心肺复苏术147例的护理

对我院2001-10～2003-10由护士参与施行的心肺复苏(CPR)147例总结分析如下. 1临床资料 1.1一般资料本组男83例,女64例,年龄最大71岁,最小8岁,平均41.6岁.其中有机磷中毒42例,慢性阻塞性肺部疾病46例,脑血管意外25例,脑外伤8例,急性呼吸窘迫综合征9例,心源性肺水肿2例,心源性猝死15例.     

成人心肺复苏术的护理研究进展

对近年有关成人心肺复苏术中基础生命支持、高级生命支持、持续生命支持的进展及其护理进行综述。     

成人心肺复苏术的护理研究进展

对近年有关成人心肺复苏术中基础生命支持、高级生命支持、持续生命支持的进展及其护理进行综述。     

心脏病患者家属心肺复苏知识的认知和需求调查

目的了解心脏病患者家属对心肺复苏知识的认知和需求。方法自行设计问卷,对心脏病患者家属168人进行调查。结果心脏病患者家属对心肺复苏知识认知差,对心肺复苏知识及急救技能的需求度高,165人愿意接受心肺复苏相关知识、心肺复苏技术的培训。结论重视对心脏病患者家属开展心肺复苏的培训,以提高家属的现场急救意识及急救技能。     

社区人群心肺复苏术认知情况调查

[目的]了解社区人群对徒手心肺复苏术（CPR）知识的认知情况,为广泛开展CPR培训提供参考。[方法]采用自行设计的问卷调查表对武汉市社区人群16 946人进行CPR认知情况调查。[结果]社区人群对CPR认知度低,只有22.88%知道或听说过,会CPR操作者574人,占3.39%。[结论]社区人群缺乏CPR知识,建议对全民进行CPR知识普及和技能培训,从而提高心脏骤停病人抢救成功率,保障人民生命安全。     

社区人群心肺复苏术认知情况调查

[目的]了解社区人群对徒手心肺复苏术(CPR)知识的认知情况,为广泛开展CPR培训提供参考。[方法]采用自行设计的问卷调查表对武汉市社区人群16 946人进行CPR认知情况调查。[结果]社区人群对CPR认知度低,只有22.88%知道或听说过,会CPR操作者574人,占3.39%。[结论]社区人群缺乏CPR知识,建议对全民进行CPR知识普及和技能培训,从而提高心脏骤停病人抢救成功率,保障人民生命安全。     

护理本科实习生对学校手术室护理教学的认知与需求调查

目的：了解护理本科实习生对学校手术室护理教学的认知与需求,为学校手术室护理教学的改革提供依据与参考。方法采用自行设计的对学校手术室护理教学的认知及需求问卷,对广州地区三级甲等医院刚完成手术室护理实习的6所高校160名本科实习护生进行调查。结果54名（33．75％）表示学校手术室护理理论教学的内容安排能满足手术室护理实习需求;121名（75．63％）表示需要在今后的理论教学中采用多种教学方式;对理论教学内容的需求最高的项目为“手术室的无菌操作技术”,占80．00％;61名（38．13％）表示学校手术室护理实践教学的内容安排能满足手术室护理实习需求;143名（89．38％）表示需要在今后的实践教学中采用多种教学方式,对实践教学内容的需求最高的项目为“手术人员的准备（外科刷手、穿脱手术衣、戴无菌手套）”,占91．88％。结论从护理本科实习生的角度分析学校手术室护理教学仍存在一定不足,护理教育者在进行学校手术室护理教学改革时,应不断强化基础,与临床实际相贴近,与专业发展相结合。     

护理实习生多元文化护理认知现状调查及分析

目的了解上海浦东新区护理实习生多元文化护理的认知水平及相关因素,为多元文化护理培训课题的设置提供依据及管理建议。方法采用“护士多元文化护理问卷”（四个维度）进行认知调查,对浦东3所综合性教学医院全体护理实习生共305名在同一时间段内进行调查。结果护理实习生多元文化护理认知总体得分为（104．99±9．41）分,其中知识理论维度得分最低为（25．84±6．53）分;87．9％护生不知道“朝阳模式”;总体及格率为36％,良好率及优秀率为0;护生认知水平低于同一区域临床护士的认知水平（P〈0．01）;本科及专科护生对宗教风俗的认知水平显著高于中专护生（P〈0．05）;护生每日学习时间≥3h者总体认知水平显著高于≤2h者（P〈0．01）;95％～99％护生认为,影响认知水平的主要因素有：①学校没有要求过;②没有培训过;③不知道有此内容。结论浦东新区护理实习生多元文护理认知水平亟待提高,必须采取果断措施加强教育培训与教学管理。     

