动物在体心脏传导系统标测技术的研究生教学新模式探索

doi:10.12300/j.issn.1674-5817.2022.059

实验动物与比较医学 ›› 2022, Vol. 42 ›› Issue (5): 466-471.DOI: 10.12300/j.issn.1674-5817.2022.059

所属专题：教育教学培训实践

动物在体心脏传导系统标测技术的研究生教学新模式探索

王小康¹, 赵若瑾², 吕昀徽¹, 岳广新¹, 刘尚雨³, 贺婷¹, 彭鹏¹, 孟亮¹, 李巨波¹, 张宝杰¹, 申晨¹, 崔永春¹()(), 王欣¹^,²()()

^1.北京协和医学院, 中国医学科学院阜外医院, 国家心血管病中心, 心血管疾病国家重点实验室, 心血管植入材料临床前研究评价北京市重点实验室, 动物实验中心, 北京 102800
^2.北京协和医学院, 中国医学科学院阜外医院, 国家心血管病中心, 心血管疾病国家重点实验室, 心脏外科中心, 北京 100037
^3.北京协和医学院, 中国医学科学院阜外医院, 国家心血管病中心, 心血管疾病国家重点实验室, 心律失常中心, 北京 100037

收稿日期:2022-04-28 修回日期:2022-06-06 出版日期:2022-10-25 发布日期:2022-11-04
通讯作者:
王欣（1971—），男，医学博士，主任医师，研究方向：心血管外科。E-mail：fuwaiwangxin@188.com。ORCID：0000-0003-1554-7802

崔永春（1975—），女，医学博士，副研究员，研究方向：心血管疾病基础研究。E-mail：cuiyongchun@fuwai.com。ORCID：0000-0002-7636-4244
作者简介:王小康（1998—），女，硕士研究生，研究方向：心血管疾病基础研究。E-mail：k15042429018@163.com
赵若瑾（1996—），女，硕士研究生，研究方向：心血管外科。E-mail：675801165@qq.com
基金资助:
北京协和医学院研究生教育教学改革项目“心血管外科研究生课程教育盲点——心脏传导系统解剖”(10023201800203/2018E-JG04)

A Novel Model for in-vivo Training of Postgraduates on Cardiac Electrical Conduction System Mapping Skills

Xiaokang WANG¹, Ruojin ZHAO², Yunhui LÜ¹, Guangxin YUE¹, Shangyu LIU³, Ting HE¹, Peng PENG¹, Liang MENG¹, Jubo LI¹, Baojie ZHANG¹, Chen SHEN¹, Yongchun CUI¹()(), Xin WANG¹^,²()()

^1.Beijing Municipal Key Laboratory for Pre-clinical Evaluation of Cardiovascular Implantation Devices, Animal Experimental Center, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 102800, China
^2.Cardiac Surgery Center, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
^3.Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China

Received:2022-04-28 Revised:2022-06-06 Published:2022-10-25 Online:2022-11-04
Contact: WANG Xin (ORCID: 0000-0003-1554-7802), E- mail: fuwaiwangxin@188.com;
CUI Yongchun (ORCID: 0000-0002-7636-4244), E- mail: cuiyongchun@fuwai.com

摘要/Abstract

摘要：

目的探索一种“理论授课-实体操作-5WHYs分析-针对性强化训练-考核”（STIM）临床技能教学新模式。方法 10名教育背景和技术水平相当的心血管专业研究生，分别接受STIM模式（n=5）和传统“理论-操作-考核”（TPT，n=5）模式心脏传导系统解剖及电生理标测专项技术教学，通过比较两组学生的考核成绩，对两种教育模式的教学效果进行评价。结果与TPT组比较，STIM组学生对心脏传导系统解剖位置和结构的理论知识掌握更加扎实，电解剖图、电压图、电激动图和电传导图的构建和解读更快，且准确度更高。结论 STIM教学模式能够有效提升研究生临床基本手术技能，调动学生学习的主动性，是一种值得心血管专业研究生教学中广泛推广的专项技能强化教学模式。

关键词: 心血管外科, 动物实验, 研究生, 教学模式, 心脏传导系统

Abstract:

Objective StandardizationTo explore a novel special technique intensive mode (STIM) of teaching cardiac conduction system mapping skills. This method includes theoretical lecture, in vivo operation, 5-whys methods of analyses, intensive-problem oriented trainings, and assessments. Methods Ten post-graduates majoring in cardiology who have equivalent education backgrounds and technical levels were randomly divided into two groups (n=5 per group). All participants underwent a skill training on cardiac electrophysiology mapping, with one group training under the STIM and the other group under the traditional "theory-practice-test" (TPT) mode. The effect of these two educational techniques were evaluated at the end of the training. Results Postgraduates in the STIM group had a more solid grasp of the anatomical position and structure of the cardiac conduction system than those in the TPT group. During in-vivo operation, the students in the STIM group reconstructed and interpreted the electroanatomical maps, voltage maps, electric excitation maps, and electric conduction maps more accurately and quickly than those in the TPT group. Conclusion The STIM teaching mode more effectively improved the basic surgical skills of postgraduates, stimulated the students' learning initiative, and improved the quality of education. STIM is a kind of intensive teaching mode of special skills, and is worth widely implementing in the education of postgraduates majoring in cardiovascular diseases.

