医院急救中心对警察徒手心肺复苏培训的探讨

目的观察新鲜芦荟预防各种化疗药物组合所致静脉炎的效果。方法采用不等量随机对照试验，将1510例恶性肿瘤患者按出生时间单月分入观察组（n=1000），双月分入对照组（n=510）。两组化疗时均按常规静脉穿刺，观察组患者静脉穿刺后将新鲜芦荟叶片在穿刺点上方2cm处开始外敷，剖开外敷的芦荟大小为长15～20cm、宽6～8cm、厚0.5cm，纱布覆盖后用胶布固定，2h更换1次，直至化疗结束。对照组患者静脉穿刺处不予芦荟外敷。结果观察组、对照组静脉炎发生率分别为3．50％、23．53％，两组比较，差异有显著性意义（P〈0．01）；两组不同化疗组合模式静脉炎发生率比较，差异有显著性意义（P〈0．05，P〈0．01）；观察组静脉炎轻于对照组（均P〈0．01）；两组≤30min、～24h、～72h时间段静脉炎发生率比较，差异有显著性意义（均P〈0．01）。结论新鲜芦荟叶片外敷预防性静脉炎具有良好的效果，且方法简便、经济实用。     

公众对徒手心肺复苏认知度的调查

目的了解公众对徒手心肺复苏术（CPR）相关知识的认知度，为开展全民急救培训提供依据。方法采用自行设计的问卷对公民1072人进行CPR知晓程度、获取信息的途径、现场的处理、正确的CPR操作、接受培训的意愿等方面的调查。结果401人（37．4％）表示知道CPR，仅听说过者488人（45．5％），不知道者183人（17．1％）。仅79人（7．4％）直接从专业书籍或专业人士处获取信息。假设现场有人发生猝死时230人（21．5％）选择现场急救，其中仅17人（1．6％）表示可以正确实施CPR操作，但未通过任何形式的资格考试且未持有资格证书。结论公众对CPR的知晓率不高，急救技术普及率低。应在公众中开展广泛的CPR培训，强化公众的现场急救意识及急救技能。     

公众对徒手心肺复苏认知度的调查

目的 了解公众对徒手心肺复苏术(CPR)相关知识的认知度,为开展全民急救培训提供依据.方法 采用自行设计的问卷对公民1 072人进行CPR知晓程度、获取信息的途径、现场的处理、正确的CPR操作、接受培训的意愿等方面的调查.结果 401人(37.4%)表示知道CPR,仅听说过者488人(45.5%),不知道者183人(17.1%).仅79人(7.4%)直接从专业书籍或专业人士处获取信息.假设现场有人发生猝死时230人(21.5%)选择现场急救,其中仅17人(1.6%)表示可以正确实施CPR操作,但未通过任何形式的资格考试且未持有资格证书.结论 公众对CPR的知晓率不高,急救技术普及率低.应在公众中开展广泛的CPR培训,强化公众的现场急救意识及急救技能.     

电话心肺复苏研究进展

院外心脏骤停急救仍然是世界难题之一,此事件不仅发生率高并且由于大多突发、病情危机,以至预后不良。徒手心肺复苏术是应对该事件的有效手段,弥补了救护车到达前的空缺时间,改善预后。由于多种原因的影响,徒手心肺复苏术具有一定局限性。而电话心肺复苏的出现在一定程度上是对徒手心肺复苏术的改进。然而电话心肺复苏在实践过程中,所暴露出的弊端仍然会影响旁观者心肺复苏的质量。因此本研究对电话心肺复苏术的研究进展进行综述,以期推进电话心肺复苏术的发展与完善。     

消防员徒手心肺复苏术认知情况调查及技能培训

目的探讨对消防员进行徒手心肺复苏术（CPR）知识和技能培训的效果。方法针对102名消防员CPR认知情况调查问卷的调查结果进行理论讲解、多媒体演示，并在模拟人上行CPR术操作培训，最后考核评估。结果12人（11．8％）听说过CPR，对CPR相关知识的掌握率不足10％。培训后，CPR技能掌握者达84．3％．基本掌握者12．8％．未掌握者2．9％。结论对消防员采用调查-讲解-实践-考核的模式，可在短期内提高其CPR技能水平。     

消防员徒手心肺复苏术认知情况调查及技能培训

目的 探讨对消防员进行徒手心肺复苏术(CPR)知识和技能培训的效果.方法 针对102名消防员CPR认知情况调查问卷的调查结果进行理论讲解、多媒体演示,并在模拟人上行CPR术操作培训,最后考核评估.结果 12人(11.8%)听说过CPR,对CPR相关知识的掌握率不足10%.培训后,CPR技能掌握者达84.3%,基本掌握者12.8%,未掌握者2.9%.结论 对消防员采用调查-讲解-实践-考核的模式,可在短期内提高其CPR技能水平.     

