一种用于气管造口术教学的多功能低成本动物模型的制作
1Physiology and Experimental Surgery, Department of Translational Medicine,Università del Piemonte Orientale, 2Centro Interdipartimentale di Didattica Innovativa e di Simulazione in Medicina e Professioni Sanitarie – SIMNOVA,Università del Piemonte Orientale, 3Section of Anesthesia and Intensive Care, Azienda Ospedaliera Maggiore della Carità,Università del Piemonte Orientale, 4Section of ENT, Azienda Ospedaliera Maggiore della Carità, Department of Health Sciences,Università del Piemonte Orientale, 5Section of General Surgery Department of Health of Sciences, Azienda Ospedaliera Maggiore della Carità,Università del Piemonte Orientale, 6Department of Education,Azienda Ospedaliera Maggiore della Carità
Summary
本文阐述了一种新型的多用途低成本动物基准模型的制造的每一个步骤, 用于声门下气道接入管理。视频中显示了所有的程序。该模型的真实性及其对训练特定临床动作的适用性, 由独立的高级耳鼻喉科医生和麻醉师进行了评估。
Abstract
气管造口术是最常见的程序之一, 通过各种技术在重症监护室和紧急情况下进行。尽管如此, 缺乏对这一程序的培训, 影响了其结果, 这也取决于操作人员的灵活性。在这里, 我们考虑到了具体的培训和模拟。本文旨在描述在视频和图像的支持下, 制造一种新的多功能低成本动物基准模型的每一步, 并通过向专业人员管理一份调查问卷, 获得对该模型质量的意见。在程序方面的经验。
10名技术专家参加了考试。该模型的解剖现实主义得分平均为 3.45/5;4.75/5 作为模拟课程和评估的培训工具的有用性。建立模型所需的时间为 15分钟, 费用为10€。动物基准模型被认为是一个非常有用的模拟器气管造口术的训练和评估。因此, 它可以作为医学课程和居住的工具。
Introduction
对于每一位处理危重、患病和急诊患者的医生来说, 气道管理困难是一项关键技能。2013年发表的一篇评论估计, 使用手术气道技术 “不能通风, 不能插管” 的发病率从0到 18.5%1不等。
气管造口术是最古老的外科手术之一, 被广泛用作需要长时间人工通气的患者的声下气道下通道通道访问的首选方法。它最初是在手术室进行的, 在许多医院, 特别是重症监护室 (ICU)2,已经成为日常的练习床头。介绍了几种技术, 包括外科 (ST) 和经皮气管造口术 (PCT)。气管造口术已被广泛报道具有较高的并发症发生率。一项国家审计报告说, 在重症监护室, 50% 的与飞行有关的死亡或脑损伤是由气管造口并发症造成的3。通常, 高并发症发生率反映出对技术不熟悉和培训不足。
另一种在术中进入气道的方法是进行环磷酰手术 (ct), 这被广泛认为是一种策略, 以应对 “不能通风, 不能插管“ 的情况, 无论是在院前和医院内护理4. 在气道衰竭的患者中, 负责气道管理的临床医生必须熟悉该技术, 这是一种快速且有可能挽救生命的回退操作。因此, 实践和培训发挥着关键作用, 因为它的成功取决于操作员的灵活性5。然而, 由于过去几十年气道管理的改善, 气管切开术和紧急手术气道的需求有所下降。这导致缺乏临床经验, 减少了对这种挽救生命的技术的接触, 这可能对手术质量产生不利影响, 最终影响6、7 人患者的安全。
目前, 仿真是培养医疗和手术技能的一种常见而有效的教学方法, 尤其是对正在学习新能力的新手来说, 是 8,9。仿真可以重现临床程序或情况, 为受训者提供第一手接触临床场景和复杂的技术, 同时消除患者10的风险。
从虚拟现实到动物模型, 各种模拟器被用于训练手术气道管理11、12、13、14。据报道, 模型和人体模型的实践是麻醉学和急诊医学居民15、16 最常见的教学形式。尸体也被用来教授颈部解剖和程序技能17。然而, 所有这些备选办法的费用有时高得令人望而却步, 并可能带来伦理和道德上的制约和挑战。还为教育目的描述和建议了低成本模拟器, 但没有用于培训所有的声门下气道接入程序。
在这份手稿中, 我们描述了如何制造一个易于制作的, 低成本和高保真的基准模型, 模拟人类颈部进行旋皮切除术, 经皮和手术气管造口术及其评价。主要目的是设计一个易于制作的模型, 随时可用的材料, 以便任何人都可以简单地模仿和复制它。组装该模型的总时间约为 15分钟, 成本估算约为 10€, 包括资源和制造 (20€/h)。
Protocol
