交换按压手对胸外按压质量和疲劳的影响

目的 研究心肺复苏(cardiopulmonary resuscitation,CPR)时交换按压手的按压方式对胸外按压质量及操作者疲劳的影响.方法 177名经标准基础生命支持培训的医学生,用抽签方式随机确定按压方式(交换按压手即上下手交换的方式或传统按压方式)的先后顺序,两种方式间隔7d,分别在模拟人上进行10个循环的标准成人单人CPR;记录按压质量、CPR前后操作者的生理参数、主观疲劳指标.计量资料用均数±标准差(x(-)±s)表示,两组均数比较用成组t检验,两组率的比较用x2检验,不感到疲劳的概率用Kaplan-Meier方法评估,以P＜0.05为差异具有统计学意义.结果 在以优势手为初始按压手的操作者中,交换按压手组和传统按压组按压质量均差异无统计学意义(P＞0.05),CPR后Borg疲劳评分差异无统计学意义(13.17 ±1.62 vs.13.41 ±2.11,P=0.437),出现疲劳的循环数也差异无统计学意义(P =0.127).在以非优势手为初始按压手的操作者中,交换按压手组比传统按压组按压深度更深[(39±10) mm vs.(38±9) mm,P=0.015],CPR后Borg疲劳评分更低(12.67 ±2.03 vs.13.33 ±1.95,P=0.011),出现疲劳的循环数更晚(P =0.041).结论 CPR中交换按压手的按压方式能延缓以非优势手为初始按压手的操作者的疲劳,改善胸外按压质量.

The effects of up-down hand position switch on the quality of external chest compression and fatigue during cardiopulmonary resuscitation

Objective To investigate the effects of up-down hand position switch on the quality of external chest compression and the fatigue of rescuers during cardiopulmonary resuscitation (CPR).Methods Two methods of external chest compression were compared in the experiment.One method was a chest compression by alternating two oberlapped hans up-and-down compressing directly on the chest wall,and the other was the chest compression without alternating hand positions.A total of 177 medical students trained by standard basic life support course were randomly assigned to the sequences of those two methods by drawing lots.Two different methods of chest compression were separately performed at 7 days interval.Each time,10 cycles of standard adult CPR were made on the manikin.The data including CPR quality,physiological variables and subjective fatigue feeling of the rescuers before and after CPR were recorded.The results were expressed as mean ± SD.The t test was used to compare the means of two groups,and x2 test was used to compare the frequency between groups.The probability of event-free (no fatigue appearance) was estimated by KaplanMeier.The statistical significance was defined as P ＜ 0.05.Results Among the rescuers,those used the dominant hand in contact with the sternum firstly,there were no significant differences in chest compression quality (P＞0.05),Borg scores afterCPR (13.17±1.62vs.13.41±2.11,P=0.437),or cycle number of fatigue appearance (P =0.127) between the alternating compressing hand position group and the conventional compressing without alternating hand position group.While among the rescuers,those used the non-dominant hand in contact with the sternum firstly,compression depth was deeper [(39 ± 10) mm vs.(38 ±9) mm,P=0.015],Borg score after CPR was lower (12.67 ±2.03 vs.13.33 ± 1.95,P =0.011),and the appearance of fatigue appeared later (P =0.041) in the compression with alternating hand positions group,compared with the conventional compression without alternating hand positions group.Conclusion The updown hand position alternate during CPR may delay the fatiguewhich appeared earlier in non-dominant hand position rescuers and improve the quality of external chest compressions.