心脏性猝死高危病人家庭成员心肺复苏培训方法的研究

[目的]探讨适合我国国情的对心脏性猝死高危病人家庭成员的心肺复苏(CPR)培训方法,提高心脏性猝死高危病人家庭成员心肺复苏能力。[方法]采取对照研究的方法,将猝死高危病人家庭成员150人作为观察组进行心肺复苏培训,培训采取两级培训的方法,即先对社区医生,再由社区医生对家庭成员进行培训;将社区公众130人作为对照组,直接对其进行心肺复苏培训。分别对两组培训前、培训后即刻、培训后半年心肺复苏知识掌握情况进行问卷调查。[结果]观察组培训后即刻回答问题的正确率显著提高,且明显高于对照组。[结论]先对社区医生进行CPR培训,再由社区医生对猝死高危病人家属进行一对一个体CPR培训,可以有效地提高对心脏性猝死急救知识的掌握程度,是一项行之有效的方法。     

社区高危人群家属心肺复苏知识认知现状及技能培训

目的:通过了解某社区高危人群家属徒手心肺复苏(CPR)知识和技能知晓程度,探讨对其进行CPR知识及技能培训的意义及实施方法。方法:选择心血管疾病家属93名作为调查培训的对象,对其问卷调查和实施急救知识和技能培训。结果:被调查者所在社区未开展CPR知识及技能培训,高危人群家属CPR知识和技能缺乏,理论知识平均得分为(12.30±1.11)分,操行技能无一人合格;经培训后,CPR理论知识平均得分为(24.7±1.56)分,与培训前比较差异有统计学意义(P<0.05);操行技能与培训前比较差异有统计学意义(P<0.01)。结论:对社区居民普及CPR知识和技能,对减少院前猝死、提高院前急救成功率起着至关重要的作用。     

广州东部地区公众徒手心肺复苏术掌握现状调查及培训分析

目的了解广州东部地区公众对徒手心肺复苏术（CPR）掌握现状,探讨对公众进行CPR培训的方法。方法对广州东部地区738人进行CPR培训,培训前后理论和操作考试。结果广州东部地区公众普遍缺乏心肺复苏知识和技能。培训后操作考试合格率从培训前12．0％提高到100．0％。结论广州东部地区公众普遍缺乏心肺复苏基本知识和技能,规范培训能有效提高公众心肺复苏技能。     

护理干预对心脏性猝死高危患者家属急救能力的影响

目的 探讨护理干预对心脏性猝死高危患者家属对相关疾病认知水平及救助能力的影响,提高家属的现场急救能力.方法 对180名心脏性猝死高危患者家属随机分成实验组和对照组,各90例.对观察组实施护理干预措施,包括疾病健康宣教、相关急救知识及心肺复苏技能培训、心理疏导等,对照组不进行护理干预.患者离科前1d对其家属进行相关知识及急救技能测查.结果 观察组掌握的相关急救知识及心肺复苏技能明显优于对照组,2组比较差异有非常显著性(P＜0.01).结论 护理干预和急救技能培训能有效提高心脏性猝死高危患者家属对相关疾病的认知水平及现场紧急救助能力,从而提高院前心肺复苏的成功率,降低病死率.     

护理干预对心脏性猝死高危患者家属急救能力的影响

目的 探讨护理干预对心脏性猝死高危患者家属对相关疾病认知水平及救助能力的影响,提高家属的现场急救能力.方法 对180名心脏性猝死高危患者家属随机分成实验组和对照组,各90例.对观察组实施护理干预措施,包括疾病健康宣教、相关急救知识及心肺复苏技能培训、心理疏导等,对照组不进行护理干预.患者离科前1d对其家属进行相关知识及急救技能测查.结果 观察组掌握的相关急救知识及心肺复苏技能明显优于对照组,2组比较差异有非常显著性(P＜0.01).结论 护理干预和急救技能培训能有效提高心脏性猝死高危患者家属对相关疾病的认知水平及现场紧急救助能力,从而提高院前心肺复苏的成功率,降低病死率.     

