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[人工耳蜗植入学习曲线的研究]

[Investigate of the learning curve of cochlear implantation].

作者信息

Tang Jun, Tan Songhua, Fang Qin, Miao Wenjie, Tang Anzhou

机构信息

Department of Otorhinolaryngology Head and Neck Surgery, First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China.

Department of Otorhinolaryngology Head and Neck Surgery, First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China. Email:

出版信息

Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2014 Aug;49(8):649-53.

Abstract

OBJECTIVE

To investigate the learning curve of cochlear implantation and its guiding significance for clinical surgery.

METHODS

A retrospective analysis of the clinical data of two otologists in early cochlear implant surgeries, including 98 cases of Dr. A and 54 cases of Dr. B.Statistics of the two doctors incidence of complications and operating time. Operation time as index were drawing a, b two groups of cases of scatter plot, the oscillating sine curve model Y = sin(X)-P/2 and logarithmic curve model Y = b1ln(X)+b0 curve fit were analyzed. Then, extract the early 90 cases of surgery by Dr. A which was divided into a, b, c three groups with 30 cases a group. The operating time and complications were further compared and analyzed(SPSS 16.0).

RESULTS

From the operation sequence,A and B physicians, early operation cases cost more operating time, and more complications.Learning curve before and after about 30 cases appeared inflection point, showing a rapid decline in period (learning phase) and slow decline period (consolidation phase) in two stages.Group contrast to Dr. A's early 90 consecutive cases, the operating time of Phase b and Phase c decreased significantly than Phase a (P(a-b) < 0.01, P(a-c) < 0.01), while there was no significant difference between group Phase b and Phase c (P(b-c) = 0.68), the complication rate of Phase b and Phase c decreased significantly than Phase a (P(a-b) < 0.01, P(a-c) < 0.01), while there was no significant difference between group Phase b and Phase c (P(b-c) = 0.15).

CONCLUSIONS

Our department of cochlear implantation followed the learning curve rule. The minimum number of cases that should accumulate in the learning phase needs about 30 cases.

摘要

目的

探讨人工耳蜗植入术的学习曲线及其对临床手术的指导意义。

方法

回顾性分析两位耳科医生早期人工耳蜗植入手术的临床资料,其中A医生98例,B医生54例。统计两位医生的并发症发生率及手术时间。以手术时间为指标绘制a、b两组病例的散点图,分别采用振荡正弦曲线模型Y = sin(X)-P/2和对数曲线模型Y = b1ln(X)+b0进行曲线拟合分析。然后,选取A医生早期的90例手术病例,分为a、b、c三组,每组30例。进一步比较分析手术时间及并发症情况(SPSS 16.0)。

结果

从手术顺序来看,A、B两位医生早期手术病例的手术时间较长,并发症较多。学习曲线在大约30例前后出现拐点,呈现出快速下降期(学习阶段)和缓慢下降期(巩固阶段)两个阶段。对比A医生的90例连续早期病例,b组和c组的手术时间较a组显著缩短(P(a-b) < 0.01,P(a-c) < 0.01),而b组和c组之间差异无统计学意义(P(b-c) = 0.68);b组和c组的并发症发生率较a组显著降低(P(a-b) < 0.01,P(a-c) < 0.01),而b组和c组之间差异无统计学意义(P(b-c) = 0.15)。

结论

本科室人工耳蜗植入术遵循学习曲线规律。学习阶段积累的最少病例数约需30例。

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