The learing curve for intraoperative echocardiography during congenital heart surgery
The learing curve for intraoperative echocardiography during congenital heart surgery
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先天性心脏病手术术中超声心动图学习曲线
DOI：
10.1016/0003-4975(92)91013-y
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发表时间：
1992
期刊：
影响因子：
--
通讯作者：
J. Kisslo
中科院分区：
文献类型：
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作者：
R. Ungerleider;W. Greeley;R. Kanter;J. Kisslo
我们的研究小组先前已经报道了在先天性心脏病修补术中使用术中超声心动图和多普勒彩色血流成像（IE-DCFI）的大量前瞻性经验。我们现在已经在621例患者中进行了IE-DCFI，并观察到这项技术的影响发生了重大变化，在我们最近的经验中（最后207例患者）已经稳定下来。为了评估IE-DCFI的手术学习曲线，我们将患者分为三组：第1组，患者1 - 207;第2组，患者208 - 414;第3组，患者415 - 621。在年龄或疾病实体方面，两组之间没有重大差异。进行IE-DCFI检查所需的平均时间从第1组的3.75 ± 1.77分钟降至第2组的3.35 ± 1.52分钟，并保持稳定。需要在手术室进行翻修的患者数量（基于IE-DCFI结果）从第1组的17例（8%）降至第2组的7例（3%），再降至第3组的5例（2%）。此外，第2组和第3组的翻修成功率为100%，而第1组中18%的患者离开手术室时，IE-DCFI显示存在持续残留缺损。外科医生可以获得自己解释IE-DCFI结果的能力，并使用它来增强先天性心脏病的手术修复，但这需要至少200例的经验。一旦技能得到完善，该技术将确定2%至3%的患者在离开手术室之前将从手术翻修中受益，并将指导该翻修。当我们学会更准确地评估IE-DCFI数据时，没有IE-DCFI识别问题的患者离开手术室的良好结局的可能性从第1组的88%提高到第2组的95%，再到第3组的97%。
Our group has previously reported a large prospective experience with the use of intraoperative echocardiography with Doppler color-flow imaging (IE-DCFI) during the repair of congenital heart defects. We have now performed IE-DCFI in 621 patients and have observed a major change in the impact of this technology, which has stabilized during our most recent experience (the last 207 patients). To evaluate the surgical learning curve with IE-DCFI, we divided patients into three groups: group 1, patients 1 through 207; group 2, patients 208 through 414; and group 3, patients 415 through 621. There were no major differences between groups with respect to age or disease entities. The average time needed to perform an IE-DCFI examination decreased from 3.75 ± 1.77 minutes in group 1 to 3.35 ± 1.52 minutes in group 2 and has remained stable. The number of patients requiring revisions in the operating room (based on IE-DCFI findings) decreased from 17 (8%) in group 1 to 7 (3%) in group 2 to 5 (2%) in group 3. Furthermore, revisions were 100% successful in correcting the problem in groups 2 and 3, whereas 18% of group 1 patients left the operating room with persistent residual defects by IE-DCFI. Surgeons can acquire the ability to interpret the results of IE-DCFI themselves and use it to enhance their operative repair of congenital heart defects, but this requires an experience of at least 200 cases. Once skills are refined, the technique will identify 2% to 3% of patients who would benefit from operative revision before leaving the operating room and will direct that revision. As we learned to more accurately evaluate IE-DCFI data, the likelihood of a good outcome for patients leaving the operating room without IE-DCFI-identified problems improved from 88% in group 1 to 95% in group 2 to 97% in group 3.
术中常规使用心外膜超声心动图和多普勒彩色血流成像来指导和评估先天性心脏病病变的修复情况。
DOI：
--
发表时间：
1990
期刊：
The Journal of thoracic and cardiovascular surgery
影响因子：
--
作者：
Ungerleider,RM;Greeley,WJ;Sheikh,KH;Philips,J;Pearce,FB;Kern,FH;Kisslo,JA
通讯作者：
Kisslo,JA