Saied Nahel N, Helwani Mohammad, Tabakian Hagop, Srinivasan John
Department of Anesthesiology, St Louis University, School of Medicine, St Louis, MO 63110, USA.
J Cardiothorac Vasc Anesth. 2006 Oct;20(5):652-5. doi: 10.1053/j.jvca.2006.03.020. Epub 2006 Aug 9.
The purpose of this study was to determine the current teaching practice of thoracic epidural procedures in the United States and to determine the effect of the teaching sequence of thoracic and lumbar epidurals on technical difficulties and complications.
The first part was a survey, which was distributed to all American Board of Anesthesiology-accredited programs. The second part was a noninterventional retrospective review of 2,007 epidural procedures in a university teaching program.
The survey questions were designed to determine the number of epidural procedures performed monthly on various services, teaching sequence, insertion technique, indications, and service provider.
The survey received 81 responses (60%) from 134 programs; 34% of the programs placed more thoracic than lumbar epidurals, 92% of the programs placed epidurals mainly for postoperative pain control, and 88% of programs mainly teach lumbar before thoracic epidurals, whereas only 10 programs (12%) mainly teach residents thoracic before lumbar epidurals. The authors' residents were divided into 2 groups: group 1 (42 residents, 70%) who learned thoracic before lumbar epidurals and group 2 (18 residents, 30%) who learned lumbar before thoracic epidurals during their earlier obstetric anesthesia training. There were no significant differences between the 2 groups in the degree of technical difficulties or the incidence of procedure-related complications.
Thoracic epidurals are widely taught in the United States. Most programs teach lumbar before thoracic epidurals. Thoracic epidurals are safe to teach without prior experience with lumbar epidurals.
本研究旨在确定美国目前胸段硬膜外操作的教学实践，并确定胸段和腰段硬膜外操作的教学顺序对技术难度和并发症的影响。
第一部分为一项调查，发放给所有经美国麻醉学委员会认证的项目。第二部分是对某大学教学项目中2007例硬膜外操作进行的非干预性回顾性研究。
调查问卷旨在确定各科室每月进行的硬膜外操作数量、教学顺序、穿刺技术、适应证及操作执行者。
134个项目中有81个（60%）回复了调查；34%的项目胸段硬膜外操作比腰段硬膜外操作更多，92%的项目进行硬膜外操作主要是为了控制术后疼痛，88%的项目主要在腰段硬膜外操作教学之前进行胸段硬膜外操作教学，而只有10个项目（12%）主要在腰段硬膜外操作教学之前进行胸段硬膜外操作教学。作者将住院医师分为两组：第1组（42名住院医师，70%）在产科麻醉培训早期先学习胸段硬膜外操作，第2组（18名住院医师，30%）先学习腰段硬膜外操作。两组在技术难度程度或操作相关并发症发生率方面无显著差异。
在美国，胸段硬膜外操作教学广泛开展。大多数项目在胸段硬膜外操作教学之前进行腰段硬膜外操作教学。在没有腰段硬膜外操作经验的情况下进行胸段硬膜外操作教学是安全的。
