医学生参与心肺复苏对急诊患者抢救质量的影响

摘要

Objective To investigate the effect of medical student involvement on the quality of actual cardiopulmonary resuscitation (CPR).Methods A digital video-recording system was used to record and analyze CPR procedures for adult patients from March 2011 to September 2012.Results Twenty-six student-involved and 40 non-student-involved cases were studied.The chest compression rate in the studentinvolved group was significantly higher than that in the non-student-involved group (P ＜ 0.01).The proportion of compressions at " above 110 cpm" was higher in the student-involved group (P =0.021),whereas the proportion at "90 ～ 110 cpm" was lower in the student-involved group (P =0.015).The ratio of hands-off time to total manual compression time was significantly lower in the student-involved group than in the non-student-involved group (P ＜ 0.05).In contrast,the student-involved group delivered a higher ventilation rate compared with the non-student-involved group (P ＜ 0.05).The observed time delay to first compression and first ventilation was very similar between the groups.There were no significant differences between groups in either return of spontaneous circulation or time from survival to discharge.Conclusions Student-involved resuscitation teams were able to perform good CPR,with higher compression rates and fewer interruptions.However,the supervision from medical staff is still needed to ensure appropriate chest compression and ventilation rate in student-involved actual CPR in the emergency department.%目的 探讨医学生参与心肺复苏对临床急诊患者抢救质量的影响.方法 自2011年3月至2012年9月,笔者用一套数字录像系统记录在本院急救中心接受心肺复苏的成年急诊患者抢救过程,并对其进行分析.其中医学生参与急救的病例26例,为医学生参与组;无医学生参与的病例40例,为无医学生参与组.结果 医学生参与组胸外按压频率远高于无医学生参与组(P＜0.01).在医学生参与组中,胸外按压频率在110次/min以上者所占比例较高(P=0.021),而胸外按压频率为90 ～ 110次/min者所占比例较低(P=0.015).医学生参与组中断按压时间占人工按压总时间比例明显低于无医学生参与组(P＜0.05).医学生参与组实现通气频率高于无医学生参与组(P＜0.05).两组第1次胸外按压和人工通气的延迟时间相似,自主循环恢复率与存活率差异无统计学意义(P＞0.05).结论 医学生参与的复苏团队能够实现高质量的心肺复苏,即较高频率的胸外按压和较少的按压中断.但为了确保恰当的胸外按压频率和通气频率,有医学生参与的临床心肺复苏仍需在专业医务人员的监督与指导下进行.