March J A, Farrow J L, Brown L H, Dunn K A, Perkins P K
Pitt County Memorial Hospital, East Carolina University School of Medicine, Department of Emergency Medicine, Greenville, North Carolina, USA.
Prehosp Emerg Care. 1997 Oct-Dec;1(4):269-72. doi: 10.1080/10903129708958822.
The widespread use of orotracheal intubation with rapid-sequence induction has made it difficult for emergency medical services (EMS) professionals to gain experience in nasotracheal intubation (NTI) in a controlled and supervised setting. The purpose of this study was to determine whether a training session on NTI with a breathing manikin can be used to improve the self-assessed skill level and comfort of EMS professionals.
A prospective trial was conducted with a convenience sample of 33 EMS professionals, previously trained in NTI techniques. For the training session, a Laerdal airway manikin was modified by replacing the lungs with self-inflating resuscitation bag. The bag could then be squeezed to simulate breathing, with an inspiratory and expiratory phase. Following didactic instruction, and with direct supervision, each participant practiced NTI using this breathing manikin. Each participant completed a questionnaire, both before and after the training session, to determine self-assessed comfort and skill level for both oral and nasal intubations (0 = lowest, 10 = highest). The pre- and postintervention scores were compared using the Wilcoxon signed-rank test, alpha = 0.01.
Following the training session, the comfort level for NTI by the participants increased significantly from a median value of 2 to 7 (p = 0.001). Furthermore, the self-assessed skill level for NTI following the training session increased significantly from a median value of 4 to 8 (p = 0.0001). As expected, there were no significant differences noted in self-assessed skill level for orotracheal intubation following the training session. However, there was statistically significant improvement in self-assessed comfort levels for orotracheal intubation after the skills laboratory, p = 0.0001.
For EMS professionals, a training session for NTI using a relatively inexpensive and easily assembled breathing manikin model increases both comfort and self-assessed skill level.
经口气管插管配合快速诱导的广泛应用，使得急救医疗服务（EMS）专业人员难以在可控且有监督的环境中积累经鼻气管插管（NTI）的经验。本研究的目的是确定使用带呼吸人体模型的NTI培训课程是否可用于提高EMS专业人员的自我评估技能水平和舒适度。
对33名先前接受过NTI技术培训的EMS专业人员进行便利抽样，开展一项前瞻性试验。在培训课程中，对Laerdal气道人体模型进行了改造，用自动充气复苏袋替换了肺部。然后可以挤压袋子来模拟呼吸，包括吸气和呼气阶段。在进行理论指导并在直接监督下，每位参与者使用这个带呼吸的人体模型练习NTI。每位参与者在培训课程前后都完成了一份问卷，以确定其对经口和经鼻插管的自我评估舒适度和技能水平（0 = 最低，10 = 最高）。使用Wilcoxon符号秩检验比较干预前后的分数，α = 0.01。
培训课程后，参与者进行NTI的舒适度从中位数2显著提高到7（p = 0.001）。此外，培训课程后NTI的自我评估技能水平从中位数4显著提高到8（p = 0.0001）。正如预期的那样，培训课程后经口气管插管的自我评估技能水平没有显著差异。然而，技能实验室培训后经口气管插管的自我评估舒适度有统计学显著提高，p = 0.0001。
对于EMS专业人员，使用相对便宜且易于组装的带呼吸人体模型进行NTI培训课程可提高舒适度和自我评估技能水平。