在读大学生心肺复苏培训的效果及分析

目的了解某大学在读大学生心肺复苏知识和技能的掌握现状,并观察分析培训后的效果,以期对相关部门管理者有所启发。方法对湖北省某大学211名在读非医学类本科生进行心肺复苏(cardiopulmonary resuscitation,CPR)知识及技能规范授课,并通过问卷调查形式了解被调查者培训前后CPR知晓程度、获取信息途径、接受培训意愿等。结果 (1)接受培训意愿:99.1%的被调查者表示愿意参加急救知识培训。(2)培训前学习途径:在此次培训前被调查者中44.1%已通过专业书籍、电视、网络等途径接触一些心肺复苏相关信息,仅有9%曾参加心肺复苏专业培训,在假设现场有人发生猝死情况时98.6%选择愿意实施现场急救,其中仅3.8%可以正确实施CPR操作。(3)培训后效果:通过此次培训大学生对心肺复苏基本步骤掌握程度明显提高,有99.5%的大学生对本次授课内容、形式表示满意,并愿意再次接受此类急救知识培训。结论在读大学生对CPR的知晓率不高,急救技术在校园普及率低。医护人员应积极走进大学校园进行系列、规范急救知识培训,在拓展医护人员服务领域的同时有效提高大学生急救知识和技能,以期为普及全民院前急救能力奠定基础。     

临床护理实习生心肺复苏知识、技能与实施意愿调查

目的：了解临床护理实习生心肺复苏( cardiopulmonary resuscitation,CPR)理论知识和技能掌握情况以及院外实施心肺复苏意愿,为开展心肺复苏培训提供参考依据。方法采用“临床护理实习生心肺复苏调查问卷”与“单人徒手心肺复苏行为操作考核评分表”对某三甲医院176名护理实习生进行心肺复苏知识、技能掌握与现场实施心肺复苏意愿调查。结果临床护理实习生总体对CPR基础知识掌握较好,CPR技能掌握有待提高,不同学历护理实习生对CPR理论知识和技能掌握差异有统计学意义( P<0.05),护理实习生对陌生人和亲近人实施CPR意愿差异有统计学意义( P<0.05),对同一对象实施人工呼吸与胸外心脏按压意愿差异有统计学意义( P<0.05)。结论护理实习生CPR技能有待提高,学校和医院需进一步加强对护理实习生CPR培训与复训,找出现场施救的障碍因素,提高护理实习生院外实施CPR的意愿。     

住院冠心病患者家属心肺复苏培训意愿及障碍的调查分析

目的:了解冠心病患者家属对学习心肺复苏技能的意愿及影响其学习和实施心肺复苏的可能原因,为进一步进行有效的心脏性猝死高危家属实施心肺复苏技能培训提供依据.方法:采用自设调查问卷对2009年1～5月在北京宣武医院心脏科住院的冠心病患者家属进行问卷调查.结果:80例样本中愿意参加实施心肺复苏培训的有66人(82.5%),女性稍高于男性,低龄者高于高龄家属.结论:多数的冠心病患者家属愿意参加实施心肺复苏的培训,建立院内教育体系及公众预防体系及合理有效的培训方法是提高公民实施心肺复苏意识和技能的重要因素.     

