社区居民心肺复苏知识调查及其对策

采用自制问卷调查表对200名社区居民进行心肺复苏知识掌握情况调查,为进行健康教育提供参考。结果社区居民心肺复苏知识知晓率低,被调查者所在学校和社区未开展心肺复苏急救知识教育。提示社区居民缺乏心肺复苏知识,应对全民进行多层次、多样性的心肺复苏等急救知识的普及教育,以提高抢救成功率。     

同伴教育在社区居民心肺复苏培训中的应用

目的探讨社区居民有效的心肺复苏培训方法。方法随机选取某社区居民100人按单、双数分成实验组和对照组各50人。两组均接受心肺复苏理论知识培训和操作技能培训,培训后对照组根据培训内容和宣传小册进行自我学习,实验组采取同伴教育方法学习。分别于培训前后进行心肺复苏理论知识调查和操作考核。结果培训后实验组理论知识得分为(51.30±15.08)分、操作考核得分为(16.72±2.39)分,对照组分别为(49.00±15.19)分、(15.82±2.86)分,两组比较,差异有统计学意义(P0.05,P0.01)。结论对社区居民进行心肺复苏培训时采取同伴教育,可提高其心肺复苏知识及操作技能水平。     

同伴教育在社区居民心肺复苏培训中的应用

目的探讨社区居民有效的心肺复苏培训方法。方法随机选取某社区居民100人按单、双数分成实验组和对照组各50人。两组均接受心肺复苏理论知识培训和操作技能培训,培训后对照组根据培训内容和宣传小册进行自我学习,实验组采取同伴教育方法学习。分别于培训前后进行心肺复苏理论知识调查和操作考核。结果培训后实验组理论知识得分为（51.30±15.08）分、操作考核得分为（16.72±2.39）分,对照组分别为（49.00±15.19）分、（15.82±2.86）分,两组比较,差异有统计学意义（P〈0.05,P〈0.01）。结论对社区居民进行心肺复苏培训时采取同伴教育,可提高其心肺复苏知识及操作技能水平。     

Willingness towards cardiopulmonary resuscitation training and implementation in community residents and its influencing factors

目的 了解社区居民学习和实施心肺复苏技能意愿的现状,并分析其原因.方法 采用自设问卷对郑州市2个社区的338名居民进行调查.问卷内容包括居民学习和实施心肺复苏的意愿、学习和实施心肺复苏技能的影响因素.结果 94.4％社区居民非常愿意或愿意参加心肺复苏培训,但仅有12.4％居民接受过相关培训.79.0％居民表示当目击亲人或朋友心脏骤停事件发生时,愿意对其实施心肺复苏；而陌生人发生心脏骤停时,仅29.9％愿意实施心肺复苏.影响居民学习心肺复苏技能的主要原因是未找到免费的专业培训机构.结论 社区居民学习心肺复苏技能的意愿很高,但普及率以及实施率较低.应大力宣传心肺复苏的重要性和实用性,经常到社区以及用人单位进行心肺复苏相关知识的培训.     

心血管疾病患者家属对心肺复苏知识的知晓及学习意愿调查

目的了解心血管疾病患者家属对徒手心肺复苏术(CPR)相关知识的知晓度和需求度,为后期开展心血管疾病患者家属急救技能培训提供依据。方法自行设计心血管疾病患者家属CPR知识现状及学习意愿调查表,对677名心血管疾病患者家属进行调查。结果451人(66.62%)家属听闻过CPR,仅111人(16.40%)接受过急救知识学习或培训。542人(80.06%)愿意学习相关急救知识,444人(65.58%)愿意参与CPR培训。结论心血管疾病患者家属对CPR的知晓率较高但掌握率低,家属参与CPR培训需求高,可在心血管疾病患者家属中广泛开展CPR急救知识培训。     

小剂量硝酸甘油在心肺复苏中的应用

目的 探讨小剂量硝酸甘油在心肺复苏术中的临床疗效.方法 将我院重症监护病房中发生心脏骤停的患者按随机数字表法分为对照组(127例)和试验组(132例),对照组按照《2010年国际心肺复苏和心血管急救指南》进行急救,胸外心脏按压,液体扩容,肾上腺素静脉注射,多巴胺、多巴酚丁胺升压,呼吸机辅助呼吸等综合治疗,试验组在对照组治疗的基础上,加用小剂量硝酸甘油(5 μg/min)微量泵泵入,比较两组患者心脏复苏成功率,复苏成功时间,有创动脉血压及24h存活率.结果 试验组患者心脏复苏成功率及24h存活率、复苏成功时间与对照组比较差异有统计学意义(P＜0.05)；两组患者有创动脉血压比较差异无统计学意义(P＞0.05).结论 心肺复苏术中应用小剂量硝酸甘油可明显提高心肺复苏成功率,提高患者存活率,并且对外周动脉血压无明显影响.     

