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| 1 | 超声评估A型主动脉夹层术后膈肌功能不全:发生率、危险因素及对预后的影响显示文摘目的应用床旁超声技术评估StanfordA型主动脉夹层术后膈肌功能不全的发生情况,分析膈肌功能不全可能的危险因素以及对患者预后的影响。方法前瞻性收集2017年2月至5月入住复旦大学附属中山医院心脏外科监护室的成人升主动脉+全/半弓置换+降主动脉象鼻支架术后患者。行脱机试验时(T管脱机)应用床旁超声技术测量患者双侧膈肌位移,根据膈肌位移情况将其分成两组:膈肌功能不全组及膈肌功能正常组。比较两组患者基线资料、手术相关情况及预后指标。结果本研究共入组42例患者,其中膈肌功能不全组32例,膈肌功能正常组10例。与膈肌功能正常组相比,膈肌功能不全组患者患侧膈肌位移明显减小[(0.450±0.331)cmvs.(1.801±0.616)cm,P〈0.01],健侧膈肌位移无明显变化[(2.013±0.655)cmvs.(1.801±0.616)cm,P=0.2541,此外,膈肌功能不全组患者膈肌厚度无明显变化[(0.184±0.028)cmw.(0.189±0.028)cm,P=0.559],而膈肌厚度变异率明显下降[(4.67%±3.63)%vs.(23.58%±10.69)%,P〈0.01],同时呼吸频率明显增快[(24.13±4.98)次/minvs.(20.50±3.17)次/min,P=0.037]。膈肌功能不全组患者阻断时间[(121.78±27.75)minvs.(93.10±18.84)min,P=0.004]、体外时间[(208.09±32.78)minvs.(182.70±24.38)min,P=0.03]明显延长,进一步二元logistic分析发现阻断时间延长是膈肌功能不全的高危因素;两组患者术后机械通气时间(88hvs.37h,P=0.194)差异无统计学意义,但膈肌功能不全组患者NIV使用率(46.88%vs.10%,P=0.036)显著增加。其他预后指标如术后并发症、病死率及住ICU时间两组患者差异无统计学意义。结论StanfordA型主动脉夹层术后膈肌功能不全较常见,高危因素为阻断时间延长。术后拔除口插管后序贯无创机械通气的治疗方案是可行的。 | 郝光伟 俞颖 马国光 侯君谊 杨晓梅 贺黉裕 屠国伟 罗哲 | 2018 | 中华急诊医学杂志2018，27，8： | 4 |
| 2 | Ultrasound curriculum taught by first-year medical students: A four-year experience in Tanzania显示文摘BACKGROUND: Diagnostic imaging is an integral aspect of care that is often insufficient, if not altogether absent, in rural and remote regions of low to middle income countries(LMICs) such as Tanzania. The introduction of ultrasound can significantly impact treatment in these countries due to its portability, low cost, safety, and usefulness in various medical assessments. This study reviews the implementation of a four-week ultrasound course administered annually from 2013–2016 in a healthcare professional school in Mwanza, Tanzania by first-year allopathic US medical students.METHODS: Participants(n=582, over 4 years) were recruited from the Tandabui Institute of Health Sciences and Technology to take the ultrasound course. Subjects were predominantly clinical officer students, but other participants included other healthcare professional students, practicing healthcare professionals, and school employees. Data collected includes pre-course examination scores, post-course examination scores, course quiz scores, demographic surveys, and postcourse feedback surveys. Data was analyzed using two-tailed t-tests and the single factor analysis of variance(ANOVA).RESULTS: For all participants who completed both the pre-and post-course examinations(n=229, 39.1% of the total recruited), there was a significant mean improvement in their ultrasound knowledge of 42.5%, P<0.01.CONCLUSION: Our data suggests that trained first-year medical students can effectively teach a point of care ultrasound course to healthcare professional students within four weeks in Tanzania. Future investigation into the level of long-term knowledge retention, impact of ultrasound training on knowledge of human anatomy and diagnostic capabilities, and how expansion of an ultrasound curriculum has impacted access to care in rural Tanzania is warranted. | Scan P. Denny William B. Mintccr Rcccc T.H. Fcnning Sahil Aggarwal Dcbora H. Lee Shclla K. Raja Kaavya R. Raman Allison O. Farfcl Priya A. Patcl MarkLicbcr Mcgan E. Bcrnstcin Shadi Lahham John C. Fox | 2018 | World Journal of Emergency Medicine2018，9，1： | 2 |