督导强化模式对心脏猝死高危者家属心肺复苏知识保持的影响

目的评价两种不同强化模式对心肺复苏(CPR)知识保持的影响,以寻求一种适合对公众进行CPR培训的强化模式。方法采用随机安慰剂对照临床试验的研究设计,应用方便取样的方法,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(SCD)高危人群的家属集中进行CPR培训。培训结束后将研究对象随机分为督导强化组(集中CPR培训后给予CPR教学光盘并且之后给予督导强化)、自我强化组(集中CPR培训后给予CPR教学光盘,并且要求进行自我强化)、对照组(集中CPR培训后给予安慰剂光盘,并且之后不要求进行任何强化)。分别于培训前、培训后即刻、培训后3个月对研究对象进行CPR知识水平的测试。结果培训后3个月,3组研究对象的知识得分均随着时间变化而下降,督导强化组知识得分从培训后即刻的(17.23±2.26)分下降到(15.25±2.63)分,较其他两组下降幅度最小(P0.05)。结论督导强化模式可以使研究对象培训后的CPR知识得到巩固,但是还需要在更广泛的人群中对这种强化模式进行深入的研究。     

家属心肺复苏培训对提高心脏猝死高危患者存活率的影响

目的 探讨分析心脏猝死高危患者家属进行心肺复苏培训对提高患者存活率的影响。方法 选择重庆医科大学附属第二医院心内科住院部2012年2月至2016年6月收治的610名心脏猝死高危患者的家属为研究对象。利用随机抽签法将其分为两组,观察组305名患者家属接受系统的心肺复苏培训方案;对照组305名患者家属只接受床旁健康宣教及公休会等。分析两组患者心脏骤停后存活率及其家属对急救知识及技能的掌握情况。存活的定义为患者心脏骤停经复苏抢救,患者出现自主心搏、自主呼吸,且在高级生命支持下存活时间＞24 h。存活率=（心脏骤停后存活人数/心脏骤停事件总例数）×100%。结果 观察组患者家属对心脏猝死诱因、防治措施、心脏骤停判断等方面知识的掌握情况均好于对照组（P＜0.05）;观察组患者家属应急反应时间平均为（81.02±37.01）s,明显短于对照组（169.62±30.69）s;观察组患者家属护理满意度97.05%,明显优于对照组83.28%。随访1年,观察组患者存活率（88.51%）高于对照组（70.45%）,差异有统计学意义（P＜0.05）。结论 对心脏猝死高危患者家属进行心肺复苏培训,能够有效提高家属的急救水平及应急能力,利于提高患者存活率。     

The effect of cardiopulmonary resuscitation training on psychological variables of cardiac rehabilitation patients

As a component of cardiac rehabilitation (CR), cardiopulmonary resuscitation (CPR) training is widely recommended. These recommendations advocate the importance of offering CPR training to cardiac patients' families. Prior research examining the effect of CPR training on the cardiac patients spouse or family member, suggests that receiving CPR training within a supportive environment such as cardiac rehabilitation causes no adverse psychological effects in the family members. Patients are often excluded from CPR training due to fears of the possible physiological consequences. Conversely, there may be negative psychological consequences for patients who are excluded from CPR training. Although cardiac patients are at high risk of cardiac arrest themselves this should not preclude them from having the ability to help another. The aim of this study was to assess the impact on anxiety, depression and perception of control (POC) of CPR training for the cardiac patients as an integral part of an 8-week phase III Cardiac Rehabilitation Programme. Fifty-eight patients and 54 family members or partners attending an 8-week CR programme were offered optional CPR training during the final week of the programme. Forty-nine patient subjects were evaluated at four time points, using the hospital anxiety and depression scale and the control attitudes scale. Seventy-five percent (n = 37) of patients participated in the CPR training. Teaching CPR to cardiac patients did not affect anxiety levels adversely. There was an overall significant decrease in anxiety scores for both patient groups over time (p = 0.0071). Both patient groups showed an average moderate level of POC at baseline but the POC level in those who did the CPR training continued to increase slightly throughout the study period. If the patient agreed to undertake CPR training approximately 61% of their relatives or partners also undertook the training, but when the patient did not avail of the CPR training only 20% of their relatives or partners participated. Cardiac patients would appear to have a desire to learn CPR. It is recommended that cardiac patients be involved in CPR training as it poses them no adverse psychological consequences and may improve their perception of control. Inclusion of the patients in the CPR training may help increase the participation in CPR training by cardiac patients' families.     

