Prenner Stuart B, Wayne Diane B, Sweis Ranya N, Cohen Elaine R, Feinglass Joe M, Schimmel Daniel R
Division of Cardiology, Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Chicago, Illinois.
Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Catheter Cardiovasc Interv. 2018 May 1;91(6):1054-1059. doi: 10.1002/ccd.27203. Epub 2017 Aug 2.
The aim of this study is to determine whether simulation-based education (SBE) translates into reduced procedure time, radiation, and contrast use in actual clinical care.
As a high volume procedure often performed by novice cardiology fellows, diagnostic coronary angiography represents an excellent target for SBE. Reports of SBE in interventional cardiology are limited and there is little understanding of the potential downstream clinical impact of these interventions.
All diagnostic coronary angiograms performed at a single center between January 1, 2011 and June 30, 2015 were analyzed. Random effects linear regression models were used to compare outcomes between procedures performed by 12 cardiology fellows who underwent simulation-based training and those performed by 20 traditionally trained fellows.
Thirty-two cardiology fellows performed 2,783 diagnostic coronary angiograms. Procedures performed by fellows trained with SBE were shorter (mean of 23.98 min vs. 24.94 min, P = 0.034) and were performed with decreased radiation (mean of 56,348 mGycm vs. 66,120 mGycm , P < 0.001). After controlling for year in training, procedure year, access site, and supervising attending physician, training on the simulator was independently associated with 117 fewer seconds of fluoroscopy time per procedure (P = 0.04).
Diagnostic coronary angiography SBE is associated with decreased use of fluoroscopy in downstream clinical care. SBE may be a useful tool to reduce radiation exposure in the cardiac catheterization laboratory.
本研究旨在确定基于模拟的教育（SBE）是否能在实际临床护理中缩短手术时间、减少辐射和造影剂使用。
诊断性冠状动脉造影作为一项常由心脏病学新手进行的高工作量手术，是SBE的一个理想目标。介入心脏病学中SBE的报告有限，对这些干预措施潜在的下游临床影响了解甚少。
分析了2011年1月1日至2015年6月30日在单一中心进行的所有诊断性冠状动脉造影。使用随机效应线性回归模型比较12名接受基于模拟训练的心脏病学住院医师所进行的手术与20名传统训练的住院医师所进行的手术的结果。
32名心脏病学住院医师进行了2783例诊断性冠状动脉造影。接受SBE训练的住院医师所进行的手术时间更短（平均23.98分钟对24.94分钟，P = 0.034），且辐射量减少（平均56348毫戈瑞厘米对66120毫戈瑞厘米，P < 0.001）。在控制了培训年份、手术年份、穿刺部位和指导主治医师后，模拟器训练与每次手术的透视时间减少117秒独立相关（P = 0.04）。
诊断性冠状动脉造影SBE与下游临床护理中透视使用的减少相关。SBE可能是减少心导管实验室辐射暴露的一种有用工具。
