生物医学工程学杂志

生物医学工程学杂志

新型心脏外科手术模拟训练系统的设计与评估

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手术训练系统可以模拟手术环境,提高受训人员的操作技能。本文设计了一种新型的心脏外科手术模拟训练系统,并选择离体猪心脏作为心脏外科手术模拟训练系统的心脏模型,通过设计机械运动装置来实现心脏模型的跳动,同时可调整机械结构运动的频率来改变心脏模型的跳动频率。为验证该系统的合理性,将 12 名非医学专业学生与 12 名医学专业学生分为两组,使用心脏外科手术模拟训练系统进行为期 7 d 的不停跳冠脉搭桥手术训练,记录受训人员训练前后完成搭桥的时间,并由 3 名外科医生采用对象结构评价技能(OSATS)评估标准对每名学员的冠脉搭桥手术训练结果进行评分。通过训练,两组受训人员完成搭桥缝合的时间均显著缩短,训练前后的 OSATS 评分均得到提高。结果表明,心脏外科手术模拟训练系统在提高受训人员手术技巧、操作技能、掌握手术器械的使用等方面具有较好的训练效果。

Simulations can mimic the environment that refers to the surgery operation to improve the technical skills of the trainees. In this paper, we designed a new cardiac surgery simulative training system. The isolated pig heart was selected as the heart model. A mechanical device was designed to achieve the beating of heart model. At the same time, adjusting frequencies of mechanical movement could change the rating of heartbeat. In order to validate the rationality of the system, 12 non-medical specialty students and 12 medical specialty students were divided into two groups, which consecutively accepted seven-days of training for off-pump coronary artery bypass grafting using the cardiac surgery simulative training system. The time for completing bypass grafting before and after training were recorded. And the bridging outcomes of each trainee were assessed by 3 surgery cardiac surgeons using the object structured assessments of technical skill (OSATS) criteria. After training, each trainee could finish the bypass suturing in a shorter time than before training, and the scores of each trainee assessed by OSATS criteria were also improved. The results showed that the cardiac surgery simulative training system had better training effect in improving the surgical techniques, operation skills and proficiency of surgical instruments of trainees.

关键词: 心脏外科; 冠脉搭桥手术; 模拟与仿真; 训练与评价

Key words: cardiac surgery; coronary artery bypass grafting; modelling and simulation; training and evaluation

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1. Parker S. 人体. 左焕琛译. 上海: 上海科学技术出版社, 2010: 1-256.
2. 胡大一, 郭艺芳. 2009 年心脏病学进展. 中国实用内科杂志, 2010 (2): 99-101.
3. 陈伟伟, 高润霖, 刘力生, 等. 《中国心血管病报告 2016》概要. 中国循环杂志, 2017, 32(6): 521-530.
4. Robertson J M, Dias R D, Yule S, et al. Operating room team training with simulation: a systematic review. J Laparoendosc Adv Surg Tech A, 2017, 27(5): 475-480.
5. Bouma W, Kuijpers M, Bijleveld A, et al. A new beating-heart off-pump coronary artery bypass grafting training model. Interact Cardiovasc Thorac Surg, 2015, 20(1): 7-9.
6. Trehan K, Kemp C D, Yang S C. Simulation in cardiothoracic surgical training: where do we stand?. J Thorac Cardiovasc Surg, 2014, 147(1): 18-24, e2.
7. Ribeiro I B, Ngu J M, Gill G, et al. Development of a high fidelity pressurized porcine beating heart simulator for cardiac surgery training. Perfusion, 2017, 32(7): 568-573.
8. Valdis M, Chu M W, Schlachta C M, et al. Validation of a novel virtual reality training curriculum for robotic cardiac surgery: a randomized trial. Innovations (Phila), 2015, 10(6): 383-388.
9. 张浩, 曲丹, 徐志云. 一种心脏手术模拟训练系统, CN103310693A. 2013.
10. 郑晨, 宋成利. 多用途腹腔镜手术训练器的设计. 第二军医大学学报, 2013, 34(6): 666-670.
11. Reznick R, Regehr G, Macrae H, et al. Testing technical skill via an innovative "bench station" examination. Am J Surg, 1997, 173(3): 226-230.
12. Hilal Z, Kumpernatz A K, Rezniczek G A, et al. A randomized comparison of video demonstration versus hands-on training of medical students for vacuum delivery using Objective Structured Assessment of Technical Skills (OSATS). Medicine, 2017, 96(11): e6355.
13. Tesche L J, Feins R H, Dedmon M M, et al. Simulation experience enhances medical students' interest in cardiothoracic surgery. Ann Thorac Surg, 2010, 90(6): 1967-1974.
14. Ha U S, Lee K W, Kim S W, et al. The influence of prior laparoscopic experience on learning laparoendoscopic single site surgery: a prospective comparative preliminary study using cystorraphy in a live porcine model. BMC Urol, 2017, 17(1): 57-62.
15. 刘唐威, 刘浩, 郭盛兰, 等. 802 例正常成人超声心动图测值及其影响因素. 中国医学影像技术, 2004, 20(1): 66-69.
16. 陈小蒙, 黄永存. 猪心解剖的实践教学与探讨. 临床和实验医学杂志, 2006, 5(11): 1873.
17. 李柱国. 机械设计及理论. 北京: 科学出版社, 2003: 1-735.
18. 王苏. 直流电机PWM调速研究及单片机控制实现. 机电工程技术, 2008, 37(11): 82-84, 95.
19. Combest S, Hantler C B. Coronary artery bypass grafting (CABG). Decision Making in Anesthesiology, 2007, 4(2): 282-285.
20. Fann J I, Caffarelli A D, Georgette G, et al. Improvement in coronary anastomosis with cardiac surgery simulation. J Thorac Cardiovasc Surg, 2008, 136(6): 1486-1491.
21. Fann J I, Calhoon J H, Carpenter A J, et al. Simulation in coronary artery anastomosis early in cardiothoracic surgical residency training: the Boot Camp experience. J Thorac Cardiovasc Surg, 2010, 139(5): 1275-1281.
22. Nesbitt J C, St Julien J, Absi T S, et al. Tissue-based coronary surgery simulation: medical student deliberate practice can achieve equivalency to senior surgery residents. J Thorac Cardiovasc Surg, 2013, 145(6): 1453-1459.