别后，成功气管插管的比值比随着累积实践而改善[每次额外插管的比值比（OR）= 1.05; 95%置信区间（CI）1.00-1.09]。而随着Mallampati分级（OR = 0.32，95%CI 0.23-0.24）和分级（OR = 0.57，95%CI 0.39 ~ 0.84）的增加，成功率显著降低。插管失败的主要原因（57%）是由于喉镜位置的次优放置导致声带可视化不良。学生的满意度和信心的能力，进行气管插管增加了每一个额外的程序，但多次失败的尝试和任何并发症的发生后显着下降。结论：医学生获得的气管插管的能力，并克服了重大挑战，通过累积的临床实践的程序。版权所有（C）2013，爱思唯尔台湾有限公司及台湾医学会. All rights reserved.
Background/Purpose: Tracheal intubation is a critical life-saving invasive procedure. Medical students generally obtain the skill of performing tracheal intubation in the operating theater during their anesthesiology rotation. In this study, we sought to characterize medical students' skill acquisition of tracheal intubation.Methods: We retrospectively reviewed the logbooks of 94 medical students who had completed a 3-4 week rotation in our department between January 2011 and June 2012.Results: Ninety-four students performed 934 tracheal intubations. The success rate of intubation was 76.7%. After adjustment for age, body mass index, Mallampati class and grade, American Society of Anesthesiology (ASA) scores, and surgical category, the odds ratio of successful tracheal intubation improved with cumulative practice [odds ratio (OR) = 1.05 for each additional intubation performed; 95% confidence interval (CI) 1.00-1.09]. By contrast, the success rate decreased significantly with increasing scores of Mallampati class (OR = 0.32 for each increase in class; 95% Cl 0.23-0.24) and grade (OR = 0.57 for each increase in grade; 95% Cl 0.39 -0.84). The main reason for intubation failure (57%) was poor visualization of vocal cords, due to suboptimal placement of the position of the laryngoscope. The satisfaction and confidence of students regarding the ability of performing tracheal intubation increased with each additional procedure, but decreased significantly after multiple unsuccessful attempts and the occurrence of any complication.Conclusion: Medical students acquired the ability of tracheal intubation and overcame major challenges through cumulative clinical practice of the procedure. Copyright (C) 2013, Elsevier Taiwan LLC & Formosan Medical Association. All rights reserved.