情景模拟演练对提高严重产后出血患者救治能力的分析

目的 分析情景模拟演练培训对提高救治严重产后出血患者能力及降低死亡率的效果.方法 2018年7月和2019年9月对广东省某地级市产科医护人员(共228人次)分别进行为期3d的严重产后出血情景模拟培训,通过理论授课、单项操作培训、团队急救演练、团队急救小组示范等形式,进行产后出血急救理论知识、技能操作、人员分工及站位管理...     

急救模拟培训在产科临床实践中的意义

产科急救模拟培训可提高产科医务工作者处理复杂危急重症的临床综合技能、增强临床处理信心、提高团队沟通能力,有效降低相关不良母儿结局的发生,但培训效果会随着间隔时间延长逐渐减弱。因此,强调急救模拟培训在产科危急重症处理(肩难产、脐带脱垂、产后出血、子痫)中的运用,并要注重定期、重复培训。     

模拟人在孕产妇心肺复苏团队演练中的运用

孕产妇心跳骤停是产科临床的最紧急事件,熟练掌握和运用心肺复苏技术是救治患者的关键。利用模拟人进行团队演练能提高产科医护人员掌握心肺复苏技能及临床抢救的能力。     

模拟人在产科模拟教学和急救演练中的作用

产科急危重症是围产期母婴死亡的主要原因,一旦发生及时救治是挽救母婴生命的关键。模拟人在产科急救演练中弥补了传统教学模式的不足,提高了教学效果,有利于产科急危重症围产期结局的改善。     

情景模拟培训在医学教育中的价值

情景模拟培训在医学教育中具有模拟真实性、无医疗风险、个体化教育、客观规范化、可重复性等优势。在产科急重症抢救方面使用模拟训练,可提高团队成员应急能力和沟通协作能力,从而最大限度地改善医疗结局,保障医疗安全。     

产科快速反应团队的建立和演练

鉴于产科病情突变、易变、多变，在孕产妇病情发展初期时即采取有效的处置措施，而不是待其病情恶化后才进行复苏抢救的快速反应团队（RRT）尤为重要。产科RRT的建立需要医院、产科及其他科室的共同支持。RRT建成后的培训、演练及考核也需定期开展，使RRT团队能力不断提升。     

SimMom模拟人在产科医师培训中的作用

产科是一门实践性强、应急性高、对团队合作要求高的临床医学。在患者安全性要求更高的今天,产科医生需要通过模拟训练来提高临床操作技能和团队合作能力以应对各种急危重症。现对SimMom模拟人在产科医师培训中的研究进展进行讨论。     

产科急救多学科团队管理和产科快速反应团队建立的作用

正产科患者病情变化快、特点急,常需要急救支持。又由于产科急救涉及母胎,因此较普通急救相比有其特殊性。早期识别患者病情变化,快速做出反应,并联合多学科对患者进行救治,是提高孕产妇救治成功率及降低死亡率的重要措施。目前越来越强调多学科团队管理(multidisciplinary treatment,MDT)模式和产科快速反应团队(rapid respond team,RRT)在产科急救中的作用。     

子痫前期的干预与管理

子痫前期以发病异质性、临床表现多样性、母胎预后差为其特点,针对疾病高危人群的管理、严重并发症的预警、关键环节核查的标准化管理以及定期急救技能的培训和演练,是早期诊断疾病、及时判断病情和正确处理、改善母胎预后的有效手段。     

PBL联合OSCE教学策略在高质量产科模拟教学中的应用

目的 探讨以问题为基础的学习（PBL）联合临床技能多站式考试（OSCE）教学策略在高质量产科模拟教学中的应用效果。方法 选取2016级产科1班和2班为研究对象,按照实施教学管理方案不同,将产科1班作为试验组,实施PBL联合OSCE教学策略,产科2班作为对照组,实施常规教学指导,每组30名。比较两组教学效果和专业OSCE考试成绩。结果 试验组在提高分析及解决能力、激发学习兴趣、促进内容记忆、提高临床思维能力、加强团队协作及提高医患沟通能力占比均高于对照组,差异有统计学意义（P<0.05）。试验组病史采集、病历书写、产前检查、临床技能操作及产科手术操作评分均高于对照组,差异有统计学意义（P<0.05）。结论 产科模拟教学指导过程中,以PBL联合OSCE教学策略指导,能够提高产科模拟教学质量。     

羊水栓塞的团队流程化抢救

羊水栓塞是危及母胎生命的罕见并发症，早期识别并尽快启动抢救团队，采用正确的抢救流程，可以改善母胎预后。医护团队应该规范产科干预，降低羊水栓塞风险。医疗机构应该制定羊水栓塞的标准化抢救流程，实施规范救治。组建快速反应团队，早期识别并实施多学科救治是抢救成功的关键。对抢救团队进行周期性培训和演练，通过点评和反馈可以提高团队紧急状态下的沟通能力和综合救治能力。     

Management of the Eclamptic Patient

Eclampsia is defined as the development of convulsions and/or coma unrelated to other cerebral pathology during pregnancy or in the postpartum period in patients with signs and symptoms of preeclampsia. It is a life-threatening obstetrical emergency that is not limited to occurrence in tertiary care centers. Obstetricians and perinatal nurses in every facility therefore must be familiar with the diagnosis and management of this complication of pregnancy. Astute care by the obstetrical team is of paramount importance in eclampsia management because of increased risks of maternal trauma, volume overload, gastric aspiration, and fetal distress. Basic principles in the management of eclampsia are maternal support of vital functions, protection of mother from injury, prevention of recurrent convulsions, correction of maternal hypoxemia or acidemia, control of severe hypertension, and initiation of the delivery process. Parenteral magnesium sulfate remains the anticonvulsant agent of choice in eclamptic patients. Administration of magnesium sulfate requires personnel to be familiar with its pharmacology, side effects, and appropriate antidote in the event of overdosage. With a well-formulated management plan, improved maternal and fetal outcome is achievable in this infrequent but severe complication of pregnancy.     