萨勃心肺复苏机在急诊心肺复苏中的应用研究

目的探讨萨勃心肺复苏机在心脏呼吸骤停患者进行心肺复苏中的应用价值。方法将2004年1月至2007年12月使用萨勃心肺复苏机抢救心脏呼吸骤停患者50例作为治疗组,2000年5月至2003年12月徒手心肺复苏抢救心脏呼吸骤停患者80例作为对照组。比较两组复苏中患者收缩压和血氧饱和度（以复苏开始5～10min时的数据作为统计资料）、自主循环恢复（ROSC）率、住院率、并发症发生情况。结果治疗组在改善心脏呼吸骤停患者的收缩压、血氧饱和度方面明显优于对照组,P〈0．05;治疗组ROSC率及住院率均高于对照组（分别为44％、40％与25％、21％）,P〈O．05。两组复苏期间主要并发症比较差异无统计学意义。结论萨勃心肺复苏机克服了徒手心肺复苏中因为医护人员或患者影响复苏效果的因素,使心肺复苏更趋标准有效。萨勃心肺复苏机能提高血液灌注压,增加每搏输出量,提高心脑的血氧供应,显著提高心肺复苏成功率,值得临床推广应用。     

临床护士心肺复苏技能不同培训方法的比较研究

目的寻找临床护士心肺复苏(cardiopulmonary resuscitation,CPR)技能培训的最佳方法。方法采用目的抽样法抽取3所三级甲等医院的内科、外科和急诊科在职临床护士162名,分别采用传统讲授练习(A组,n=54)、多媒体指导练习(B组,n=54)和自我指导练习(C组,n=54)3 种方法进行培训。测试培训前后成人单人CPR操作成绩;比较培训前后三组成绩。结果培训后三组CPR操作测试成绩均高于培训前(均P<0.01),而B组成绩明显高于A组(Z=-2.040, P<0.05)和C组(Z=-3.209, P<0.01)。结论3种方法对临床护士进行CPR培训均有效,而多媒体指导练习为最佳培训方法。     

艾司洛尔混合肾上腺素对心肺复苏后大鼠心肌的保护作用

目的 探讨艾司洛尔混合肾上腺素对心肺复苏后大鼠心肌的保护作用。方法 66只雄性Wistar大鼠随机分为3组（n=22），假手术组（Sham组）：不进行窒息和复苏；肾上腺素组（AD组）；肾上腺素＋艾司洛尔（AD＋ES）组。吸入4％异氟醚麻醉诱导，气管切开后机械通气．吸入1％～1．5％异氟醚维持麻醉，机械通气10min时静脉注射维库溴铵0．01mg／100g，5min后断开呼吸机致窒息，10min后进行心肺复苏。用动脉血（1ml／100g）、肝素（50U／100g）、碳酸氢钠（0．1mEq／100g）和肾上腺素（4μg／100g）／或混合艾司洛尔（100μg／100g）制成“复苏合剂”。左股动脉置管用于测压．右股动脉置管至主动脉弓用于复苏时给药。AD组、AD＋ES组在自主循环恢复（复苏）后30、120、180min分别处死6只大鼠，取心肌，电镜下观察心肌的超微结构，并测定线粒体ATP酶活性。复苏后持续监测心电图、心率（HR）、平均动脉压（MAP）。结果 与Sham组比较，AD组复苏后10～180min时HR增快，AD＋ES组仅在复苏后5min时HR一过性增快，AD组、AD＋ES组复苏后心肌线粒体Na^＋-K^＋-ATP酶、Ca^2＋-ATP酶活性降低（P〈0．05或0．01）；与AD组比较，AD＋ES组复苏后10～180min时HR降低，上述两种酶的活性升高（P〈0．05）。AD＋ES组复苏后心肌的损伤均轻于AD组。结论 艾司洛尔混合肾上腺素对心肺复苏后大鼠心肌有一定的保护作用，升高了线粒体ATP酶活性。     

