一医三护协作模式与心肺复苏专用车在心肺复苏中的应用

The clinical application of new cooperative mode of 3 nurses and 1 doctor with integrated vehicle in CPR

目的探讨一医三护协作模式与心肺复苏专用车在临床心肺复苏中的应用。方法将81例心跳呼吸骤停患者分为对照组(41例)和观察组(40例)。观察组采用一医三护协作模式与心肺复苏专用车进行心肺复苏,对照组采用一医二护协作模式与传统急救车。比较两组患者入科时APACHEⅡ评分和原发病因、心肺复苏开始和完成时间、完成气管插管和心脏电除颤时间、复苏成功率、24 h存活率、14 d存活率、复苏成功后pH值、氧分压(PaO2)、二氧化碳分压(PaCO2)、血乳酸(Lac)等指标,同时比较分析实施救治的医务人员对两种抢救方案的满意度。结果两组患者在入科时APACHEⅡ评分及病因无明显差异(P>0.05)。观察组心肺复苏开始和完成时间、完成气管插管和心脏电除颤时间均少于对照组(P<0.01),复苏成功率及14 d存活率高于对照组(P<0.05,P<0.01),复苏成功后观察组患者动脉血pH值和PaO2高于对照组(P<0.01),但PaCO2和Lac水平则低于对照组(P<0.01)。医务人员对观察组抢救方案满意度高于对照组(P<0.05)。结论一医三护与心肺复苏专用车的协助复苏方案较传统复苏模式可缩短抢救措施的实施时间,提高复苏成功率及存活率,改善复苏后患者的酸碱失衡及氧合,更易为医护人员所接纳及实施,适合在临床推广。

Objective To discuss the clinical application of new cooperative mode of 3 nurses and 1 doctor with integrated vehicle in CPR .Methods A total of 81 cases of patients with cardiopulmonary arrest were included and randomly divided into control group （ n=41 ） and treatment group （ n=40 ）; in which cooperative mode of 2 nurses and 1 doctor with conventional emergency vehicle and mode of 3 nurses and 1 doctor with advanced integrated vehicle were used , respectively.The APACHE Ⅱscores, primary diseases, CPR duration, endotracheal intubation time , electrical defibrillation time, resuscitation success rate, survival rates at 24 h and on 14 d, pH value, and PaO2, PO2 and Lac after CPR were compared;and the satisfaction degree from medical staff were also investigated .Results At admission , there was no significant difference in the APACHE Ⅱ score or primary disease between the two groups （P〉0.05）.After CPR, the CPR duration, endotracheal intubation time and electrical defibrillation time were significantly shorter in treatment group than those in control group （P〈0.01）, with significantly higher resuscitation success rate （P〈0.05）, survival rate on 14 d （P〈0.01）;Significant higher artery pH value （P〈0.01） and PaO2（P〈0.01）, and lower PaCO2（P〈0.05） and Lac level （P〈0.05） were also observed in treatment group .Meanwhile, the satisfaction degree from medical staff was also significantly higher in treatment group （P〈0.05）.Conclusion Compared with conventional mode and vehicle , the new cooperative mode of 3 nurses and 1 doctor with advanced integrated vehicle can reduce the rescue time , improve the acid-base imbalance and oxygenation , increase resuscitation success rate and survival rate in CPR patients , with more feasible application .