基于客观考核的院内急救能力影响因素分析  

Analysis of factors affecting in-hospital emergency response capability based on objective assessment

作　　者：丛鲁红[1] 翟姗姗 王慧[2] 段军[2] Cong Luhong;Zhai Shanshan;Wang Hui;Duan Jun(Department of Education,China-Japan Friendship Hospital,Beijing 100029,China;Department of Intensive Care Unit,China-Japan Friendship Hospital,Beijing 100029,China)

机构地区：[1]中日友好医院教育处,北京100029 [2]中日友好医院重症医学科,北京100029

出　　处：《中华危重病急救医学》2024年第6期652-655,共4页Chinese Critical Care Medicine

基　　金：北京市住院医师规范化培训质量提高项目(2021023);北京大学医学部教育教学研究课题(2019YB21)。

摘　　要：目的分析院内医护人员实施心肺复苏(CPR)质量的影响因素,探讨提升其院内急救能力的培训方法。方法采用横断面研究方法,纳入2021年12月在中日友好医院重症监护病房(ICU)和普通内科病房工作的医护人员作为考核受试者。使用美国心脏协会(AHA)心肺复苏质量改进(RQI)模型,对受试者进行成人及婴儿模拟人的胸外按压和球囊面罩通气的技能考核。ICU受试者在接受RQI客观考核的同时,由两名导师对其操作进行主观评分。比较ICU与普通内科病房受试者之间以及医生与护士之间的RQI模型客观考核评分差异、受试者对成人和婴儿CPR的RQI模型客观评分差异、受试者不同站位按压评分的差异,以及ICU受试者接受按压和通气考核时传统主观评分与RQI模型客观评分的差异。结果最终纳入75名医护人员,其中ICU 50名(包括医生24名、护士26名)及普通内科病房25名(包括医生10名、护士15名)。ICU医护人员针对成人CPR技能的评分均明显高于普通内科病房医护人员〔成人按压评分(分):82.5(66.0,96.5)比65.0(52.5,74.5),成人通气评分(分):82.0(68.8,98.0)比61.0(48.0,82.0),均P<0.01〕。护士组针对成人及婴儿的按压评分均明显高于医生组〔成人按压评分(分):77.0(68.5,89.5)比63.0(40.8,90.3),婴儿按压评分(分):54.4±25.1比41.5±18.5,均P<0.05〕。而医护人员针对婴儿CPR的按压和通气评分均明显低于针对成人CPR的复苏评分〔按压评分(分):48(29,65)比76(58,90),通气评分(分):56(42,75)比76(60,96),均P<0.01〕。当施救者处于模拟人右侧时,针对成人CPR的按压评分明显升高〔分:79.0(65.0,92.0)比65.0(51.3,77.0),P<0.05〕。ICU医护人员接受按压和通气考核时,针对成人CPR的传统主观评分均明显高于RQI模型客观评分〔成人按压评分(分):88.8(79.4,92.5)比82.5(66.0,95.5),成人通气评分(分):95.0(80.0,98.1)比82.0(68.8,98.0),均P<0.01〕。结论丰富的抢救经验与CPR技能提Objective To analyze the factors affecting the quality of cardiopulmonary resuscitation(CPR)performed by medical staff in hospital and to explore the training methods to enhance their in-hospital emergency response capabilities.Methods A cross-sectional study was conducted,involving medical staff of intensive care unit(ICU)and general internal medicine wards in China-Japan Friendship Hospital in December 2021.The American Heart Association(AHA)resuscitation quality improvement(RQI)model was used to evaluate the skills of the subjects in performing external chest compressions and bag-mask ventilation on adult and infant simulators.While ICU subjects were undergoing RQI model objective assessment,two instructors also provided subjective scoring for their operations.The study compared the differences in RQI model objective assessment scores between ICU and general internal medicine ward subjects,between doctors and nurses,in the RQI model objective scoring for adult and infant resuscitation,in the scoring differences of different positions for chest compressions,and the differences between traditional subjective scoring and RQI objective scoring when ICU subjects were assessed for compression and ventilation.Results A total of 75 medical staffs were enrolled,consisting of 50 from the ICU(including 24 doctors and 26 nurses)and 25 from the general internal medicine wards(including 10 doctors and 15 nurses).The ICU medical staff's scores for adult resuscitation skills were significantly higher than those of the general internal medicine ward medical staff[adult compression score:82.5(66.0,96.5)vs.65.0(52.5,74.5),adult ventilation score:82.0(68.8,98.0)vs.61.0(48.0,82.0),both P<0.01].The nursing group's compression scores for both adult and infant were significantly higher than those of the doctor group[adult compression score:77.0(68.5,89.5)vs.63.0(40.8,90.3),infant compression score:54.4±25.1 vs.41.5±18.5,both P<0.05].The compression and ventilation scores for the infant were significantly lower than those for adult

关 键 词：心搏骤停 心肺复苏 基础生命支持 质量改进 重症医学 

分 类 号：R-4[医药卫生] C975[经济管理—劳动经济]