通常供人类食用的动物解剖部分是在当地的肉店购买的 (图 1)。因此, 它们可以在没有具体限制或卫生条例的情况下很容易运输和储存。 1. 清洁猪的上呼吸道 借助解剖手术刀、Adson 钳和 Metzembaum 剪刀, 通过切割和解剖, 从周围多余的组织 (侧肌、多余的舌头) 中清洁气管和喉部。 取出组织, 直到喉软骨几乎暴露, 气管环很容易触诊。 ?…
Representative Results
我们评估了易于制造的、低成本和高保真的基准模型的可行性和可接受性, 该模型模拟了人类颈部作为环状甲状腺切除术、经皮和手术气管造口术训练的工具。在回顾了当前外科教学中模拟的文献后, 设计了一种测量仪器。调查问卷包括以下内容会议:a. 与会者的一般数据和人口统计数据;b. 基准模型的保真度;c. 经皮切除术、经皮和手术气管造口术是否适合由制造的…
Discussion
所制作的低成本和高保真基准模型模拟了人的颈部, 并使手术切除术、经皮和手术气管造口术成为可能。由耳鼻喉科资深医生和麻醉师进行的设计调查评估了该模型在多大程度上复制了颈部的物理特性及其是否适合训练给定的声室下气道访问程序。
一些自制的模型或模拟器已经被报道, 我们试图克服它们的局限性。Netto 等18 人提出的猪模型缺乏皮肤和气管之?…
Divulgazioni
The authors have nothing to disclose.
Acknowledgements
作者感谢诺瓦拉的 Azienda Ospedaliera 大学 Maggiore della Carità的帮助。
Materials
| Foam | BRICOSELF ITALIA, vercelli | na | Used to stabilyze the model on the wooden tablet |
| Insuline Syringe | na | na | Used to draw linea alba with india ink |
| Pig Esophagus | Butcher shop (Il mercato carni, di Dutto Srl. – 28100, Novara (Italy) | na | Wet material used to build the simulated muscular layers and fascia |
| Pig skin | Butcher shop (Il mercato carni, di Dutto Srl. – 28100, Novara (Italy) | na | Wet material used to obtain the simulated skin |
| Pig thymus | Butcher shop (Il mercato carni, di Dutto Srl. – 28100, Novara (Italy) | na | Wet material used to build the simulated thyroid |
| SILK suture – Vetsuture SILK 2/0 (Metric 3) Ago 3/8 30mm Reverse Cutting (12 pz) | Sanitalia Care Srl | SILK2CN | Sutures to tight all the parts of the model |
| Surgical instruments scissors, forceps, knife, needle holder | na | na | na |
| Swine upper airways | Butcher shop (Il mercato carni, di Dutto Srl. – 28100, Novara (Italy) | na | Wet material used to build the model |
| white india ink - pelikan 10ml | Cartoleria Manzoni di Lo Monaco Rosaria s.a.s. 97019 Vittoria, Italy | 36340 | Ink used to mark the linea alba on the esophagus |
| Wood stapler | BRICOSELF ITALIA, vercelli | na | Used to staple on the model |
| Wooden tablet | BRICOSELF ITALIA, vercelli | na | Used to stabilyze the model with the stapler |
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Citazione di questo articolo
Sacco Botto, F., Ingrassia, P. L., Donato, P., Garzaro, M., Aluffi, P., Gentilli, S., Olina, M., Grossini, E. Manufacture of a Multi-Purpose Low-Cost Animal Bench-Model for Teaching Tracheostomy. J. Vis. Exp. (147), e59396, doi:10.3791/59396 (2019).