中华急诊医学杂志
中華急診醫學雜誌
중화급진의학잡지
CHINESE JOURNAL OF EMERGENCY MEDICINE
2013年
10期
1193-1197
,共5页
张军根%付卫林%钱利娜%鲁美丽
張軍根%付衛林%錢利娜%魯美麗
장군근%부위림%전리나%로미려
心搏骤停%心肺复苏%临床路径%院前急救%培训
心搏驟停%心肺複囌%臨床路徑%院前急救%培訓
심박취정%심폐복소%림상로경%원전급구%배훈
Cardiac arrest%Cardiopulmonary resuscitation%Clinical pathway%Training%Pre-hospital care
目的 探讨临床路径对急救小组复苏效能的改进效果.方法 设计心搏骤停院前救治临床路径,通过模拟病例对杭州市急救中心一线急救小组实施培训,对培训前后的各项救治指标进行测评、比对.结果 符合条件的45个急救小组培训前现场实施心电监护、气管插管、开通静脉的仅8(17.8％)、5(11.1％)、6(13.3％)组,前3 min中断按压时间(102.13 ±13.68)s,辅助人员球囊成功通气比例0.37±0.09,现场心电取证、告知签字仅8组(17.8％)、6组(13.3％),复苏与取证能同时进行的仅2组(4.4％).培训后心电监护、气管插管、开通静脉分别达到45组(100％)、43组(95.6％)、43组(95.6％),按压中断时间缩短到(69.73±7.66)s,成功通气比例0.57±0.12；现场心电取证、告知签字取证分别达到了40组(88.9％)、43组(95.6％),复苏取证同时进行达到了36组(80.0％).结论 院前心肺复苏质量低下,临床路径是急救小组实现院前心肺复苏从高风险低效能到低风险高效能转变的有效工具,在现有体制机制下值得推广运用.
目的 探討臨床路徑對急救小組複囌效能的改進效果.方法 設計心搏驟停院前救治臨床路徑,通過模擬病例對杭州市急救中心一線急救小組實施培訓,對培訓前後的各項救治指標進行測評、比對.結果 符閤條件的45箇急救小組培訓前現場實施心電鑑護、氣管插管、開通靜脈的僅8(17.8％)、5(11.1％)、6(13.3％)組,前3 min中斷按壓時間(102.13 ±13.68)s,輔助人員毬囊成功通氣比例0.37±0.09,現場心電取證、告知籤字僅8組(17.8％)、6組(13.3％),複囌與取證能同時進行的僅2組(4.4％).培訓後心電鑑護、氣管插管、開通靜脈分彆達到45組(100％)、43組(95.6％)、43組(95.6％),按壓中斷時間縮短到(69.73±7.66)s,成功通氣比例0.57±0.12；現場心電取證、告知籤字取證分彆達到瞭40組(88.9％)、43組(95.6％),複囌取證同時進行達到瞭36組(80.0％).結論 院前心肺複囌質量低下,臨床路徑是急救小組實現院前心肺複囌從高風險低效能到低風險高效能轉變的有效工具,在現有體製機製下值得推廣運用.
목적 탐토림상로경대급구소조복소효능적개진효과.방법 설계심박취정원전구치림상로경,통과모의병례대항주시급구중심일선급구소조실시배훈,대배훈전후적각항구치지표진행측평、비대.결과 부합조건적45개급구소조배훈전현장실시심전감호、기관삽관、개통정맥적부8(17.8％)、5(11.1％)、6(13.3％)조,전3 min중단안압시간(102.13 ±13.68)s,보조인원구낭성공통기비례0.37±0.09,현장심전취증、고지첨자부8조(17.8％)、6조(13.3％),복소여취증능동시진행적부2조(4.4％).배훈후심전감호、기관삽관、개통정맥분별체도45조(100％)、43조(95.6％)、43조(95.6％),안압중단시간축단도(69.73±7.66)s,성공통기비례0.57±0.12；현장심전취증、고지첨자취증분별체도료40조(88.9％)、43조(95.6％),복소취증동시진행체도료36조(80.0％).결론 원전심폐복소질량저하,림상로경시급구소조실현원전심폐복소종고풍험저효능도저풍험고효능전변적유효공구,재현유체제궤제하치득추엄운용.
Objective To explore the improvement of cardiopulmonary resuscitation (CPR) efficiency by rescue team through the clinical access to pre-hospital care.Methods Mter establishment of clinical approaches to cardiac arrest,the training program of first line personnel of rescue teams in the Hangzhou Emergency Center was carried out with practice on simulated patients and scenario.A total of 45 eligible teams were randomly enrolled for study by observing the performance of some essential resuscitation techniques before and after training.Result The efficiency of resuscitation performed by rescue team for cardiac arrest was generally not good enough before training evidenced by the shortage of application of ECG monitoring,endotracheal intubations and establishing intravenous line which were only 8 (17.8％),5(11.1％),6 (13.3 ％),respectively,and the interruption time of chest compression during the first three minutes was (102.13 ± 13.68) seconds and the successfully artificial respiration ratios by assistant members was (0.37 ± 0.09),and ratios of ECG forensics and written inform consent were 8 (17.8％) and 6 (13.3％) respectively,CPR and forensics done simultaneously was only 2 (4.4％).The efficiency of rescue for cardiac arrest was obviously improved after training by the clinical approaches proved by the increase in application of ECG monitoring,endotracheal intubations,intravenous line set up reached to 45 (100％),43 (95.6％),43 (95.6％),respectively,and the interruption time of chest compression during the first three minutes was shorten to (69.7 ± 7.7) seconds and the successfully artificial respiration ratios done by assistant members was (0.57 ±0.12) after training.The ratios of on-site ECG forensics and written inform consent were 40 (88.9％) and 43 (95.6％),respectively,and CPR and evidence obtained simultaneously was up to 36 (80.0％).The efficiency of work done by teams was obviously improved and the risk of miserable events was controlled.Conclusions The clinical approaches to cardiac arrest in prehosptial care is the efficient strategy to rescue the patient with cardiac arrest and it is worthy to popularize at present.