设置急救联络员分类情景模拟培训提高护士心肺复苏技能

目的提高全院护士急救技能。方法将心脏骤停设计为3类模拟情景,设置病区急救联络员并培训,由急救联络员负责培训各病区护士。结果设立病区急救联络员并运用不同情境模拟培训后,抽考护士CPR技能考核成绩显著提高(P0.01);护士对此培训模式持肯定态度。结论将心脏骤停情景案例进行归类,并设立病区急救联络员实施以点带面的培训,能有效提高全院护士的急救技能。     

体外心肺复苏的研究进展北大核心CSCD

体外心肺复苏(extracorporeal cardiopulmonary resuscitation,ECPR)是指在传统心肺复苏后仍未恢复持续自主循环的心脏骤停患者中应用体外膜肺氧合技术,以提供更高的心输出量及有效气体交换,保证器官灌注。近年来ECPR在患者救治过程中取得了良好效果。ECPR常见适应证包括年龄<70岁,有可电复律的初始心律,有目击者的心脏骤停,5 min内旁观者心肺复苏,心肺复苏后15 min内未恢复持续自主循环。准确判断ECPR应用指征、迅速安装体外生命支持设备以及高质量管理是改善预后的关键。本文就ECPR的开始时机和患者选择、近期结果、影响因素及并发症进行综述。     

基于Utstein模式心肺复苏注册单的设计与应用

目的基于Utstein模式设计心肺复苏注册单并应用于临床,以提高心肺复苏质量数据记录的完整性、准确性。方法基于Utstein模式,优化设计心肺复苏注册单并应用于临床,比较实施前后心肺复苏技术的核心数据记录的完整性和及时性,以评价注册单的临床应用效果。结果注册单应用前后患者CPR关键信息记录的缺失率比较,差异有统计学意义(P0.05,P0.01)。实施后48例CPR记录均在抢救过程中同步完成。结论基于Utstein模式的心肺复苏注册单使用,使数据记录及时性、完整性提高。规范了心肺复苏流程,提高了心肺复苏质量。     

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。     

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。     

In-hospital cardiopulmonary resuscitation: organization, management and training in hospitals of different levels of care

BACKGROUND: : During recent years in-hospital cardiopulmonary resuscitation (CPR) management has received much attention. This can be attributed to the Utstein model for in-hospital CPR developed in 1997. The present status of in-hospital resuscitation management in Finnish hospitals is not known. Therefore, a study was designed to describe the organization of training and clinical management of CPR in Finnish hospitals of different levels of care. METHODS: : In the summer of 2000, we performed a cross-sectional mail survey throughout Finland, including all district, central and university hospitals. The questionnaire outlined in detail in-hospital resuscitation management and training. For analysis the hospitals were divided into primary, secondary and tertiary groups, depending on levels of care. RESULTS: : Most hospitals (72%) reported having a physician or a nurse in charge of resuscitation management and training. Training in advanced life support was more common among nurses (80%) than among physicians (53%). Surprisingly, a majority of respondents (75%) reported that they felt training in CPR was insufficient. On the general wards and on wards treating cardiac patients, defibrillation was in most cases performed by a physician (91% and 51%, respectively), and less often by a nurse (16% and 31%, respectively). In the secondary and tertiary hospitals cardiac arrest was managed by a cardiac arrest team (53% and 62%, respectively) and in the primary hospitals by the ward physician (56%), anesthesiologist or emergency physician on call (44%). Most hospitals used do-not-resuscitate orders (83%) but only 33% of the hospitals had a unified style of notation. Systematic data collection was practised in 55% of hospitals, predominantly by using a model of their own. Only a few hospitals (11%) used the in-hospital Utstein model. CONCLUSION: : Our study showed that more attention needs to be paid to CPR management in Finnish hospitals. At present, 25% of hospitals do not have an appointed physician or nurse in charge of organizing CPR management. The study also revealed a lack of regular organized training in resuscitation for physicians. Fifty-five per cent of hospitals practise systematic data collection, but only 11% according to the Utstein template; and without which further quality assurance is difficult.     

哈尔滨市居民血脂相关膳食知识掌握现状及影响因素

目的了解哈尔滨市居民对血脂相关膳食知识的掌握现状,并分析其影响因素。方法采用自制血脂相关膳食知识问卷调查哈尔滨市居民881名。结果血脂相关膳食知识问卷标准化得分为54.34±14.96,5个维度得分由高到低依次为胆固醇膳食知识、总能量膳食知识、脂肪膳食知识、膳食纤维膳食知识、健康生活方式知识。回归分析结果显示,居民血脂相关膳食知识掌握受家庭所在地、文化程度、家庭人均月收入、是否吸烟影响(调整R2=0.148)。结论哈尔滨市居民血脂相关膳食知识掌握呈中等偏下水平,家庭在农村、低学历、家庭人均月收入低、吸烟人群血脂相关膳食知识掌握较差,应将其作为血脂相关膳食健康教育的重点人群。     

