麻醉医师的科研思维能力如何培养？

xyz-cn99

作为一个临床麻醉医生，真正的要在实验上面花太多时间那简直是不可能，而且很多医生就有这样的想法，只有实验研究才会出文章，出好文章，其实不尽然，本期《麻醉学》杂志中发表了几篇都是十分大家临床上十分常见的麻醉处理方式，但是人家可以发到四点几分的麻醉学，为什么我们就不可以想到这样的idea，并在临床中观察实践呢，或者说通过看这样的文献有了自己的想法，变通一下，用在别的上面；或者在别的专科杂志上找到余麻醉相通的文章，并联系到麻醉工作的应用呢，下面我举两个麻醉学发表的文章，谈谈自己对科研的看法
第一篇讲的是关于门诊手术术后恢复指数的应用
Development of the Functional Recovery Index for Ambulatory Surgery and Anesthesia
Background: It is increasingly important to evaluate patients' recovery after ambulatory surgery. The authors developed the Functional Recovery Index (FRI) to assess postdischarge functional recovery for ambulatory surgical patients.
Methods: The scale development involved four phases: item generation, item selection, reliability, and validity testing. A draft questionnaire was tested and revised. Items were selected through testing endorsement frequency, factor analysis, and testing internal consistency. The interrater reliability was calculated. Construct validity was tested by multiple hypotheses on convergent validity, extreme groups, and discriminant validity. Responsiveness was assessed by measuring the FRI postoperatively and comparing minor versus more extensive surgery. The rate of response and the time for completion of the questionnaire were recorded.
Results: The final questionnaire had 14 items grouped under 3 factors. Each item was scored from 0 to 10, with 0 = no difficulty and 10 = extreme difficulty with the activity. The 3 factors were summated for a total score. Internal consistency for the 3 factors (pain and social activity, lower limb activity, and general physical activity) was as follows: Cronbach α = 0.90, 0.89, and 0.86, respectively. Interrater reliability was 0.99. Convergent validity for FRI versus verbal rating scale pain score was 0.76. Discriminant validity testing showed that the type of surgery was significant and that intermediate (β = 0.138) and major surgery (β = 0.337) were associated with higher FRI scores than minor surgery. The time to complete the questionnaires ranged between 4 min 10 s and 4 min 35 s.
Conclusions: The FRI had excellent reliability, good validity, responsiveness, and acceptability, indicating that this questionnaire will be a good instrument for assessing functional recovery of ambulatory surgical patients.
首先这个评分方法是第一次使用的，因为在全文中并没有引用别人的文献，但是这样的话，文章之前很多的工作我们都可以省掉，但是最后的14项内容以及三个因素（疼痛，社会能力与下肢活动，基本状况，）我们就可以利用他的方法做我们以后的临床研究了，比如在临床中LC，无疼肠镜，等均可以研究
第二篇文章是关于OSAS的几篇文献，在之前很多呼吸杂志和睡眠杂志中都出现了CPAP治疗OSAS的有效性的报道，但是在围手术期CPAP的应用并不多见，是否可以做相关的调查呢？
Continuous Positive Airway Pressure via the Boussignac System Immediately after Extubation Improves Lung Function in Morbidly Obese Patients with Obstructive Sleep Apnea Undergoing Laparoscopic Bariatric Surgery
Background: Morbidly obese patients are at elevated risk of perioperative pulmonary complications, including airway obstruction and atelectasis. Continuous positive airway pressure may improve postoperative lung mechanics and reduce postoperative complications in patients undergoing abdominal surgery.
Methods: Forty morbidly obese patients with known obstructive sleep apnea undergoing laproscopic bariatric surgery with standardized anesthesia care were randomly assigned to receive continuous positive airway pressure via the Boussignac system immediately after extubation (Boussignac group) or supplemental oxygen (standard care group). All subjects had continuous positive airway pressure initiated 30 min after extubation in the postanesthesia care unit via identical noninvasive ventilators. The primary outcome was the relative reduction in forced vital capacity from baseline to 24 h after extubation.
Results: Forty patients were enrolled into the study, 20 into each group. There were no significant differences in baseline characteristics between the groups. The intervention predicted less reduction in all measured lung functions: forced expiratory volume in 1 s (coefficient 0.37, SE 0.13, P = 0.003, CI 0.13-0.62), forced vital capacity (coefficient 0.39, SE 0.14, P = 0.006, CI 0.11-0.66), and peak expiratory flow rate (coefficient 0.82, SE 0.31, P = 0.008, CI 0.21-0.1.4).
Conclusions: Administration of continuous positive airway pressure immediately after extubation maintains spirometric lung function at 24 h after laparoscopic bariatric surgery better than continuous positive airway pressure started in the postanesthesia care unit.
文章中作者表示早期即拔管后应用CPAP可以预防拔管后呼吸功能不全。其实他所应用的器械并不复杂，这样的病人也是随处可见的，为什么我们就没有这么好的想法，并实行他呢？
上述两篇文章，第一篇稍复杂，但是我们可以应用里面得到的结论，在之后的临床工作中应用，并设计临床试验，积累资料，加上好的统计分析和写作水平应该发篇文章是不成问题的第二篇文章完全是一个他科知识应用到麻醉的很好的例子，
所以我们平时不要老是抱怨自己水平低，条件有限，我相信只要自己有心，平时多注意对新知识，新方法的了解积累，厚积薄发，肯定可以提高自己的科研和临床水平并且很好的服务病人的。