护理专业实习生康复知识需求的调查分析

目前，我国有6000万残疾人，约占总人口的5％。同时，人口老龄化进程也正在加快，预测到2015年，60岁以上人口将超过2亿．占总人口的14％m。约有50％老年患者需要康复医疗服务。此外．由于疾病谱的改变，慢性病问题将更加突出。这就需要大批具有康复专业知识和技能的护理人员，来满足广大群众对康复医疗服务的需求。而大专院校临床实习的护生对康复知识的掌握程度直接关系到毕业后能否适应临床工作。为此．我们对5所省级医院136名护理专业的实习生进行了随机调查，现报告如下。     

农村社区护理人员心肺复苏技能掌握及培训的现状

目的了解基层（农村社区服务站）护理人员心肺复苏（cardiopul monary resuscitation,CPR）技能掌握及培训的现状,为实施CPR技能培训提供依据。方法对45名农村社区服务站护理人员进行CPR技能掌握和培训情况的问卷调查。结果农村社区服务站的护理人员CPR技能掌握不佳,75.56%的护理人员认为会CPR操作,能独立规范完成CPR操作的仅为5.88%;从没有参加过急救技能培训的护理人员占53.33%;表示＂非常需要＂或＂需要＂急救技能培训的有42名,占93.33%。结论基层护理人员CPR技能和相关理论知识薄弱,但护理人员对培训的需求较高,应尽快给予规范的急救技能培训。     

Socioeconomic Status Is Associated with Provision of Bystander Cardiopulmonary Resuscitation

Objective. Although socioeconomic status (SES) has been linked to multiple health outcomes, there have been few studies of the effect of SES on the provision of bystander cardiopulmonary resuscitation (CPR) during cardiac arrest events and no studies that we know of on the effect of SES on the provision of dispatcher-assisted bystander CPR. This study sought to define the relationship between SES and the provision of bystander CPR in an emergency medical system that includes dispatcher-provided CPR instructions. Methods. This study was a retrospective, cohort analysis of cardiac arrests due to cardiac causes occurring in private residences in King County, Washington, from January 1, 1999, to December 31, 2005. We used the tax-assessed value of the location of the cardiac arrest as an estimate of the SES of potential bystanders as well as multiple measures from 2000 Census data (education, employment, median household income, and race/ethnicity). We also examined the effect of patient and system characteristics that may affect the provision of bystander CPR. Logistic regression models were used to analyze the association of these factors with two outcomes: the provision of bystander CPR with and without dispatcher assistance. Results. Forty-four percent (1,151/2,618) of cardiac arrest victims received bystander CPR. Four hundred fifty-seven people (17.5% of the entire study population, 39.7% of those who received any bystander CPR) received CPR without telephone instructions. A total of 694 people received dispatcher-assisted bystander CPR (25.6% of the entire population, 60.4% of those receiving any bystander CPR). After adjusting for demographic and care factors, we found a strong association between the tax-assessed value of the cardiac arrest location and increased odds of the provision of bystander CPR without dispatcher instructions and bystander CPR with dispatcher assistance compared with no bystander CPR. Conclusions. This study suggests that higher bystander SES is associated with increased rates of bystander CPR with and without dispatcher instructions. CPR training programs that target lower-SES communities and assessment of these training methods may be warranted.     

心脏猝死高危者家属心肺复苏知识与技能培训的重点和难点

目的 通过对心脏猝死高危者家属进行心肺复苏知识与技能的培训,以探讨公众掌握心肺复苏知识与技能的重点和难点.方法 应用方便取样方法,选取首都医科大学附属宣武医院、中国医学科学院阜外心血管病医院住院的心脏猝死(sudden cardiac death.SCD)高危人群的家属集中进行心肺复苏(cardiopulmonary resuscitation,CPR)培训.培训结束后对研究对象进行CPR知识和技能测试.结果 培训后即刻对受训家属进行知识与技能的测试,98.4%的家属CPR知识测试通过,但是只有34.3%的家属技能测试合格,65.7%都需要多次反复指导才能做到技能达标.结论 公众对CPR知识与技能的掌握程度不一致,CPR技能是公众CPR培训的重点与难点.     

