时间-分段教学法与传统教学法在椎管内穿刺教学中的比较：一项随机对照试验
张 帆 （ 中南大学湘雅三医院麻醉科 ）
乐 园 （ 中南大学湘雅三医院麻醉科 ）
https://doi.org/10.37155/2705-0653-0703-39Abstract
本文旨在评估“时间-分段”（TS）教学法在椎管内穿刺教学中的有效性。106名一年级住院医师被随机 分为两组，一组接受传统教学（n = 53），另一组接受TS教学（n = 53）。传统教学包括理论讲解和模型练习；TS教 学将椎管内穿刺分为三个阶段，每个阶段设定时间限制，要求学生在规定时间内完成分配的任务。两组的课程均持续 4小时，课程结束后进行操作考核和问卷调查，询问学生进行椎管内穿刺的熟练程度、操作意愿和信心，以及对教学 的满意度。TS组在椎管内穿刺考核中的得分高于传统教学组，操作时间短于传统教学组。此外，TS组进行椎管内穿 刺的熟练程度、操作意愿和信心、对教学的满意度都高于传统教学组。因此，与传统教学方法相比，TS教学法在椎管 内穿刺教学中更有效。
Keywords
时间-分段教学；时间限制；椎管内穿刺Full Text
PDFReferences
[1]Margolis MS, DeBusk AA, Moster ML, Falardeau
JM, Eggenberger ER, Sergott RC, Van Stavern GP. Lumbar
Puncture for Diagnosis of Idiopathic Intracranial Hypertension
in Typical Patients. J Neuroophthalmol.2021;41(3):375-378.
[2]杨培中,刘永博,刘向东.颅内压监护下脑室外引流联
合腰椎穿刺治疗颅脑损伤合并外伤性蛛网膜下腔出血的
效果研究[J].中国实用医刊,2025,52(1):50-53.
[3]叶海宾,皇甫彪,李莉,白耀武.不同穿刺点椎管内麻
醉分娩镇痛对产妇产程及母婴结局的影响[J].临床误诊误
治,2025,38(1):70-74.
[4]徐文婷,杨颖,易慧琳.剖宫产术后疼痛原因和疼痛管
理方法研究进展[J].实用医技杂志,2024,31(3):219-224.
[5]Uyel Y, Kilicaslan A. Preprocedural Ultrasonography
Versus Landmark-Guided Spinal Anesthesia in Geriatric
Patients with Difficult Anatomy: A Prospective Randomized
Trial. Eurasian J Med.2021;53(1):9-14.
[6]郭高锋,豆立冬,崔明珠.肥胖孕产妇剖宫产术椎管内
麻醉时不同定位及穿刺方式效果的比较[J].中华麻醉学杂
志,2024,44(12):1470-1475.
[7]Huang C, Zhang Y, Diedrich DA, Li J, Luo W,
Zhao X, Guo Y, Luo Y, Zhang T, Wang X, Huang W, Xiao
Y. A horizontal and perpendicular interlaminar approach
for intrathecal nusinersen injection in patients with spinal
muscular atrophy and scoliosis: an observational study.
Orphanet J Rare Dis.2024;19(1):268.
[8]符丰宗.浅论进行椎管内麻醉患者常见的并发症及
处理方法[J].当代医药论丛,2015,(5):3-4.
[9]Pirenne V, Dewinter G, Van de Velde M. Spinal
anaesthesia in obstetrics. Best Pract Res Clin Anaesthesi
ol.2023;37(2):101-108.
[10]Ma J, Wang Q, Xia X, Guo Z, Feng Q, Zhou Y, Yuan H.
Inclusion of the workshop model in the standardized training ofemergency medicine residents. Heliyon.2023;9(5):e15942.
[11]Carstensen SMD, Velander MJ, Konge L,
Østergaard M, Pfeiffer Jensen M, Just SA, Terslev L.
Training and assessment of musculoskeletal ultrasound
and injection skills-a systematic review. Rheumatology
(Oxford).2022;61(10):3889-3901.
