Chao Anne, Chou Wei-Han, Huang Hsing-Hao, Yeh Yu-Chang, Lin Chen-Jung
Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan.
Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan.
J Formos Med Assoc. 2015 Sep;114(9):855-9. doi: 10.1016/j.jfma.2013.07.019. Epub 2013 Sep 7.
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.
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.
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% CI 0.23-0.24) and grade (OR = 0.57 for each increase in grade; 95% CI 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.
Medical students acquired the ability of tracheal intubation and overcame major challenges through cumulative clinical practice of the procedure.
背景/目的：气管插管是一项挽救生命的关键侵入性操作。医学生通常在麻醉科轮转期间在手术室获得气管插管操作技能。在本研究中，我们旨在描述医学生气管插管技能的习得情况。
我们回顾性分析了2011年1月至2012年6月间在我科完成3 - 4周轮转的94名医学生的日志。
94名学生共进行了934次气管插管。插管成功率为76.7%。在对年龄、体重指数、马兰帕蒂分级和年级、美国麻醉医师协会（ASA）评分以及手术类别进行校正后，气管插管成功的优势比随着累积实践而提高[每次额外进行一次插管的优势比（OR）= 1.05；95%置信区间（CI）1.00 - 1.09]。相比之下，随着马兰帕蒂分级（每升高一级OR = 0.32；95% CI 0.23 - 0.24）和年级（每升高一级OR = 0.57；95% CI 0.39 - 0.84）的升高，成功率显著降低。插管失败的主要原因（57%）是由于喉镜位置放置欠佳导致声带视野不佳。学生对气管插管能力的满意度和信心随着每次额外操作而增加，但在多次尝试失败和出现任何并发症后显著下降。
医学生通过该操作的累积临床实践获得了气管插管能力并克服了主要挑战。
