利用模拟人研究操作者疲劳对心肺复苏质量的影响

An investigation into fatigue of witness and quality of external chest compression in the resuscitation Manikin

目的 探讨2010年国际心肺复苏指南胸外按压标准对非医学专业的心肺复苏操作者按压质量和疲劳程度的影响.方法 选择广东工业大学自动化学院96名学员,按照自愿原则参与基础生命支持课程培训.学员按随机数字法分入2010指南组与2005指南组,分别教授相应指南推荐的按压标准.学员在模拟人上进行练习并考核合格后进入正式研究.两组学员分别进行8 min连续不间断的单纯胸外按压,对比两组间学员的基础状态、按压深度、按压频率、主客观疲劳程度变化情况.结果 2010指南组、2005指南组分别有42、39人纳入正式研究,两组间学员在性别构成比、年龄、身高、体质量、基础心率、收缩压、乳酸等差异无统计学意义.利用重复测量方差对8 min胸外按压过程分析显示,2010指南组按压深度、按压频率均显著高于2005指南组（P＜0.05）,但同时伴随2010指南组操作后的心率、收缩压、乳酸变化均高于2005指南组（P＜0.05）.从主观疲劳程度分析,尽管2010指南组学员在第1分钟仍处于主观相对轻松状态[（11.35＆#177;1.29）vs.（10.54＆#177;1.74）,P=0.000],但已客观出现按压质量下降的事实[（47.63＆#177;7.87） mm vs.（40.26＆#177;5.93） mm,P=0.000].结论 非医学专业人士按照2010年指南进行心肺复苏时,可以实施符合指南要求的胸外按压,但同时会加速疲劳.在按压第1分钟,虽然操作者主观未疲劳,但已出现按压质量下降.因此,本研究提示,实施单纯连续胸外按压时,进行l min轮换可能更有利于保证按压质量.

Objective To investigate the effect of fatigue of witness and quality of external chest compression according to the requirement of 2010 guidelines for cardiopulmonary resuscitation.Methods A total of 96 volunteer participants in basic life support training course were recruited from the College of Automation in the Guangdong University of Technology.All volunteers were randomly （random number） divided into two groups：2010 guidelines group and 2005 guidelines group.The instructors explained the procedures of external chest compression as required as per different guidelines and then guided the trainees to practice CPR as they learned.Trainees,who completed entire training course and passed the examination,were eligible into the study.In the final investigation,trainees of two groups were asked to perform 8-min continuous external chest compression of CPR.The demographics of trainees such as age,gender,tallness,body weight,heart rate （HR）,systolic blood pressure （SBP）,diastolic blood pressure （DBP）,blood lactate and rating of perceived exertion （RPE） were recorded before and immediately after CPR.Results Of them,42 and 39 subjects were finally enrolled into 2010 group and 2005 group,respectively.There was no statistically significant difference in basic status of trainees between two groups.After 8-min external chest compression,trainees in 2010 guidelines group brought about greater compression depth and rate than those in 2005 guidelines group （P 〈0.05）.On the contrary,HR,SBP and lactate were also higher in 2010 guidelines group than those in 2005 guidelines group （P 〈 0.05）.Furthermore,the quality of external chest compression declined to a sub-optimal pattern [（47.63 ＆#177;7.87） mm vs.（40.26 ＆#177;5.93） mm,P =0.000] even though RPE value still indicated a status of relative easiness [（11.35 ＆#177; 1.29） vs.（10.54 ＆#177; 1.74）,P =0.000].Conclusions When the recommendation of 2010 guidelines for cardiopulmonary resuscitation was followed,trainees in current study could perform optimal compression depth and rate even in the occurrence of increased fatigue.Therefore,study on this manikin showed it had better to conduct rescuer-exchange in every minute so as to get high quality of external chest compression.