社区公众心肺复苏急救知识的现状调查与培训

目的了解社区公众对心肺复苏急救知识掌握的现状，寻求有效提高公众急救意识、应急能力的方法。方法采用自制问卷对1003名社区公众进行心肺复苏（CPR）急救知识现场调查，并由5名护理人员对该人群分批进行CPR急救知识培训，比较培训前后公众对CPR急救知识的知晓率。结果培训后社区公众对CPR急救知识的知晓率显著高于培训前（均P〈0．01）。结论社区公众CPR急救知识水平亟待提高。以社区为单位开展群众性CPR急救知识普及，可显著提高其CPR知识和技能，有利于社区公众应对突发公共卫生事件。     

The impact of providing help: Emergency workers and cardiopulmonary resuscitation attempts

Although anecdotes suggest that emergency medical technicians often themselves have to cope with severe trauma as a result of their work, almost all empirical work has been concerned with the aftermath of disaster. Fourteen volunteer ambulance attendants were asked about resuscitation attempts in which they had been involved. It was found that many of these evidenced a persistent psychological aftermath. Some of these individuals experienced vivid, involuntary, and uncontrollable thoughts, feelings, and/or mental images concerning their attempt. Perceived control and coping responses were examined, and found to be related to the impact of the resuscitation attempt upon the ambulance personnel. Data from this preliminary investigation indicate the need for further work in the area, and with related populations, such as nonprofessionals who attempt cardiopulmonary resuscitation.     

心肺复苏教育游戏对护理本科生心肺复苏教学知识获得与保留的影响

目的 探索心肺复苏教育游戏对护理本科生心肺复苏教学知识获得与保留的影响,为提高心肺复苏教学效果提供参考.方法 将2016级护理本科生100名随机分为对照组和观察组各50名,在心肺复苏教学中分别运用传统教学和心肺复苏教育游戏教学.教学后1周评价两组心肺复苏教学知识获取情况,临床实习第3、6、10个月评价两组心肺复苏教学知识保留水平.结果 观察组心肺复苏理论考核总分与综合能力得分评价显著优于对照组(均P＜0.05).知识保留趋势预测分析显示,学生知识保留水平呈持续下降趋势,下降至6个月后,进入一段较平稳的阶段,至第10个月后,预测分析呈现继续下降趋势.结论 心肺复苏教育游戏用于护理本科生心肺复苏教学,有利于护生心肺复苏知识与技能持续保留,可作为心肺复苏护理教育的辅助教学方法,建议教学后第6个月复训.     

高职护生对不同人群实施现场心肺复苏态度的调查分析

目的了解高职护生(下称护生)对院外发生心搏骤停的不同人群实施心肺复苏的态度以及影响护生实施现场心肺复苏的因素。方法采用问卷对127名护生进行不同人群实施心肺复苏态度的调查。结果分别有1.5%、14.1%、41.8%、41.8%、62.2%的护生表示不愿意对亲人或朋友、儿童、老年人、陌生男性、创伤患者实施现场心肺复苏。不愿意实施现场急救的诸多原因中位于第一位的是“担心由于自己急救知识、技术的局限而不能胜任现场急救任务”。与心肺复苏(人工呼吸加心脏按压)相比,护生更愿意单纯实施心脏按压(P<0.01)。结论护生实施院外现场心肺复苏意识较差,在急救护理教学过程中,应注重对护生急救意识及急救态度的培养,为护生提供有效的现场急救实践,帮助他们体验急救经历,增强角色意识,成为现场急救的积极参与者。     

Predictors and outcome of cardiopulmonary resuscitation (CPR) calls in a large haemodialysis unit over a seven-year period.

