CAJ | 학술논문

目的探讨人工耳蜗植入术的学习曲线及其对临床手术的指导意义.方法回顾分析2009年5月至2013年2月我科两位耳科医师开展人工耳蜗植入术早期病例的临床资料,其中甲医师98例,乙医师54例.分别统计两位手术医师人工耳蜗植入术的并发症发生率及手术耗时情况,以手术耗时为指标分别绘制甲、乙两组手术病例的散点图,采用振荡正弦曲线模型Y=sin (X)-P/2及对数曲线模型Y =b1ln(X) +bo进行曲线拟合并进行对比分析.以30例为一组将甲医师完成的前90例病例按手术日期的先后顺序分成a、b、c三组,对其并发症及手术耗时进行进一步比较分析(SPSS16.0).结果从手术先后顺序看,甲、乙两位医师早期手术均耗时较长、且易发生并发症,在30例前后出现拐点,呈现出快速下降期(学习阶段)和缓慢下降期(巩固阶段)两个阶段.对甲医师前期90例连续病例的分组对比发现,a组与b、c两组的手术耗时差异具有统计学意义(P值均＜0.01),而b、c两组手术耗时差异无统计学意义(P=0.68);a组与b、c两组的并发症发生率差异具有统计学意义(P值均＜0.01),而b、c两组并发症发生率差异无统计学意义(P=0.15).结论我科人工耳蜗植入术遵循学习曲线规律,学习阶段需积累的最小病例数约为30例.
목적 탐토인공이와식입술적학습곡선급기대림상수술적지도의의.방법 회고분석2009년5월지2013년2월아과량위이과의사개전인공이와식입술조기병례적림상자료,기중갑의사98례,을의사54례.분별통계량위수술의사인공이와식입술적병발증발생솔급수술모시정황,이수술모시위지표분별회제갑、을량조수술병례적산점도,채용진탕정현곡선모형Y=sin (X)-P/2급대수곡선모형Y =b1ln(X) +bo진행곡선의합병진행대비분석.이30례위일조장갑의사완성적전90례병례안수술일기적선후순서분성a、b、c삼조,대기병발증급수술모시진행진일보비교분석(SPSS16.0).결과 종수술선후순서간,갑、을량위의사조기수술균모시교장、차역발생병발증,재30례전후출현괴점,정현출쾌속하강기(학습계단)화완만하강기(공고계단)량개계단.대갑의사전기90례련속병례적분조대비발현,a조여b、c량조적수술모시차이구유통계학의의(P치균＜0.01),이b、c량조수술모시차이무통계학의의(P=0.68);a조여b、c량조적병발증발생솔차이구유통계학의의(P치균＜0.01),이b、c량조병발증발생솔차이무통계학의의(P=0.15).결론 아과인공이와식입술준순학습곡선규률,학습계단수적루적최소병례수약위30례.
Objective To investigate the learning curve of cochlear implantation and its guiding significance for clinical surgery.Methods A retrospective analysis of the clinical data of two otologists in early cochlear implant surgeries,including 98 cases of Dr.A and 54 cases of Dr.B.Statistics of the two doctors incidence of complications and operating time.Operation time as index were drawing a,b two groups of cases of scatter plot,the oscillating sine curve model Y =sin(X)-P/2 and logarithmic curve model Y =b1 ln (X) + b0 curve fit were analyzed.Then,extract the early 90 cases of surgery by Dr.A which was divided into a,b,c three groups with 30 cases a group.The operating time and complications were further compared and analyzed (SPSS 16.0).Results From the operation sequence,A and B physicians,early operation cases cost more operating time,and more complications.Learning curve before and after about 30 cases appeared inflection point,showing a rapid decline in period (learning phase) and slow decline period (consolidation phase) in two stages.Group contrast to Dr.A's early 90 consecutive cases,the operating time of Phase b and Phase c decreased significantly than Phase a (Pa-b ＜0.01,Pa-c ＜0.01),while there was no significant difference between group Phase b and Phase c (Pb-c =0.68),the complication rate of Phase b and Phase c decreased significantly than Phase a (Pa-b ＜ 0.01,Pa-c ＜ 0.01),while there was no significant difference between group Phase b and Phase c (Pb-c =0.15).Conclusions Our department of cochlear implantation followed the learning curve rule.The minimum number of cases that should accumulate in the learning phase needs about 30 cases.