沙盘模拟在产科专科培训的应用初探

目的探讨沙盘模拟培训在产科专科培训应用中的可行性和有效性。 方法培训班以沙盘模拟形式对学员进行产科急危重症与助产技术培训，采用"沙盘推演—学员操作—导师点评—导师演示"的培训模式，内容包括子痫、产后出血、肩难产、阴道助产和新生儿窒息复苏。选取200名学员为研究对象，并随机分成5个团队，培训前后对学员进行理论知识和操作技能考核，根据考核标准由导师组进行打分，并对每个团队的抢救流程进行考核评分。同时培训前后发放调查问卷对培训课程进行反馈。 结果经培训后，学员的理论考核成绩(91.1±14.5)分较培训前(75.6±24.0)分明显提高，差异有统计学意义(P<0.05)。各操作模块考核前后成绩分别为：子痫(73.7±5.6)分与(90.6±3.9)分，产后出血(71.2±8.7)分与(88.9±4.8)分，阴道助产(70.1±7.9)分与(90.0±4.8)分，肩难产(74.6±5.7)分与(91.5±2.3)分，新生儿窒息(73.2±4.7)分与(91.2±2.5)分，培训后成绩明显提高，差异有统计学意义(P<0.05)。团队考核的Topsis分析结果显示，团队3在多项指标上都是最优秀的，综合排名第一名，尤其是方案设计。团队5在临床技能表现突出，在团队配合和患者沟通方面做得也比较好。团队2和团队4各项指标都表现不足。 结论团队3大部分成员来自三甲医院，经常参加产科模拟培训班，因此总体素质较高，而团队2和团队4来自基层医院的成员居多，接受培训的次数较少，因此成绩偏弱，尤其在流程、沟通和团队配合等方面，还需要加强培训。沙盘模拟培训作为一种新型的体验式培训模式，具有创新性、互动性、趣味性，并具有实战性，在产科急危重症专科培训中具有较大的发展前景。     

子痫伴发脑型疟疾24例临床分析

目的 ５探讨子痫伴发脑型疟疾的临床特点。方法 对１９９５年７月至１９９８年１０月间,坦桑尼亚桑给巴尔列宁收治的２４例子痫发脑型疟患者的临床资料进行回顾性分析。结果 全组患者均有不同程度的昏迷,高热和抽搐,所有患者血涂片查疟原虫均为阳性。并接受了抗疟疾,抗子痫的综合治疗。     

Eclampsia: 134 consecutive cases

OBJECTIVE: A retrospective analysis of all cases of eclampsia (134) at Korle Bu Teaching Hospital, Accra, Ghana, in 1991, was undertaken to determine future directions in prevention and management. METHODS: One hundred and thirty-four consecutive cases of eclampsia were reviewed to assess possible risk factors, associated medical impact, and the usefulness of prenatal care. RESULTS: Risk factors for the development of eclampsia include: young age, delivery in the rainy season, nulliparity, multiple pregnancy, prolonged labor, and lack of prenatal care. Eclampsia is associated with high maternal and perinatal mortality. CONCLUSIONS: Future emphasis on prenatal clinics, and earlier detection and management of pre-eclampsia should lessen the incidence of this severe obstetric emergency.     

Eclampsia in Finland in 1990-1994

BACKGROUND: Eclampsia is a serious threat to both maternal and fetal well-being. We started the present study because no recent data are available on the incidence of eclampsia and the outcome of patients with this serious disorder in Finland. METHODS: The incidence of eclampsia in Finland in 1990-1994 was studied retrospectively. The data were retrieved from the National Birth Register and the Finnish Hospital Discharge Register. Patient records were reviewed. RESULTS: Seventy-seven cases of eclampsia were found in the hospital records, which gave an eclampsia incidence of 2.4 per 10,000 deliveries (95% confidence intervals 1.9 to 2.9). Eclampsia was preceded by severe pre-eclampsia in 84% and by mild pre-eclampsia in 8% of the patients. Ten mothers suffered from severe eclampsia-related complications but, fortunately, none of the mothers died. Perinatal mortality was 5%, and 33% of the newborns were small for gestational age. CONCLUSIONS: Eclampsia is rare in Finland. Its low incidence is probably due to improved neonatal care that allows earlier deliveries before the progress of preeclampsia to eclampsia.     

Health Care Team Training and Simulation-Based Education in Obstetrics During the COVID-19 Pandemic

Health care team training and simulation-based education are important for preparing obstetrical services to meet the challenges of the COVID-19 pandemic. Priorities for training are identified in two key areas. First, the impact of infection prevention and control protocols on processes of care (e.g., appropriate and correct use of personal protective equipment, patient transport, preparation for emergency cesarean delivery with the potential for emergency intubation, management of simultaneous obstetric emergencies, delivery in alternate locations in the hospital, potential for increased decision-to-delivery intervals, and communication with patients). And second, the effects of COVID-19 pathophysiology on obstetrical patients (e.g., testing and diagnosis, best use of modified obstetric early warning systems, approach to maternal respiratory compromise, collaboration with critical care teams, and potential need for cardiopulmonary resuscitation). However, such training is more challenging during the COVID-19 pandemic because of the requirements for social distancing. This article outlines strategies (spatial, temporal, video-recording, video-conferencing, and virtual) to effectively engage in health care team training and simulation-based education while maintaining social distancing during the COVID-19 pandemic.