BACKGROUND: Cardiac mortality is the leading cause of death in dialysis patients, with cardiac arrests being most frequent. Our purpose was to determine the epidemiology, predictors and outcomes of calls for cardiopulmonary resuscitation (CPR) occurring in our haemodialysis unit. METHODS: We reviewed retrospectively all calls for CPR occurring in our unit between August 1997 and December 2004 and compared data to a cohort of chronic haemodialysis patients from our unit. Dialysis sessions performed in the ICUs were not included. RESULTS: A total of 38 calls occurred over 307,553 sessions, corresponding to an incidence of 0.012%. In a multivariate logistic regression model, statistically significant predictors to have a call for CPR were ischaemic heart disease (OR: 3.93; 95% CI: 1.70-9.07), heart failure (OR: 2.74; 95% CI: 1.12-6.74) and female gender (OR: 2.96; 95% CI: 1.37-6.43). Patients who had a call for CPR had a lower dialysis vintage than control patients (OR: 0.98; 95% CI: 0.965-0.996). Twenty of the 38 events presented on Mondays or Tuesdays (P = 0.012); 78% occurred during haemodialysis, vs 14 and 8% immediately after and immediately before dialysis but still on the unit, respectively. Of the 38 events, 24 were true cardiopulmonary arrests. Cardiac etiology was the most frequent (34%) and only 4 events were attributed to potassium disorders. One quarter of patients were dialyzed against a dialysate potassium concentration of 1 mmol/l or below. An arrhythmia was identified in 19 patients; a malignant ventricular fibrillation or ventricular tachycardia was most frequently found (32%), followed by severe bradycardia (26%). For the whole group, there were 6 deaths (16%) within 48 h; 30 patients (79%) were alive at 30 days and discharged from the hospital. Among the 24 cardiopulmonary arrests, there were 4 deaths (17%) within 48 h; 18 patients (75%) were alive at 30 days and discharged from the hospital. There was a trend for worse prognosis at 60 days when related to cardiopulmonary etiology (P = 0.054) and when a true cardiopulmonary arrest occurred (P = 0.134). CONCLUSIONS: This study confirms that arrest codes occur more frequently on Mondays and Tuesdays in a haemodialysis unit. Survival after an arrest code appears to be better than in certain other circumstances, probably in part because of the presence of witness, physician and equipment, and vascular access being readily available.     

A Medically Staffed Emergency Ambulance Service. Report of a 5-year Prospective Study

The results of a prospective 5-year study of a medically staffed ambulance service are presented. There was a total of 558 turn-outs distributed among a mixed patient material. In 192 cases, resuscitation was attempted and this proved primarily successful in 59 patients. A total of 23 of these resuscitated patients could be discharged, 19 without cerebral sequelae, two with slight brain damage and two with severe brain damage. In 44 further cases, other relevant forms of emergency treatment were administered. It is concluded that prehospital treatment at the scene of accident seems beneficial to patients with life-threatening conditions.     

利用护理实训中心进行《妇产科护理》教学

目的探讨在护理实训中心对高护生进行《妇产科护理》实训教学的效果。方法将01级高护生设为对照组(65名),在旧实训室进行《妇产科护理》实训教学;02级高护生设为实验组(100名),在新护理实训中心进行《妇产科护理》实训教学,比较两组教学效果。结果在利于实践能力培养、激发学习兴趣、利于理论与实践相结合、提高记忆和学习效果等5方面实验组与对照组比较,χ2=10.58、6.28、15.86、6.34、6.92,P<0.01或P<0.05,差异有显著性意义;实验组骨盆外测量、产前检查、接生、妇科检查、外阴擦洗和阴道灌洗及上药等护理操作技能考核成绩与对照组比较,t=3.32、5.52、6.43、5.26、2.58、2.89,P<0.01或P<0.05,差异有显著性意义。结论在护理实训中心进行《妇产科护理》实训教学,可提高高护生《妇产科护理》教学质量。     

Comparison of Adrenaline and Phenylephrine in Out-of-Hospital Cardiopulmonary Resuscitation: A Double-Blind Study

Phenylephrine, a strong alpha-adrenergic receptor-stimulating agent, was compared with adrenaline in 65 patients with out-of-hospital cardiac arrest, in a double-blind study. The resuscitation was performed by the physician-staffed Prehospital Emergency Care Unit of Helsinki University Central Hospital. The patients received either 1.0 mg of phenylephrine or 0.5 mg of adrenaline i.v. in the treatment of fine ventricular fibrillation, asystole or electromechanical dissociation. If two doses of either drug did not restore circulation, 0.5 mg of known 0.01% adrenaline was given i.v., maximally twice. In the adrenaline group, which consisted of 36 patients with a mean age of 61 years, 10 patients (28%) were successfully resuscitated. The phenylephrine group consisted of 29 patients with a mean age of 62 years. In this group nine patients (31%) were successfully resuscitated. The two groups were comparable regarding their apnoea-times, and there was no difference in the need for extra adrenaline between the groups. No adverse effects, such as hypertension or bradycardia, were noted in the patients treated with either adrenaline or phenylephrine, nor did the overall rate of successful resuscitation fall during the test period. It is concluded that phenylephrine seems as effective as adrenaline in the treatment of cardiac arrest, but further studies seem warranted.