[12]Overskott HL, Markholm CE, Sehic A, Khan
Q. Different Methods of Teaching and Learning Dental
Morphology. Dent J (Basel).2024;12(4):114.
[13]刘伟,申传安,赵晓东,柴家科.情景模拟教学在青
年医师危重烧伤急救技能培训中的效果探讨[J].中国医
刊,2017,52(6):98-101.
[14]程娟,顾胜利,蒋珺,王颖,徐新量,董怡.超声医学科
住院医师分级分段递进式培训模式的初步探索[J].中国毕
业后医学教育,2024,8(7):514-517.
[15]Peluso MJ, Tapela N, Langeveldt J, Williams
ME, Mochankana K, Motseosi K, Ricci B, Rodman A,
Haverkamp C, Haverkamp M, Maoto R, Luckett R, Prozesky
D, Nkomazana O, Barak T. Building Health System Capacity
through Medical Education: A Targeted Needs Assessment
to Guide Development of a Structured Internal Medicine
Curriculum for Medical Interns in Botswana. Ann Glob
Health.2018;84(1):151-159.
[16]Witmer HDD, Dhiman A, Jones AD, Laffan
AM, Adelman D, Turaga KK. A Systematic Review of
Operative Team Familiarity on Metrics of Efficiency,
Patient Outcomes, Cost, and Team Satisfaction. Ann
Surg.2022;276(6):e674-e681.
[17]Yu JH, Chang HJ, Kim SS, Park JE, Chung WY,
Lee SK, Kim M, Lee JH, Jung YJ. Effects of high-fidelity
simulation education on medical students' anxiety and
confidence. PLoS One.2021;16(5):e0251078.
[18]Chuan A. Education and training in ultrasoundguided regional anaesthesia and pain medicine. Curr Opin An
aesthesiol.2020;33(5):674-684.
[19]Wang Z, Shen J. Simulation Training in Spine
Surgery. J Am Acad Orthop Surg.2022;30(9):400-408.
[20]Kohli R, Replogle K, Gough-Goldman A, Taylor B,
Maughan B, Sehgal HS, Herink MC, Hemmings R, Mahoney
S, McDonnell MM, McLemore K, Schwarz E. Launching
an innovative educational model addressing substance use
disorders and dental pain management (Project ECHO® in
dentistry). BMC Oral Health.2022;22(1):402.
[21]封菲,谢亚佳,曹立群.基于课程思政的牙体牙髓住
院医师分层分段教学模式初探[J].中国继续医学教育,2024,
16(13):190-194.
JM, Eggenberger ER, Sergott RC, Van Stavern GP. Lumbar
Puncture for Diagnosis of Idiopathic Intracranial Hypertension
in Typical Patients. J Neuroophthalmol.2021;41(3):375-378.
[2]杨培中,刘永博,刘向东.颅内压监护下脑室外引流联
合腰椎穿刺治疗颅脑损伤合并外伤性蛛网膜下腔出血的
效果研究[J].中国实用医刊,2025,52(1):50-53.
[3]叶海宾,皇甫彪,李莉,白耀武.不同穿刺点椎管内麻
醉分娩镇痛对产妇产程及母婴结局的影响[J].临床误诊误
治,2025,38(1):70-74.
[4]徐文婷,杨颖,易慧琳.剖宫产术后疼痛原因和疼痛管
理方法研究进展[J].实用医技杂志,2024,31(3):219-224.
[5]Uyel Y, Kilicaslan A. Preprocedural Ultrasonography
Versus Landmark-Guided Spinal Anesthesia in Geriatric
Patients with Difficult Anatomy: A Prospective Randomized
Trial. Eurasian J Med.2021;53(1):9-14.
[6]郭高锋,豆立冬,崔明珠.肥胖孕产妇剖宫产术椎管内
麻醉时不同定位及穿刺方式效果的比较[J].中华麻醉学杂
志,2024,44(12):1470-1475.
