切换至 "中华医学电子期刊资源库"

中华医学超声杂志(电子版) ›› 2023, Vol. 20 ›› Issue (02) : 200 -206. doi: 10.3877/cma.j.issn.1672-6448.2023.02.008

教育培训

斑点追踪超声心动图在室壁运动评估自主教学中的应用
邢长洋1, 胡伟1, 陈慧芸2, 张倩2, 雷玉嘉3, 袁丽君1,()   
  1. 1. 710038 西安,空军军医大学唐都医院超声诊断科
    2. 710038 西安,空军军医大学唐都医院教学办
    3. 710038 西安,空军军医大学唐都医院毕教办
  • 收稿日期:2022-09-07 出版日期:2023-02-01
  • 通信作者: 袁丽君
  • 基金资助:
    陕西省创新人才推进计划-青年科技新星项目(2022KJXX-106); 空军军医大学教学研究课题; 陕西省创新人才推进计划-科技创新团队项目资助(2020TD-038)

Application of speckle tracking echocardiography in self-teaching of wall motion evaluation

Changyang Xing1, Wei Hu1, Huiyun Chen2, Qian Zhang2, Yujia Lei3, Lijun Yuan1,()   

  1. 1. Department of Ultrasound Diagnostics, Tangdu Hospital, Air Force Medical University, Xi'an 710038, China
    2. Teaching Office, Tangdu Hospital, Air Force Medical University, Xi'an 710038, China
    3. Post-Graduation Education Office, Tangdu Hospital, Air Force Medical University, Xi'an 710038, China
  • Received:2022-09-07 Published:2023-02-01
  • Corresponding author: Lijun Yuan
引用本文:

邢长洋, 胡伟, 陈慧芸, 张倩, 雷玉嘉, 袁丽君. 斑点追踪超声心动图在室壁运动评估自主教学中的应用[J]. 中华医学超声杂志(电子版), 2023, 20(02): 200-206.

Changyang Xing, Wei Hu, Huiyun Chen, Qian Zhang, Yujia Lei, Lijun Yuan. Application of speckle tracking echocardiography in self-teaching of wall motion evaluation[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(02): 200-206.

目的

采用斑点追踪超声心动图(STE)自动分析技术对超声心动图初学者进行室壁运动评估训练反馈,同传统教学法对比,明确STE在室壁运动评估自主教学中的价值。

方法

纳入2022年7月至2022年9月在空军军医大学唐都医院学习的无超声心动图基础的医学专业本科生40名,随机分为传统教学组20名和STE自主教学组20名。传统教学组由一名高年资超声心动图医师进行教学和指导,STE自主教学组通过二维动态图像和应变分析结果进行对比反馈训练。经过两阶段(每阶段25例图像)的教学训练,计算并比较2组对室壁运动评估的异常检出率、正常排除率和总体符合率,并对不同切面第二阶段的组间及组内考核成绩以及不同节段第二阶段的组间及组内考核成绩进行比较分析,以探究差异原因。

结果

传统教学组和STE自主教学组基线测试及第一阶段考核中的异常检出率、正常排除率和总体符合率差异无统计学意义(P均>0.05)。第二阶段考核中,传统教学组的异常检出率和总体符合率均优于STE自主教学组(异常检出率:73.4% vs 56.8%,总体符合率:72.9% vs 64.0%,P均<0.05)。传统教学组在心尖二腔切面的异常检出率、正常排除率和总体符合率,心尖三腔切面的异常检出率和总体符合率,心尖四腔切面的异常检出率和总体符合率均优于STE自主教学组(P均<0.05);2组组内各切面间各指标成绩差异均无统计学意义(P均>0.05)。传统教学组在基底段和中间段的异常检出率和总体符合率优于STE自主教学组(P<0.05);传统教学组对心尖段的异常检出率高于基底段和中间段(P均<0.05);STE自主教学组基底段、中间段和心尖段的异常检出率逐渐升高,心尖段的总体符合率高于基底段和中间段(P均<0.05)。

结论

STE自主教学对初学者室壁运动评估的早期训练效果能够达到与传统教学相似的水平,但在随后的训练中出现瓶颈,对基底段和中间段的室壁运动判断能力较差。

Objective

To evaluate the value of self-teaching of wall motion evaluation through feedback training by speckle tracking echocardiography (STE) for beginners in comparison with traditional teaching mode.