Comparison of three instructional methods for teaching cardiopulmonary resuscitation and use of an automatic external defibrillator to high school students

OBJECTIVE: To evaluate new instructional methods for teaching high school students cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) knowledge, actions and skills. METHODS: We conducted a cluster-controlled trial of 3 instructional interventions among Seattle area high school students, with random allocation based on classrooms, during 2003-04. We examined two new instructional methods: interactive-computer training and interactive-computer training plus instructor-led (hands-on) practice, and compared them with traditional classroom instruction that included video, teacher demonstration and instructor-led (hands-on) practice, and with a control group. We assessed CPR and AED knowledge, performance of key AED and CPR actions, and essential CPR ventilation and compressions skills 2 days and 2 months after training. All outcomes were transformed to a scale of 0-100%. RESULTS: For all outcome measures mean scores were higher in the instructional groups than in the control group. Two days after training all instructional groups had mean CPR and AED knowledge scores above 75%, with use of the computer program scores were above 80%. Mean scores for key AED actions were above 80% for all groups with training, with hands-on practice enhancing students' positive outcomes for AED pad placement. Students who received hands-on practice more successfully performed CPR actions than those in the computer program only group. In the 2 hands-on practice groups the scores for 3 of the outcomes ranged from 57 to 74%; they were 32 to 54% in the computer only group. For the outcome of continuing CPR until the AED was available scores were high, 89 to 100% in all 3 training groups. Mean CPR skill scores were low in all groups. The highest mean score for successful ventilations was 15% and for compressions, 29%. The pattern of results was similar after 2 months. CONCLUSIONS: We found evidence that interactive computer based self instruction alone was sufficient to teach CPR and AED knowledge and AED actions to high school students. All forms of instruction were highly effective in teaching AED use. In contrast to AED skills, CPR remains a set of difficult psychomotor skills that is challenging to teach to high school students as well as other members of the lay public.     

Basic life support: knowledge and attitude of medical/paramedical professionals

BACKGROUND:

Basic life support (BLS), a key component of the chain of survival decreases the arrest – cardiopulmonary resuscitation interval and increases the rate of hospital discharge. The study aimed to explore the knowledge of and attitude towards basic life support (BLS) among medical/paramedical professionals.

METHODS:

An observational study was conducted by assessing response to self prepared questionnaire consisting of the demographic information of the medical/paramedical staff, their personnel experience/attitude and knowledge of BLS based on the 2005 BLS Guidelines of European Resuscitation Council.

RESULTS:

After excluding incomplete questionnaires, the data from 121 responders (27 clinical faculty members, 21 dental and basic sciences faculty members, 29 house officers and 44 nurses and health assistants) were analyzed. Only 9 (7.4%) of the 121 responders answered ≥11, 53 (43%) answered 7-10, and 58 (48%) answered <7 of 15 questions correctly. The clinical faculty members, house officers and nurses/HA had a mean score of 7.4±3.15, 7.37±2.02 and 6.63±2.16 respectively, while dental/basic sciences faculty members attained a least mean score of 4.52 ±2.13 (P<0.001). Those who had received cardiopulmonary resuscitation (CPR) training within 5 years obtained a highest mean score of 8.62±2.49, whereas those who had the training more than 5 years back or no training obtained a mean score of 5.54±2.38 and 6.1±2.29 respectively (P=0.001). Those who were involved in resuscitation frequently had a higher median score of 8 in comparison to those who were seldom involved or not involved at all (P<0.001).