公众心肺复苏知识与培训意愿现状的调查

目的:了解广州地区公众急救意识、掌握CPR技术情况、接受相关培训的意愿与倾向;据此探讨有效提高公众急救意识和CPR技能的方法,设计有针对性的培训方法.方法:采用自行设计调查问卷,随机对580名广州公众进行CPR急救知识等方面的现场面访调查.结果:现场有陌生人倒地时,多达400人(69.0%)选择只拨打急救电话(120),而选择并上前检查伤势或进行急救的仅有86人(14.8%);但当倒地的是朋友或亲人时,则有421人(73.6%)选择拨打急救电话并检查伤势或进行急救.如被调查者接受过CPR培训,有高达336人(57.9%)愿意对需要的人进行CPR.仅有4.8%的被调查者熟悉CPR技术.52.6%的被调查者明确表示愿意参加CPR培训.绝大多数人都只愿意在短期假日(48.9%)或周末(45.5%)接受培训;多数希望通过公司或学校组织(279人次)及红十字会组织(201人次)培训CPR;培训方式倾向于现场演示(382人次)和培训人员实际指导(297人次).结论:公众具有较好的急救意愿,但多不具备CPR技能,不过愿意参加CPR培训,社会应有针对性开展有效的CPR培训,提高公众CPR技能.     

南石头街社区居民院前心肺复苏知识调查

目的了解社区居民院前心肺复苏知识掌握状况,全民普及院前心肺复苏知识。方法自行设计问卷,对595名南石头街社区居民进行院前心肺复苏知识调查。结果本组调查的社区居民对于突然有人倒地的应急处理、心肺复苏正确开放气道、评估呼吸、胸外心脏按压的部位和频率、胸外心脏按压和口对口吹气的比例等缺乏认知。高达90.1%的居民否认参加过心肺复苏的培训,而53.9%愿意参加心肺复苏知识和技能培训。结论社区居民心肺复苏知识不足,不能满足社会对现场心肺复苏的需求。应重点加强对中青年的社区常住居民心肺复苏相关知识培训,以提高社区居民猝死的抢救成功率。     

Rescuer Fatigue: Standard versus Continuous Chest-Compression Cardiopulmonary Resuscitation

Objectives Continuous chest‐compression cardiopulmonary resuscitation (CCC‐CPR) has been advocated as an alternative to standard CPR (STD‐CPR). Studies have shown that CCC‐CPR delivers substantially more chest compressions per minute and is easier to remember and perform than STD‐CPR. One concern regarding CCC‐CPR is that the rescuer may fatigue and be unable to maintain adequate compression rate or depth throughout an average emergency medical services response time. The specific aim of this study was to compare the effects of fatigue on the performance of CCC‐CPR and STD‐CPR on a manikin model. Methods This was a prospective, randomized crossover study involving 53 medical students performing CCC‐CPR and STD‐CPR on a manikin model. Students were randomized to their initial CPR group and then performed the other type of CPR after a period of at least two days. Students were evaluated on their performance of 9 minutes of CPR for each method. The primary endpoint was the number of adequate chest compressions (at least 38 mm of compression depth) delivered per minute during each of the 9 minutes. The secondary endpoints were total compressions, compression rate, and the number of breaks taken for rest. The students' performance was evaluated on the basis of Skillreporter Resusci Anne (Laerdal, Wappingers Falls, NY) recordings. Primary and secondary endpoints were analyzed by using the generalized linear mixed model for counting data. Results In the first 2 minutes, participants delivered significantly more adequate compressions per minute with CCC‐CPR than STD‐CPR, (47 vs. 32, p = 0.004 in the 1st minute and 39 vs. 29, p = 0.04 in the 2nd minute). For minutes 3 through 9, the differences in number of adequate compressions between groups were not significant. Evaluating the 9 minutes of CPR as a whole, there were significantly more adequate compressions in CCC‐CPR vs. STD‐CPR (p = 0.0003). Although the number of adequate compressions per minute declined over time in both groups, the rate of decline was significantly greater in CCC‐CPR compared with STD‐CPR (p = 0.0003). The mean number of total compressions delivered in the first minute was significantly greater with CCC‐CPR than STD‐CPR (105 per minute vs. 58 per minute, p < 0.001) and did not change over 9 minutes in either group. There were no differences in compression rates or number of breaks between groups. Conclusions CCC‐CPR resulted in more adequate compressions per minute than STD‐CPR for the first 2 minutes of CPR. However, the difference diminished after 3 minutes, presumably as a result of greater rescuer fatigue with CCC‐CPR. Overall, CCC‐CPR resulted in more total compressions per minute than STD‐CPR during the entire 9 minutes of resuscitation.     