Methods

From July 2022 to September 2022, 40 medical undergraduates without echocardiographic knowledge who were studying in the Tangdu Hospital, Air Force Medical University were recruited and randomly divided into either a traditional teaching (TT) group or an STE self-teaching (ST) group. Students in the TT group were tutored by a senior echocardiographer for wall motion evaluation, and students in the ST group were trained through comparison and feedback between two-dimensional cineloop and strain results by themselves. Both groups underwent a two-stage training session (25 cases each stage). The abnormal detection rate, normal exclusion rate and overall coincidence rate were calculated and compared between the two groups. Further view- and segment-based comparisons of results between and within groups in the second-stage test were also performed.

Results

The abnormal detection rate, normal exclusion rate, and overall coincidence rate were similar between the TT and ST groups in both baseline and first-stage tests (P>0.05 for all). In the second-stage test, the abnormal detection rate and overall coincidence rate were better in the TT group than in the ST group (abnormal detection rate, 73.4% vs 56.8%; overall coincidence rate, 72.9% vs 64.0%; P<0.05 for both). The abnormal detection rate, normal exclusion rate, and overall coincidence rate in the apical two chamber view, and the abnormal detection rate and overall coincidence rate in the apical three and four chamber views were all significantly better in the TT group than in the ST group (P<0.05 for all), but the results between different views within both groups were not significantly different (P>0.05 for all). The abnormal detection rate and overall coincidence rate in basal and middle segments were better in the TT group than in the ST group (P<0.05). In the TT group, the abnormal detection rate in apical segments was higher than that in basal and middle segments (P<0.05). The abnormal detection rate gradually increased from basal to middle to apical segments in the ST group, and the overall coincidence rate was higher in apical segments than in basal and middle segments (P<0.05).

Conclusion

The early training effects of STE ST mode are similar to those of TT mode for wall motion evaluation in beginners. However, STE ST comes to the plateau without further improvement due to the lack of guidance during the following training, leading to lower performance than TT mode, especially in the basal and middle segments.