CONCLUSIONS:

The average health personnel in our hospital lack adequate knowledge in CPR/BLS. Training and experience can enhance knowledge of CPR of these personnel. Thus standard of CPR/BLS training and assessment are recommended at our hospital.KEY WORDS: Basic life support (BLS), Cardiopulmonary resuscitation (CPR), Training, Knowledge, Attitude     

Public perceptions and experiences of myocardial infarction, cardiac arrest and CPR in London

INTRODUCTION: The lay public have limited knowledge of the symptoms of myocardial infarction ("heart attack"), and inaccurate perceptions of cardiac arrest survival rates. Levels of CPR training and willingness to intervene in cardiac emergencies are also low. AIMS: To explore public perceptions of myocardial infarction and cardiac arrest; investigate perceptions of cardiac arrest survival rates; assess levels of training and attitudes towards CPR, and explore the types of interventions considered useful for increasing rates of bystander CPR among Greater London residents. METHODS: A quantitative interview survey was conducted with 1011 Greater London residents. Eight focus groups were also conducted to explore a range of issues in greater depth and validate trends that emerged in the initial survey. RESULTS: Chest pain was the most commonly recognised symptom of "heart attack". Around half of the respondents were aware that a myocardial infarction differs from a cardiac arrest, although their ability to explain this difference was limited. The majority overestimated that at least a quarter of cardiac arrest patients in London survive to hospital discharge. Few participants had received CPR training, and most were hesitant about performing the procedure on a stranger. CONCLUSIONS: Awareness and knowledge of CPR, and reactions to cardiac emergencies, reflect relatively low levels of CPR training in London. Publicising cardiac arrest survival figures may be instrumental in prompting members of the public to train in CPR and motivating those who have been trained to intervene in a cardiac emergency.     

The knowledge and perceptions of medical personnel relating to outcome after cardiac arrest

OBJECTIVE: We sought to evaluate the knowledge of probable outcome by medical personnel for in-hospital and out-of-hospital cardiac arrests, and self-reported history of CPR training referrals for family members of cardiac patients. METHODS: One hundred people from each of three population lists were randomly selected at a large, urban school of medicine and affiliated medical center: (1) year III and IV medical students; (2) residents in family medicine, emergency medicine, internal medicine, anesthesia, and surgery; (3) attending physicians in the same departments. A questionnaire was distributed that elicited estimates of in-hospital and out-of-hospital cardiac arrest (IHCA and OHCA, respectively) survival rates, and CPR training referral history. Estimates were compared against published data for accuracy (IHCA: 5-20%; OHCA 1-10%) RESULTS: The overall response rate was 63%. Accurate in-hospital cardiac arrest estimates [% (95% CI)] of survival were provided by 51.1% (36.8-63.4%), 47.3% (35.9-58.7%), and 36.7% (23.2-50.2%) of students, residents, and attending physicians, respectively. Accurate out-of-hospital estimates of survival were provided by 51.1% (36.8-63.4%), 52.1% (40.6-63.5%), and 70.8% (57.9-83.7%), respectively. Most thought that family members of cardiac patients ought to be CPR trained (92.6%). However, few had referred any for training in the past year (16.5%). There was strong support across respondent groups for including death notification information in the ACLS training program, with 80.4% of all respondents in favor. CONCLUSIONS: This study demonstrates that medical experience is not associated with accurate estimates of cardiac arrest survival. Overwhelmingly, medical personnel believe family members should be trained to perform CPR, however, few refer family members for CPR training.     

Motivation and adult learning: a survey among hospital personnel attending a CPR course

AIM OF THE STUDY: A massive cardiopulmonary resuscitation (CPR) training programme is continued in most hospitals to make hospital personnel ready to take action in cases of cardiac arrest. Motivated course participants learn more and perform better than unmotivated course participants. This study investigates whether hospital personnel are motivated to participate in CPR courses and whether motivation correlates with important assumptions in adult learning. MATERIALS AND METHODS: A survey measuring learning motivation via the MSLQ instrument was performed among 361 hospital personnel before attending a CPR course. Assumptions of adult learning were identified and data were analysed in relation to these assumptions. RESULTS: Hospital personnel are generally motivated for learning CPR. Respondents who had been prepared for the course, who had participated in the decision about attending the course, who were working in high-risk area for cardiac arrest or were nursing personnel working in long-time close contact with patients were more motivated to CPR training than other hospital personnel. It seems like motivation correlates with adult learning assumptions such as the learners need to know, the learners self-concept, readiness to learn and orientation to learning. CONCLUSION: This study supports the assumption that CPR training should be based on an adult learning model. As preparedness, participation, readiness and relevance seem to be key factors, we may want to include these factors when training hospital personnel in CPR skills.     