Key words: Cardiovascular surgery, Animal experiment, Postgraduates, Teaching mode, Cardiac electrical conduction system

中图分类号:

R-332

王小康, 赵若瑾, 吕昀徽, 岳广新, 刘尚雨, 贺婷, 彭鹏, 孟亮, 李巨波, 张宝杰, 申晨, 崔永春, 王欣. 动物在体心脏传导系统标测技术的研究生教学新模式探索[J]. 实验动物与比较医学, 2022, 42(5): 466-471.

Xiaokang WANG, Ruojin ZHAO, Yunhui LÜ, Guangxin YUE, Shangyu LIU, Ting HE, Peng PENG, Liang MENG, Jubo LI, Baojie ZHANG, Chen SHEN, Yongchun CUI, Xin WANG. A Novel Model for in-vivo Training of Postgraduates on Cardiac Electrical Conduction System Mapping Skills[J]. Laboratory Animal and Comparative Medicine, 2022, 42(5): 466-471.

图/表 4

表1 心脏传导系统标测技术培训效果考核表

Table1 Assessment indicators for cardiac electrical conduction system mapping techniques during

序号 No.	考核项目 Assessment indicators	评分 Score
1	熟练操作标测设备，包括准确连接管路 Skilled operation of mapping equipment, including accurate pipeline connection	3
2	准确放置标测导管和起搏电极 Accurately place mapping catheter and pacing leads	2
3	准确识别标测电位，包括双电位、刺激电位 Accurately identify mapped potentials, including bipotentials and stimulation potentials	2
4	准确分辨标测图谱上的A波和V波 Accurately distinguish A wave and V wave on the mapping maps	2
5	正确构建并解读心脏电解剖图 Correctly construct and interpret cardiac electroanatomical maps	2
6	正确构建电压图 Correctly build the voltage map	3
7	正确构建电激动图，用不同颜色实时显示电激动传导顺序 Correctly construct electrokinogram and display the electrical excitation conduction sequence in real time with different colors	3
8	正确解读心脏动态电传导图，通过动画模式立体动态地显示电激动传导速度和路径 Correctly interpret the cardiac dynamic electrical conduction map, and display the electrical conduction velocity and path dynamically through the animation mode	3

图1 心脏传导系统解剖和标测技术教育模式流程图注：虚线代表传统的TPT培训模式的流程，实线代表STIM训练模式的流程。5WHYs即五问分析法。

Figure 1 Flowchart of the technical education model of cardiac electrical conduction system anatomy and mapping techniquesNote: The dotted line represents the traditional theory-practice-test (TPT) training mode, and the solid line represents the special technique intensive mode (STIM) training. 5 WHYs, five-question analysis method.

图2 心脏腔内心电图检测及Ensite三维标测示教图注：A为透视下环状电极位于右心房；B为心脏腔内心电图，其中A波代表心房波，V波代表心室波；C为心脏ensite三维电解剖图，其中红色代表主动脉，蓝色代表右心室，绿色代表左心室，白色代表右心房；D为心脏电激动传导代表性图片，传导方向为红-橙-黄-绿-青-蓝-紫；E为心脏电压代表性图片，其中紫色代表电压高于0.5 mV区域。

Figure 2 Intracardiac electrocardiogram detection and EnSite 3D mapping teaching diagramNote: A, The ring electrode is located in the right atrium under X ray. B, Intracardiac electrogram. The A wave represents atrial waves, and the V wave represents ventricular waves. C, 3D cardiac electroanatomical map generated using EnSite. The red, blue, green, and white regions represent the aorta, right ventricle, left ventricle, and right atrium, respectively. D, Representative images of cardiac electrical excitation conduction. The conduction sequence is red-orange-yellow-green-cyan-blue-purple. E, Representative images of cardiac voltage. The purple regions represent the areas where the voltage is higher than 0.5 mV.

表2 心脏电生理标测中存在的问题及原因分析

Table 2 Problem-and-reason analysis for cardiac mapping

组别

Group

问题

Problem

原因

Reason

TPT组

TPT group

标测点位识别能力差，读图不够准确，标测仪管路连接错误率较高

电生理基础知识薄弱，尤其是关于腔内电图的知识掌握不牢；未形成关于平面X线影像与三维标测建模的整体认识；心脏电生理标测仪的使用不够熟练

STIM组

STIM group

标测仪管路连接时而出错，花费时间较长

在使用心脏电生理标测仪时，学生的经验不足，操作不够熟练

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动物在体心脏传导系统标测技术的研究生教学新模式探索

A Novel Model for in-vivo Training of Postgraduates on Cardiac Electrical Conduction System Mapping Skills

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