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研究生:廖信明
研究生(外文):Hsin-Ming Liao
論文名稱:醫學生使用Trachway及Glidescope 在模型假人執行氣管插管之比較
論文名稱(外文):Comparison of tracheal intubation with Trachway or Glidescope by medical interns: a manikin study
指導教授:李宗賢李宗賢引用關係
學位類別:碩士
校院名稱:中山醫學大學
系所名稱:醫學研究所
學門:醫藥衛生學門
學類:醫學學類
論文種類:學術論文
論文出版年:2013
畢業學年度:101
語文別:中文
論文頁數:61
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研究目的:Trachway 影像式插管通條是一種新的插管工具,關於這種新插管工具的資訊非常有限,尤其是由初學者操作的情形,因此我們設計一個由35位實習醫學生參與的模型假人插管研究來比較Trachway 及 Glidescope 的插管結果。
研究方法:本研究經由中山醫學大學倫理委員會審查核准通過 ( 案號: CS-11226 ),且得到參與者的同意書。本研究採用一個隨機交叉式的研究設計 ( randomized crossover design ) ,參與者會在正常及模擬的困難插管兩種情境下進行假人模型的氣管插管。在口頭教導、示範及演練後,每位參與者會使用被隨機分配到的第一種插管工具,在一般的模型假人操作正常模式之下總計十次的氣管插管,之後再使用另一種插管工具在相同模式之下操作另外十次的氣管插管,每位參與者工具的使用順序是使用抽籤方式隨機決定,插管時間的定義為 : 從插管工具通過模型的門牙為開始,從螢幕上看到氣管內管通過聲門開始移除通條為結束;我們研究的變項包括:插管時間、Cormack&Lehane 分級、插管成功率、食道或氣管插管、可聽見的牙齒壓迫聲響、利用他人幫忙輔助的優化技巧,這些變項都會被記錄。在正常模式的所有插管完成後,由參與者評定自己感覺每項插管工具使用之難易程度 ( 使用Likert 量表,由 1 (最容易) 到 5 (最困難) )。模擬的困難插管也是以相同的模式進行。
研究結果:在成功率方面,兩種工具在兩種模式下都沒有達到統計學上的顯著水準;和Glidescope組相比,Trachway 組有比較短的插管時間(在正常模式14.3±5.2 vs. 19.7±9.7 秒, p<0.001; 模擬的困難插管模式13.9±5.7 vs. 15.9±7.0秒, p<0.001)、有較好的Cormack&Lehane 分級、較少的牙齒傷害、較少使用優化技巧、使用者評定較容易使用;但是,Trachway 組有比較多的食道插管的情況。這些結果在兩種模式下都是相似的。
結論: 在沒有經驗的醫學生操作之下,Trachway組比Glidescope組有較好的插管結果,並且使用者評定Trachway較容易使用。然而,運用在臨床上是否會有相同的結果,可能需要未來更多的研究來加以證實。

Trachway® Videolight Intubating Stylet is a new airway device. Information about Trachway® use by novice laryngoscopists is limited. We compared the outcome of tracheal intubation using Trachway® and Glidescope® performed by 35 medical interns.
Methods
This study was approved by the Institutional Review Board of Chung Shan Medical University Hospital and written informed consent was obtained from each participants. A randomized crossover design was utilized in this study. The participants performed tracheal intubations in two scenarios: normal and simulated difficult airways. Following oral instructions and a demonstration, each participant performed 10 tracheal intubations with the first device and then another 10 tracheal intubations with the other device in a normal scenario. The order of device used was randomized. Intubation time was defined as the time from insertion of the device into the mouth till the tracheal tube passed through the vocal cord as seen on the monitor. Variables studied included the followings: intubation time, the Cormack Lehane grade, successful rates, esophageal or tracheal intubation, audible dental clicking sound (indicating excessive force by the blade on the teeth) and utilization of optimization maneuvers. Thereafter, the interns rated the ease or difficulty of intubation using the Likert scale from 1 (easiest) to 5 (most difficult). Tracheal intubations in a simulated difficult airway scenario were performed in the same fashion.
Results and discussion
There was no significant difference in the success rate in both scenarios. Compared to the Glidescope group, the Trachway group had a shorter intubation time (14.3±5.2 vs. 19.7±9.7 seconds in a normal scenario, p<0.001; 13.9±5.7 vs. 15.9±7.0 seconds in a simulated difficult airway scenario, p<0.001), a better laryngoscopic view, less dental trauma, fewer optimization maneuvers and was ranked higher for ease of use. However, the Trachway group had more esophageal intubations. These findings were similar in both normal and simulated difficult airways.
We found that participants spent less time to complete intubation in the difficult scenario than in the normal scenario, especially in the Glidescope group. We thought it might be a carryover effect resulting from the learning sequence and that more practice with Glidescope was probably needed than Trachway to achieve a similar intubation performance. Repeat measure ANOVA revealed different intubation device and the number of intubation attempts both had a significant effect on intubation time. The interaction between intubation device and number of intubation attempts did not reach statistical significance.
In conclusion, the Trachway group had better intubation results than the Glidescope group in the novice operators, and Trachway was rated as easier to intubate, especially in difficult airways.

目錄
中文摘要 Ⅰ
Abstract III
第一章 緒論
第一節 研究背景與動機 1
1. 氣管插管 1
1-1氣管插管適應 2
1-2氣管插管用物準備 3
1-3 快速麻醉插管 6
2. 困難插管 8
2-1 困難插管的定義 8
2-2 困難插管的因素 9
2-3困難插管的評估方式 10
2-4困難插管的處理流程 13
3. 臨床上的問題 14
4. 動機 15
第二節 研究目的 16
第二章 文獻探討 17
第一節 氣管插管處置及重要性 17
第二節 名詞界定 20
第三章 研究設計及方法 22
第一節 研究對象 22
第二節 研究架構 23
第三節 研究工具與資料分析方法 25
第四章 研究結果 30
第五章 討論 33
第六章 結論 37
第七章 研究的限制 38
參考文獻 39
圖表 43
附圖 48
附表 55
表目錄
表1 Demographic data of participants 43
表2 Comparison between the two groups in normal airway scenario 44
表3 Comparison between the two groups in normal airway scenario 45
圖目錄
圖1 Glidescope組及Trachway組每一次插管的平均時間 --
normal airway 46
圖 2 Glidescope組及Trachway組每一次插管的平均時間 --
difficult airway 47
附圖目錄
附圖一. 氣管內管放置stylet 48
附圖二. Mallampati test and Laryngoscopic view 49
附圖三. Difficult airway algorithm 50
附圖四. Glidescope 照片 51
附圖五. Trachway 照片 52
附圖六. Cormack-Lehan laryngoscopic view 53
附圖七. Flow chart of the study 54
附表目錄
附表一. 氣管插管適應症 55
附表二. 口管氣管內管的大小選擇 56
附表三. Conditions associated with difficult intubations 57
附表四. Wilson risk factor scoring system for difficult
Intubation 58
附表五. 麻醉科實習醫師插管教學紀錄表—normal airway 59
附表六. 麻醉科實習醫師插管教學紀錄表—difficult airway 60
附表七. 比較連續變項的平均數的樣本數t-test 61

參考文獻
References
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