临床路径对急救小组心肺复苏质量效能改进.docVIP

临床路径对急救小组心肺复苏质量效能改进 　　【摘要】目的 探讨临床路径对急救小组复苏效能的改进效果。方法 设计心搏骤停院前救治临床路径，通过模拟病例对杭州市急救中心一线急救小组实施培训，对培训前后的各项救治指标进行测评、比对。结果 符合条件的45个急救小组培训前现场实施心电监护、气管插管、开通静脉的仅8（17.8%）、5（11.1%）、6（13.3%）组，前3 min中断按压时间（102.13±13.68）s，辅助人员球囊成功通气比例0.37±0.09，现场心电取证、告知签字仅8组（17.8%）、6组（13.3%），复苏与取证能同时进行的仅2组（4.4%）。培训后心电监护、气管插管、开通静脉分别达到45组（100%）、43组（95.6%）、43组（95.6%），按压中断时间缩短到（69.73±7.66）s，成功通气比例0.57±0.12；现场心电取证、告知签字取证分别达到了40组（88.9%）、43组（95.6%），复苏取证同时进行达到了36组（80.0%）。 结论 院前心肺复苏质量低下，临床路径是急救小组实现院前心肺复苏从高风险低效能到低风险高效能转变的有效工具，在现有体制机制下值得推广运用。 【关键词】心搏骤停；心肺复苏；临床路径；院前急救；培训 The improvement of cardiopulmonary resuscitation （CPR） efficiency by rescue team through the clinical access to pre-hospital care ZHANG Jun-geng， FU Wei-ling， Qian Li-na， LU Mei-li. Hangzhou Pre-hosptial Care Center， Hangzhou310006， China 【Abstract】Objective To explore the improvement of cardiopulmonary resuscitation （CPR） efficiency by rescue team through the clinical access to pre-hospital care. Methods After establishment of clinical approaches to cardiac arrest， the training program of first line personnel of rescue teams in the Hangzhou Emergency Center was carried out with practice on simulated patients and scenario. A total of 45 eligible teams were randomly enrolled for study by observing the performance of some essential resuscitation techniques before and after training. Result The efficiency of resuscitation performed by rescue team for cardiac arrest was generally not good enough before training evidenced by the shortage of application of ECG monitoring， endotracheal intubations and establishing intravenous line which were only 8（17.8%），5（11.1%），6（13.3%）， respectively， and the interruption time of chest compression during the first three minutes was （102.13±13.68） seconds and the successfully artificial respiration ratios by assistant members was （0.37±0.09）， and ratios of ECG forensics and written inform consent were 8（17.8%） and 6（13.3%） respectively， CPR and forensics done simultaneously was only 2（4.4%）. The efficienc