(网络转载 作者不详)

立青折口

同感啊！科研和临床不能脱离

943860308

经验是软件 论文著书这是硬件 中国晋级的时候就看你的硬件，不管你工作能力有多强。许多单位中这些人大有人在。

小兰anny

连续气道正压通气拔管后立即通过Boussignac系统提高肺癌阻塞性睡眠呼吸暂停接受腹腔镜减重手术的病态肥胖患者中的作用
背景：病态肥胖患者在围手术期肺部并发症的高风险，包括气道阻塞和肺不张。持续气道正压可能会提高术后的肺力学和减少腹部手术的患者术后并发症。
方法：40称为阻塞性睡眠呼吸暂停接受标准化麻醉护理腹腔镜减肥手术的病态肥胖患者被随机分配接受连续通过气道正压通气拔管后立即Boussignac系统（Boussignac组）或补充氧气（标准治疗组）。所有受试者在通过相同的无创呼吸机麻醉后监护病房的持续气道正压发起拔管后30分钟。主要成果是在用力肺活量从基线到24小时后拔管的相对减少。
结果：40例患者参加的研究中，20到各组。在组与组之间的基线特征没有显著差异。干预预测少减少在所有测量心肺功能：强制呼气量在1秒（系数0.37，0.13东南，P = 0.003，CI0.13-0.62），用力肺活量（系数0.39，SE，P = 0.006，CI 0.11 - 0.14 -0.66），呼气峰流速（系数为0.82，0.31，P=0.008，CI0.21-0.1.4东南）。
结论：持续气道正压拔管后立即保持在24 h的肺功能后腹腔镜减肥手术在麻醉后监护病房开始的压力比持续气道正压更好的管理。

小兰anny

门诊手术和麻醉的功能恢复指数
背景：这是日益重要的评估病人的门诊手术后的恢复。作者开发的功能恢复指数（FRI）评估门诊手术病人出院后的功能恢复。
方法：参与开发了四个阶段：项目生成，项目选择，可靠性和有效性的测试。问卷草案进行了测试和修订。项目选择通过测试代言频率，因子分析，并测试内部一致性。间信度计算。构造的有效性进行了测试，收敛效度，极端团体，和判别有效性的多个假说。反应性评估测量的周五术后比较轻微与更广泛的手术。录得的反应速度和完成问卷的时间。
结果：最终的问卷有14项，分为3个因素的。每个项目从0到10分，0 =无难度和10 =活动的极端困难。这3个因素累加为总成绩。为3个因素（疼痛和社会活动，下肢活动，和一般的体力活动）的内部一致性如下：信度α= 0.90，0.89，0.86，分别。间信度为0.99。周五与口头评定量表疼痛评分的收敛效度为0.76。判别有效性测试表明，该类型的手术是显著和中间（β= 0.138）和重大手术（β= 0.337），具有较高的友谊赛成绩比小手术。介乎4分10秒和第35号第4分钟的时间完成问卷
结论：周五有出色的可靠性，有效性好，响应速度，和可接受性，表明此问卷，将是一个门诊手术患者的功能恢复评估良好的仪表。

t6u123456

看不懂 翻译一下好吗

xgw1968

其实临床同科研并不矛盾，只是我们很多的临床医生缺乏专门的科研培训，缺乏科研思维而已。

回忆

好是好，但是自己专业的杂志都看不完，怎么还有时间去看别的专业的文献？

伊念

科研来源于实际并为实际服务，楼主的建议很好！

doutside

我们科室由于临床工作太忙,科研工作相当滞后,希望通过努力加强科研工作.楼主的提示是个很好的开始!

随风

个人觉得：科研和临床一样重要。要做好一个麻醉医师要付出很多！

943860308

麻烦你翻译一下好吗？