Electroencephalography during Out-of-hospital Cardiopulmonary Resuscitation

Background

At the present time there is no parameter that can estimate the quality of cerebral perfusion and possible success of cerebral resuscitation during advanced cardiac life support (ACLS) efforts. In recent years, various attempts have been made to use electroencephalography (EEG)-based cerebral neuromonitoring to assess the effectiveness of cardiopulmonary resuscitation (CPR).

Objectives

The Cerebral State Monitor M3 (Danmeter A/S, Odense, Denmark) is a portable, single-channel EEG monitor that provides the user with different EEG-based parameters and the raw waveform EEG to measure cerebral activity.

Case Report

We report two cases of out-of-hospital CPR with single-channel EEG monitoring conducted parallel to ACLS with external chest compressions. We demonstrate an artifact in waveform EEG recordings that is caused by the external chest compressions, and that leads to a miscalculation of the Burst Suppression Ratio and Cerebral State Index.

Conclusion

These cases suggest that digitally processed EEG-monitoring is not a useful tool during CPR.     

心肺复苏仪胸外心脏按压对心肺复苏成功的影响

目的:探讨心肺复苏仪胸外心脏按压对心肺复苏成功的影响。方法:将42例心跳呼吸骤停患者随机分为徒手胸外心脏按压组(A组)和心肺复苏仪胸外心脏按压组(B组)。二组均进行无创动脉血压、心电、经皮氧饱和度sPO2等监测。结果:B组的自主循环恢复率和24小时存活率均明显高于A组(P<0.05和P<0.01),但二组的出院存活率无显著性差异。B组的经皮氧饱和度明显高于A组(P<0.05),而自主循环恢复时间则明显短于后者(P<0.01);二组的平均动脉压无显著性差异。结论:心肺复苏仪胸外心脏按压在提高自主循环率,缩短自主循环恢复时间,改善患者生存机会等方面明显优于徒手胸外心脏按压。     

The Evolution of Abdominal Compression in Cardiopulmonary Resuscitation

Objective: To review the history of external abdominal compression as an adjunct to cardiopulmonary resuscitation (CPR), tracking the development of five major themes over the course of the 20th century: 1) augmentation of peripheral resistance by physical means, 2) risk of hepatic injury with abdominal compression, 3) counterpulsation vs sustained compression, 4) the abdominal pump mechanism, and 5) contact compression techniques.
Methods: Literature retrieved from successive MEDLINE English-language searches was reviewed with a special emphasis on work and concepts highlighted by participants at the First Purdue Conference on Interposed Abdominal Compression-CPR, September 1992.
Results: External abdominal compression of one form or another has been studied as a means of resuscitation by many investigators throughout the 20th century. Experimental and clinical studies have shown generally consistent evidence of hemodynamic augmentation by abdominal compression during various forms of CPR. Recent advances include a modified theoretical understanding of hemodynamic mechanisms and demonstration of clinical potential in humans. Inconsistencies in published results may be due to differences in mechanical techniques of abdominal compression. Based on these studies, a modified manual technique for "contact compression" of the abdominal aorta is recommended.
Conclusions: A technique for left-of-center, angled compression of the abdominal aorta against the crest of the spine is recommended. Further well-supervised and controlled clinical trials using this standardized technique are warranted as a prelude to more widespread clinical application of abdominal compression in CPR.