图1 传统教学组与自主教学组教学方法示意图注:STE为斑点追踪超声心动图
表1 传统教学组与STE自主教学组基线测试及考核成绩比较
图2 传统教学组和自主教学组基线测试及考核成绩变化。图a~c分别为不同阶段异常检出率、正常排除率、总体符合率,图示基线测试至第一阶段考核2组各参数变化差异无统计学意义;第一阶段考核至第二阶段考核,2组间异常检出率及总体符合率的变化差异有统计学意义注:STE为斑点追踪超声心动图
表2 不同切面第二阶段考核成绩比较
表3 不同节段第二阶段考核成绩比较
1
中华医学会超声医学分会超声心动图学组, 中国医师协会心血管分会超声心动图专业委员会. 超声心动图评估心脏收缩和舒张功能临床应用指南 [J]. 中华超声影像学杂志, 2020, 29(6): 461-477.
2
Li J, Zhang L, Wang Y, et al. Agreement in left ventricular function measured by echocardiography and cardiac magnetic resonance in patients with chronic coronary total occlusion [J]. Front Cardiovasc Med, 2021, 8: 675087.
3
Jenkins S, Alabed S, Swift A, et al. Diagnostic accuracy of handheld cardiac ultrasound device for assessment of left ventricular structure and function: systematic review and meta-analysis [J]. Heart, 2021, 107(22): 1826-1834.
4
袁丽君, 邢长洋. 二维斑点追踪成像技术应用于心肌定量分析的研究进展 [J/CD]. 中华医学超声杂志(电子版), 2021, 18(12): 1129-1131.
5
Gharibzadeh A, Shahsanaei F, Rahimi Petrudi N. Clinical and cardiovascular characteristics of patients suffering ST-segment elevation myocardial infarction after Covid-19: A systematic review and meta-analysis [J]. Curr Probl Cardiol, 2021: 101045.
6
van Mourik MJW, Zaar DVJ, Smulders MW, et al. Adding speckle-tracking echocardiography to visual assessment of systolic wall motion abnormalities improves the detection of myocardial infarction [J]. J Am Soc Echocardiogr, 2019, 32(1): 65-73.
7
Luis SA, Chan J, Pellikka PA. Echocardiographic assessment of left ventricular systolic function: an overview of contemporary techniques, including speckle-tracking echocardiography [J]. Mayo Clin Proc, 2019, 94(1): 125-138.
8
邢长洋, 袁丽君, 张宇新, 等. 二维斑点追踪技术对左心室收缩运动不同成分的分解研究 [J]. 中华超声影像学杂志, 2019, 28(5): 397-400.
9
Sacre JW, Wong C, Chan YK, et al. Left ventricular dysfunction and exercise capacity trajectory: implications for subclinical heart failure staging criteria [J]. JACC Cardiovasc Imaging, 2019, 12(5): 798-806.
10
Iskander J, Kelada P, Rashad L, et al. Advanced echocardiography techniques: the future stethoscope of systemic diseases [J]. Curr Probl Cardiol, 2022, 47(6): 100847.
[1] 王秀秀, 严霜霜, 邓晓奇, 熊峰. 二维斑点追踪成像评价左束支起搏左心室激动顺序与同步性[J]. 中华医学超声杂志(电子版), 2023, 20(04): 404-410.
[2] 李沅芝, 李一丹, 丁雪晏, 郭迪晨, 叶晓光, 王江涛, 吕秀章. 二维斑点追踪超声心动图对阵发性心房颤动患者左心室功能及机械离散度的评价[J]. 中华医学超声杂志(电子版), 2022, 19(06): 535-540.
[3] 乐元洁, 王卫栋, 贲志飞. 二维斑点追踪超声心动图联合lncRNA-肺腺癌转移相关转录因子1对脓毒症心肌病的早期诊断价值[J]. 中华危重症医学杂志(电子版), 2022, 15(03): 183-188.
[4] 黄舒恒, 曲杨, 李雪铃, 王丽晓, 古丽莎. 牙体牙髓病学本科实习教学中医疗不良事件的原因分析与对策[J]. 中华口腔医学研究杂志(电子版), 2019, 13(05): 304-310.
[5] 郭敏, 卢嘉蕊, 亓益品, 权晶晶. 模拟口镜练习在牙体牙髓实验教学中的应用[J]. 中华口腔医学研究杂志(电子版), 2019, 13(04): 242-246.
[6] 杨宁, 迟超, 刘宏宇, 韩薇, 宋雨微. 超声斑点追踪技术监测心脏移植急性排斥反应一例[J]. 中华移植杂志(电子版), 2018, 12(02): 72-74.
[7] 楼征, 张卫, 傅传刚, 于恩达, 孟荣贵, 刘佳, 卓冬兰, 李丽, 赵志青, 沈洪兴. 中文手机相关应用服务与肛肠外科学[J]. 中华结直肠疾病电子杂志, 2015, 04(01): 76-77.
[8] 何小玲, 漆洪波. 团队式模拟情景培训在产科住院医师规范化培训中的应用[J]. 中华产科急救电子杂志, 2017, 06(04): 238-242.
[9] 陈年坤, 王志坚. 模拟人在产科护理教学中的运用[J]. 中华产科急救电子杂志, 2016, 05(04): 237-239.
[10] 张晓菁, 王谢桐. SimMom模拟人在产科医师培训中的作用[J]. 中华产科急救电子杂志, 2016, 05(04): 232-236.
[11] 侯红瑛. 运用SimMom模拟人实施PBL教学的体会[J]. 中华产科急救电子杂志, 2016, 05(04): 229-231.
[12] 徐斌, 涂永久, 刘珊珊, 芮建锐, 林敏, 沙素梅. 入科前再教育教学模式在普通外科实习生诊断思维能力培养中的应用[J]. 中华诊断学电子杂志, 2021, 09(03): 165-168.
[13] 刘阿庆, 李小花, 徐焕萍, 王少春. 超声模拟系统在住院医师规培实践教学中的应用[J]. 中华诊断学电子杂志, 2018, 06(02): 108-110.
阅读次数
全文


摘要