Psychological and social impacts of automated external defibrillators (AEDs) in the home

BACKGROUND: The majority of cardiac arrests occur in the home. The placement of AEDs in the homes of at-risk patients may save lives through early defibrillation. However, the impact of having an AED in the home on psychological outcomes and quality-of-life is unknown. OBJECTIVE: The purpose of this research was to determine whether training in the use of and possessing an automated external defibrillator (AED) has an effect on a patient at risk's quality of life. METHODS: We investigated the psychological consequences of AED training and possession of such a device for patients who recently experienced an acute ischemic event. One hundred fifty eight patients and their family members were assigned at random to receive cardiopulmonary resuscitation (CPR) training (N=66) or AED/CPR training and possession of the device after training (N=92). We measured quality of life using the Short-Form (SF-36) survey and a 9-item survey we developed specifically for this study to measure differences in social activities and worries about being left alone. Participants answered these questions at enrollment, 2 weeks, 3 months, and 3 months after enrollment. RESULTS: Patients in the AED group reported lower (worse) scores on most SF-36 subscales at all periods, particularly in those subscales relating to social functioning. The differences were most often small and probably not clinically meaningful. The social activities/worry scales also favored the CPR group at all periods, but with no significant differences. CONCLUSIONS: Physicians counselling patients about AEDs should be aware of the potential effects the device may have on a patient's social functioning.     

Cardiopulmonary resuscitation training for family members of patients on cardiac rehabilitation programmes in Scotland.

Existing cardiopulmonary resuscitation (CPR) training programmes have failed to reach those most likely to witness a cardiac arrest, such as families of cardiac patients. In 1993, the Scottish Health Service Advisory Committee suggested that CPR training could be offered as part of cardiac rehabilitation programmes. A survey was carried out to identify the current extent and nature of such training and factors influencing its provision. Questionnaires were mailed to all the 45 Scottish cardiac rehabilitation programmes on the British Heart Foundation's register. A 93% response rate was achieved. Only 37% of programmes provided information to families about attending a CPR course and 37% actually provided CPR training The numbers trained by these programmes were very small. Hospital programmes were significantly more likely than community programmes to provide CPR training (chi2 = 6.65, P < 0.01) as were those which included an exercise component (chi2 = 7.63, P < 0.01). Reasons for not providing training ranged from lack of resources and lack of staff training, to not having considered it. CPR training is provided as part of cardiac rehabilitation programmes to a limited extent. Ways of recruiting and increasing the number of family members of cardiac patients who are trained in CPR need to be found.     

成人心肺复苏模拟培训考试中存在问题的调查与分析

目的 分析成人心肺复苏(CPR)模拟考试中存在的问题和因素,以便采取有效措施使每位护理人员真正掌握CPR技术的临床应用.方法 全院50岁以下的护理人员,初次参加培训考试的32人,再次培训考试的121人,以美国心脏病协会2005心肺复苏新指南为标准,以心肺复苏模拟人(TZ/ACLS8000型高级综合急救技术训练系统)为住院患者模拟抢救现场,考察护理人员急救意识、抢救措施的实施情况、护理记录的落实情况以及初次培训与再次培训掌握水平的差异性等.结果 CPR知识培训能明显提高护理人员的急救知识(P<0.01),但仍然存在很多重要细节问题;并发现初次培训与再次培训掌握水平无差异性.结论 CPR知识培训效果明显,应常规、重复培训,理论联系实际,注意细节问题,间隔时间为3～6个月.