[7]Huang C, Zhang Y, Diedrich DA, Li J, Luo W,
Zhao X, Guo Y, Luo Y, Zhang T, Wang X, Huang W, Xiao
Y. A horizontal and perpendicular interlaminar approach
for intrathecal nusinersen injection in patients with spinal
muscular atrophy and scoliosis: an observational study.
Orphanet J Rare Dis.2024;19(1):268.
[8]符丰宗.浅论进行椎管内麻醉患者常见的并发症及
处理方法[J].当代医药论丛,2015,(5):3-4.
[9]Pirenne V, Dewinter G, Van de Velde M. Spinal
anaesthesia in obstetrics. Best Pract Res Clin Anaesthesi
ol.2023;37(2):101-108.
[10]Ma J, Wang Q, Xia X, Guo Z, Feng Q, Zhou Y, Yuan H.
Inclusion of the workshop model in the standardized training ofemergency medicine residents. Heliyon.2023;9(5):e15942.
[11]Carstensen SMD, Velander MJ, Konge L,
Østergaard M, Pfeiffer Jensen M, Just SA, Terslev L.
Training and assessment of musculoskeletal ultrasound
and injection skills-a systematic review. Rheumatology
(Oxford).2022;61(10):3889-3901.
[12]Overskott HL, Markholm CE, Sehic A, Khan
Q. Different Methods of Teaching and Learning Dental
Morphology. Dent J (Basel).2024;12(4):114.
[13]刘伟,申传安,赵晓东,柴家科.情景模拟教学在青
年医师危重烧伤急救技能培训中的效果探讨[J].中国医
刊,2017,52(6):98-101.
[14]程娟,顾胜利,蒋珺,王颖,徐新量,董怡.超声医学科
住院医师分级分段递进式培训模式的初步探索[J].中国毕
业后医学教育,2024,8(7):514-517.
[15]Peluso MJ, Tapela N, Langeveldt J, Williams
ME, Mochankana K, Motseosi K, Ricci B, Rodman A,
Haverkamp C, Haverkamp M, Maoto R, Luckett R, Prozesky
D, Nkomazana O, Barak T. Building Health System Capacity
through Medical Education: A Targeted Needs Assessment
to Guide Development of a Structured Internal Medicine
Curriculum for Medical Interns in Botswana. Ann Glob
Health.2018;84(1):151-159.
[16]Witmer HDD, Dhiman A, Jones AD, Laffan
AM, Adelman D, Turaga KK. A Systematic Review of
Operative Team Familiarity on Metrics of Efficiency,
Patient Outcomes, Cost, and Team Satisfaction. Ann
Surg.2022;276(6):e674-e681.
[17]Yu JH, Chang HJ, Kim SS, Park JE, Chung WY,
Lee SK, Kim M, Lee JH, Jung YJ. Effects of high-fidelity
simulation education on medical students' anxiety and
confidence. PLoS One.2021;16(5):e0251078.
[18]Chuan A. Education and training in ultrasoundguided regional anaesthesia and pain medicine. Curr Opin An
aesthesiol.2020;33(5):674-684.
[19]Wang Z, Shen J. Simulation Training in Spine
Surgery. J Am Acad Orthop Surg.2022;30(9):400-408.
[20]Kohli R, Replogle K, Gough-Goldman A, Taylor B,
Maughan B, Sehgal HS, Herink MC, Hemmings R, Mahoney
S, McDonnell MM, McLemore K, Schwarz E. Launching
an innovative educational model addressing substance use
disorders and dental pain management (Project ECHO® in
dentistry). BMC Oral Health.2022;22(1):402.
[21]封菲,谢亚佳,曹立群.基于课程思政的牙体牙髓住
院医师分层分段教学模式初探[J].中国继续医学教育,2024,
16(13):190-194.
Copyright © 2025 张 帆,乐 园
Publishing time:2025-05-31
This work is licensed under a Creative Commons Attribution 4.0 International License
Email
Location