ORSIM模拟器提升规培医师纤支镜操作能力的实践研究

赵柏松　吴军　金赛芬　宋兴荣

[关键词] ORSIM模拟器;规培医师;纤支镜;实践研究;困难气道

[中图分类号] R-4          [文献标识码] B          [文章编号] 1673-9701（2021）22-0156-05

Research on the practice of ORSIM simulator to improve the operation ability of fiberoptic bronchoscope for standardized training physicians

ZHAO Baisong   WU Jun   JIN Saifen   SONG Xingrong

Department of Anesthesiology，Guangzhou Women and Children′s Medical Center，Guangdong，Guangzhou   510623，China

[Abstract] Difficult airway refers to the difficulty of face mask ventilation or intubation by anesthesiologists who have received professional training，and improper treatment will lead to the death of patients.Previous research has confirmed that fiberoptic bronchoscope is the most effective method to deal with difficult airway，which helps to reduce the incidence of improper airway treatment.However，it is found that anesthesiologists can′t skillfully use fiberoptic bronchoscope to deal with difficult airway.The reason is that they are short of clinically practical experience，few cases of difficult airway and emergencies.Therefore，it is impossible to give enough opportunities for standardized training physicians.Optical remote sensing imagery （ORSIM） simulator is a kind of portable virtual fiberoptic bronchoscope simulator with high simulation.Standardized training physicians with ORSIM simulator can improve their operation ability of fiberoptic bronchoscope.However，there is little research on how to train anesthesiologists to use ORSIM simulator to improve their ability to cope with difficult airway.According to this，the following scientific hypothesis is put forward.Through group training，the ORSIM simulator group is more skilled than the conventional manikin group in using fiberoptic bronchoscope.Meanwhile，the former group has lower failure rate of endotracheal intubation and can deal with difficult airway more opportunely and effectively than the latter group.This project intends to explore the optimal teaching and training scheme using ORSIM simulator and incorporate specific training methods into the anesthesia training system，so as to ultimately improve the ability of training anesthesiologists to cope with difficult airway.

[Key words] ORSIM simulator; Standardized training physicians; Fiberoptic bronchoscope; Practical research; Difficult airway

困難气道是指经过专业训练的有五年以上临床麻醉经验的麻醉科医师所经历的面罩通气困难或气管插管困难的临床情况[1]。困难气道又分为非紧急气道和紧急气道。非紧急气道：仅有困难气管插管而无困难面罩通气，患者能够维持满意的通气和氧合，能够允许有充分的时间考虑其它建立气道的方法。紧急气道：只要存在困难面罩通气，无论是否合并困难气管插管，均属紧急气道。如手术中遇到紧急型的困难气道且处理不当，患者极易陷入缺氧状态，必须紧急建立气道。其中少数患者既不能插管也不能氧合，可导致气管切开、脑损伤和死亡等严重后果。