目的 探索实时可视反馈设备能否提高救护车内的徒手胸外按压质量.方法 本研究为模拟人研究,采用随机交叉实验设计.用信封抽签法将10名年龄小于40岁,有心肺复苏经验的院前急救医务人员随机分为对照组(n=5)及反馈组(n=5).实验场地为行驶的救护车内(速度25～50 km/h),实验过程分为两部分,对照组首先进行无反馈的3组连续的2 min胸外按压,每一组之间休息2 min;随后休息5 min,再进行有反馈的3组连续的2 min胸外按压.反馈组首先进行有反馈的3组连续的2 min胸外按压,每一组之间休息2 min;随后休息5 min,再进行无反馈的3组连续的2 min胸外按压.采集按压深度、按压频率、按压留滞和按压准确率等数据.结果 对照组第二部分操作的按压频率和按压留滞均低于第一部分操作[(109.8±4.7)次/min vs.(121.2±10.1)次/min,(6.5±2.1)次/min vs.(10.4±2.8)次/min,均P＜0.05],而按压准确率高于第一部分操作[(28.2±14.3)％ vs.(16.8±9.9)％,P＜0.05],第一部分和第二部分操作按压深度的差异无统计学意义(P＞0.05);反馈组第一部分和第二部分操作的按压频率、按压深度、按压留滞及按压准确率的差异无统计学意义(均P＞0.05);反馈组整个实验中(第一部分和第二部分操作)的按压频率和按压留滞低于对照组[(111.1±5.1)次/min vs.(115.5±9.7)次/min,(6.5±1.8) vs.(8.4±4.6)次/min,均P＜0.05],按压准确率高于对照组[(22.5±13.4)％ vs.(26.7±16.0)％,P＜0.05],但两组按压深度之间的差异无统计学意义(P＞0.05).结论 实时可视反馈设备能够提高救护车上的徒手心肺复苏质量,表现在更合理的按压频率,更少的按压留滞及更高的按压准确率但总体质量仍很低,不能达到有效治疗的目的,提示发生在救护车内的心搏骤停或者转运阶段的心肺复苏需要选择更优的方案.%Objective To investigate the efficacy of real-time visual feedback on improving the quality of manual chest compression in ambulance.Methods Ten pre-hospital doctors with cardiopulmonary resuscitation experience,aged under 40 years,were recruited to this randomized,crossover,manikin research and randomly assigned into control group (n=5) and feedback group (n=5) by the sealed envelope method.The setting place was a moving ambulance with the velocity of 25～50 km/ h.The whole process consisted of two sessions.In control group,which received feedback in the second session,chest compressions were performed without interruption during each of the three 2 min phases per session,resting for 2 min between phases and for 5 min between sessions.In feedback group,which received feedback in the first session,chest compressions were performed without interruption during each of the three 2 min phases per session,resting for 2 min between phases and for 5 min between sessions.Data of compression rate,compression depth,compression detention and compression accuracy rate were collected.Results In control group,the compressions rate was lower and compression detention was shorter during the second session compared with those during the first session [(109.8±±4.7) r/min vs.(121.2± 10.1) r/min,(6.5±2.1) r/min vs.(10.4±2.8) r/min,all P＜0.05],while the compression accuracy rate during the second session was higher than that during the first session [(28.2±±14.3) ％ vs.(16.8±9.9) ％,P＜0.05].There was no significant difference in compression rate between the two sessions in control group;Compression frequency,compression depth,compression detention and compression accuracy rate did not significantly change between the two sessions in feedback group (all P＞0.05).In the whole process,the compression rate was lower and compression detention was shorter in the feedback group compared with the control group [(111.1±5.1) r/min vs.(115.5±9.7) r/min,(6.5±1.8) vs.(8.4±4.6) r/min,all P＜0.05],and the compression accuracy rate in the feedback group was higher than that in the control group[(22.5±13.4) ％ vs.(26.7±16) ％,P＜0.05].There was no significant difference in compression rate between the two groups during whole process (P＞0.05).Conclusions Although real-time visual feed back improved the quality of manual chest compression in ambulances,which demonstrated more reasonable compression rate,less compression detention and higher compression accuracy,the overall quality of reuscitation was still not enough to achieve effective treatment.This implies that more optimal methods are required to transfer the patients suffering cardiac arrest.
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