阻力单向活瓣在心肺复苏中的应用——一种新的心肺复苏技术

心肺复苏(cardiopulmonary resuscitation,CPR)成功率和存活率仍然很低,主要原因是CPR期间回心血量少,心脏和脑灌注不足。增加胸内负压的措施和器材明显提高心肺复苏的效果[1~4]。近来,Lu-rie等[5~10]又研制出在胸壁放松时增加胸内负压的阻力单向活瓣(inspiratory impedance threshold valve(device),ITV or ITD),使心肺复苏的效果进一步提高。1阻力单向活瓣应用的理论基础胸外按压是CPR的主要措施,临床应用已逾半个世纪。曾经认为,胸外按压作用于前胸壁,把心脏压向脊柱,随着连续性压-放动作的交替和循环,血液流入和流出心脏而产生人…     

Naloxone and epinephrine are equally effective for cardiopulmonary resuscitation in a rat asphyxia model

BACKGROUND: It is not known whether naloxone is as efficacious as epinephrine during cardiopulmonary resuscitation (CPR). The aim of the study was to compare the effects of naloxone and epinephrine on the outcomes of CPR following asphyxial cardiac arrest in rats. METHODS: Cardiac arrest was induced with asphyxia by clamping the tracheal tubes. Twenty-four Sprague-Dawley rats were randomized prospectively into a saline group (treated with normal saline, 1 ml intravenously, n = 8), an epinephrine group (treated with epinephrine, 0.04 mg/kg intravenously, n = 8) or a naloxone group (treated with naloxone, 1 mg/kg intravenously, n = 8) in a blind fashion during resuscitation after asphyxial cardiac arrest. After 5 min of untreated cardiac arrest, conventional manual CPR was started and each drug was administered at the same time. RESULTS: The rates of restoration of spontaneous circulation (ROSC) were one of eight (12.5%), seven of eight (87.5%) and seven of eight (87.5%) in the saline, epinephrine and naloxone groups, respectively. The rates of ROSC in the epinephrine and naloxone groups were equal and significantly greater than that in the saline group (P = 0.01 and P = 0.01, respectively). CONCLUSION: The administration of naloxone or epinephrine alone may increase the resuscitation rate, and both drugs are equally effective for CPR in a rat asphyxia model. However, the mechanism by which naloxone produces its efficacy during CPR remains unclear and further experimentation will be necessary.     

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.     

Role of arginine vasopressin in the setting of cardiopulmonary resuscitation

Arginine vasopressin (AVP) constitutes an integral part of the neuroendocrine stress response during cardiac arrest. A strong correlation between endogenous AVP secretion and outcome from cardiac arrest has led to a number of experimental studies indicating a survival benefit of AVP compared to epinephrine. In the clinical setting, however, things are less clear. Although current data suggest that both epinephrine and AVP are equally effective to restore spontaneous circulation in out-of-hospital cardiac arrest, benefits of AVP in specific patient groups, e.g. those with asystolic cardiac arrest, have been shown. The latest international guidelines recommend AVP as an alternative vasopressor drug which may replace the first or second dosage of epinephrine in the treatment of pulseless arrest If the combined use of AVP and epinephrine is superior to epinephrine alone in terms of improved hospital admission and discharge rates this needs to be re-confirmed by the results of an ongoing multicenter trial.     

Recent advances in cardiopulmonary resuscitation

Modern cardiopulmonary resuscitation (CPR) has been in existence for just over 40 years. Despite many advances, the overall survival following out-of-hospital cardiac arrest remains dismally poor. However, recent research has uncovered a number of areas of promise that may change this. Until now, all cardiac arrest victims whose initial rhythm is ventricular fibrillation have been managed the same with the emphasis on defibrillation as the initial treatment, irrespective of the time in arrest. Better understanding of the pathophysiology of prolonged arrest and studies in animal and man suggests that we should now question this concept and where there has been a delay, perform chest compressions and ventilation before attempting defibrillation. When defibrillation is required, most devices deliver a monophasic shock, despite the fact that for some time biphasic shocks have been known to be relatively more effective and less injurious. The adoption of biphasic waveforms for external defibrillation is increasing with the added advantage of smaller, lighter and more portable defibrillators. Finally, return of a spontaneous circulation does not always equate to a good outcome and many victims subsequently die from or suffer significant neurological injury. For the first time there now appears to be a method of improving outcome by instituting a period of mild hypothermia in those victims who have a return of their circulation but remain comatose. When put together, these changes offer the greatest chance for many years to improve the outcome of patients who suffer a cardiac arrest outside of the hospital environment.     

社区护士灾害准备度调查及影响因素分析

目的探讨社区护士灾害准备度情况及影响因素,为提高社区护士整体灾害应对能力提供参考。方法采用中文版灾害准备度评估工具评估辽宁省阜新市30个社区145名护士的灾害准备度水平。结果 145名护士灾害准备度总得分为(127.80±30.21)分,文化程度,职称,是否有救灾经历或参加过救灾培训是社区护士灾害准备度的影响因素(均P0.01)。结论社区护士灾害准备度水平较低,需要加强对社区护士的教育和培训。