术中床旁经胸超声心动图检查：可行性及对教育的意义
Intraoperative Point of Care Transthoracic Echocardiography: Feasibility and Implications for Education.
作者信息
Curley Jonathan M, Guerra Jessica L, Garmon Emily H, Tsang Siny, Lilie Craig J, Culp William C
机构信息
The following authors are at the University of Virginia, Charlottesville, VA: Jonathan M. Curley is an Assistant Professor of Anesthesiology in the Department of Anesthesiology and Critical Care Medicine; and Siny Tsang is a Biostatistician in the Department of Anesthesiology. The following authors are at Baylor Scott & White Medical Center, Baylor College of Medicine, Temple, TX: Jessica L. Guerra is a Cardiothoracic Anesthesiology Fellow; Emily H. Garmon is an Associate Professor of Anesthesiology; Craig J. Lilie is an Assistant Professor of Anesthesiology; and William C. Culp, Jr. is a Professor of Anesthesiology.
出版信息
J Educ Perioper Med. 2025 Apr 8;27(1):E735. doi: 10.46374/VolXXVII_Issue1_Curley. eCollection 2025 Jan-Mar.
BACKGROUND
Incorporating intraoperative ultrasound education into anesthesiology graduate medical training may benefit both trainees and the field of anesthesiology.
METHODS
This study describes the successful integration of intraoperative ultrasound training into an existing Focused Cardiac Ultrasound (FoCUS) curriculum. A retrospective analysis of educational logs from 4 postgraduate year 4 anesthesiology residents (exam n = 160) was conducted to determine the most accessible intraoperative FoCUS views, success rates of image acquisition by surgical region, and impact of abdominal insufflation and Trendelenburg positioning on success rates.
RESULTS
Parasternal views had the highest probability of successful image acquisition (parasternal long axis [PLA] odds ratio [OR] = 16.36 and parasternal midpapillary short axis [PSA] OR = 21.98 compared with subcostal 4-chamber [SC]). Extremity surgeries offered the highest success rates (52% for SC to 92.5% for PLA), whereas thoracic surgery had the lowest (9.1% for SC to 63.6% for PSA). Trendelenburg positioning increased the odds of successful image acquisition in PLA or PSA views (OR, 3.58; 95% confidence interval, 1.4-9.11).
CONCLUSIONS
Integrating intraoperative ultrasound education into existing FoCUS curricula is feasible. Educators should consider emphasizing parasternal views, which are the most accessible to anesthesia clinicians, consider the higher success rates in extremity surgeries for complete examinations, and recognize that Trendelenburg positioning may enhance image optimization.
背景
将术中超声教育纳入麻醉学研究生医学培训可能对学员和麻醉学领域都有益处。
方法
本研究描述了术中超声培训成功整合到现有的心脏聚焦超声（FoCUS）课程中的情况。对4名四年级麻醉学住院医师的教育日志进行回顾性分析（检查次数n = 160），以确定最易获取的术中FoCUS视图、按手术区域划分的图像采集成功率，以及腹部充气和头低脚高位对成功率的影响。
结果
胸骨旁视图的图像采集成功率最高（与肋下四腔心[SC]相比，胸骨旁长轴[PLA]优势比[OR] = 16.36，胸骨旁乳头肌短轴[PSA] OR = 21.98）。四肢手术的成功率最高（SC为52%，PLA为92.5%），而胸科手术的成功率最低（SC为9.1%，PSA为63.6%）。头低脚高位增加了PLA或PSA视图中图像采集成功的几率（OR，3.58；95%置信区间，1.4 - 9.11）。
结论
将术中超声教育整合到现有的FoCUS课程中是可行的。教育工作者应考虑强调麻醉临床医生最易获取的胸骨旁视图，考虑四肢手术在完整检查中的较高成功率，并认识到头低脚高位可能会增强图像优化效果。
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