| 3 | A comparison of simulation versus didactics for teaching ultrasound to Swiss medical students显示文摘BACKGROUND: Point-of-care ultrasound is an increasingly common imaging modality that is used in a variety of clinical settings. Understanding how to most effectively teach ultrasound is important to ensure that medical students learn pre-clinical content in a manner that promotes retention and clinical competence. We aim to assess the effectiveness of simulation-based ultrasound education in improving medical student competence in physiology in comparison to a traditional didactic ultrasound curriculum. METHODS: Subjects were given a pre and post-test of physiology questions. Subjects were taught various ultrasound techniques via 7 hours of lectures over two days. The control group received 2 additional hours of practice time while the experimental group received 2 hours of case-based simulations. A physiology post-test was administered to all students to complete the two-day course. RESULTS: Totally 115 Swiss medical students were enrolled in our study. The mean precourse ultrasound exam score was 39.5% for the simulation group and 41.6% for the didactic group (P>0.05). The mean pre-course physiology exam score was 54.1% for the simulation group and 59.3% for the didactic group (P>0.05). The simulation group showed statistically significant improvement on the physiology exam, improving from 54.1% to 75.3%(P<0.01). The didactic group also showed statistically signifi cant improvement on the physiology exam, improving from 59.3% to 70.0%(P<0.01). CONCLUSION: Our data indicates that both simulation curriculum and standard didactic curriculum can be used to teach ultrasound. Simulation based training showed statistically signifi cant improvement in physiology learning when compared to standard didactic curriculum. | Sagar Shah Steven Tohmasi Emily Frisch Amanda Anderson Roy Almog Shadi Lahham Roland Bingisser John C. Fox | 2019 | World Journal of Emergency Medicine2019，10，3： | 1 |
| 4 | 急性Stanford A型主动脉夹层术后膈肌功能障碍的临床研究显示文摘目的明确急性Stanford A型主动脉夹层(ATAAD)术后合并心功能不全的患者中膈肌功能障碍的发生情况及其对呼吸机撤机的影响。方法采用前瞻性研究,入选2019年1月—2021年9月入住南京医科大学附属南京医院行孙氏手术且合并心功能不全(左室射血分数<55%)的ATAAD患者43例,术后应用床旁超声测定膈肌增厚率(DTF)及膈肌移动度,根据DTF分为膈肌功能正常组及障碍组,观察对比两组患者基线资料、手术相关指标及机械通气相关临床预后等指标。结果纳入研究的ATAAD患者中膈肌功能障碍(DTF<20%)29例,发生率为67.4%(29/43)。与正常组相比,障碍组平均DTF明显小于正常组(P<0.001),平静呼气末移动度及最大呼气末移动度均小于正常组(P<0.001)。两组患者术后左室射血分数及正性肌力药物的应用情况均无统计学差异。与膈肌功能正常组相比,障碍组主动脉阻断时间(P=0.001)及体外循环时间(P=0.002)更长,而两组之间的手术时间无明显差异,膈肌功能障碍组的机械通气时间较正常组延长(P<0.001),且住ICU时间也明显延长(P=0.011)。拔管后无创辅助通气的比例、再次气管插管的比例及行气管切开术的比例,两组之间均无统计学差异。结论膈肌功能障碍在ATAAD术后合并左心功能不全的患者中发生普遍,且与机械通气时间、住ICU时间相关,以超声评价其膈肌功能简便可行,并对术后撤机具有预测及指导价值。 | 李静 沈骁 孙加奎 孙芳 薛寅莹 章文豪 章淬 | 2022 | 心血管病学进展2022，43，7： | 1 |
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