中国电话指导心肺复苏现状和影响因素分析

Current situation and analysis of influencing factors of telephone cardiopulmonary resuscitation in China

目的调研中国急救人员电话指导心肺复苏(telephone cardiopulmonary resuscitation,T-CPR)的实施现状和影响因素,分析导致T-CPR实施率低的主要原因,提出可能的解决办法。方法采用多中心的横断面调查研究,以方便抽样的方法从中国六大地理分区中分别抽取共计20个城市,通过匿名在线电子问卷的方法调查各城市急救人员对T-CPR的认知及实施情况。根据T-CPR实施频率分为常规T-CPR组和非常规T-CPR组。分别使用t检验和卡方检验分析组间计量资料和计数资料的差异。使用多因素logistic回归分析实施T-CPR的影响因素。结果①共1191人填写问卷,T-CPR的知晓率为80.94%。960人知晓T-CPR且问卷填写完整纳入研究。常规T-CPR组(401人),非常规T-CPR组(559人)。939人(97.81%)认为对于能够通过电话判定的心脏骤停,应该实施T-CPR。②401人(41.77%)在临床实践中常规实施T-CPR,其中237人(24.68%)总是实施T-CPR,164人(17.08%)经常实施T-CPR。③多因素logistic回归分析结果显示男性(OR=1.787,95%CI:1.235~2.587,P=0.002)、年龄(OR=1.025,95%CI:1.004~1.047,P=0.020)、专业背景为临床医学(OR=2.926,95%CI:1.387~6.171,P=0.005)、电话调度员(OR=5.305,95%CI:3.463~8.126,P<0.01)、使用医疗优先分级调度系统(medical priority dispatch system,MPDS)(OR=1.941,95%CI:1.418~2.656,P<0.01)、有T-CPR制度或流程(OR=3.879,95%CI:2.652~5.674,P<0.01)是急救人员实施T-CPR的有利因素。④常规T-CPR组实施T-CPR的原因中前三位依次是曾经接受T-CPR培训(67.08%)、认为T-CPR能够提高生存率(63.59%)、有标准的T-CPR流程(63.09%)。非常规T-CPR组中急救人员未实施T-CPR的原因中前三位依次是担心旁观者依从性(42.04%)、担心旁观者心肺复苏质量(38.28%)、担心医疗纠纷(36.14%)。结论急救人员T-CPR的知晓率和实施率仍然有待提高。T-CPR的实施需要依靠具备临床医学背景的电话调度员、明确的T-CPR制度、标准化的操作流程和MPDS等专业辅助工具。提高公众对心脏骤停和心肺复苏的认知、完善配套的法律法规体系,也有利于T-CPR的实施。

Objective To investigate the current situation of telephone cardiopulmonary resuscitation(T-CPR)in China,and analyze the reasons for the low implementation rate of T-CPR.Methods This was a multicenter cross-sectional survey.Twenty cities were selected from six geographical regions of China by convenient sampling method.Anonymous online electronic questionnaires were sent to emergency medical service staffs in each city.All respondents were divided into the routine T-CPR group and control group.Student's t test and Chi-square test were used to analyze the difference between groups.Multivariate logistic regression was used to analyze the influencing factors of T-CPR.Results⑴A total of 1191 questionnaires were collected.80.94%of respondents knew T-CPR.Nine hundred and sixty respondents,who knew T-CPR and completed the questionnaires,were included in the study,and were divided into the routine T-CPR group(n=401)and control group(n=559).Nine hundred and thirty-nine(97.81%)responders believed that T-CPR should be implemented for cardiac arrest patients that could be confirmed by telephone.⑵Four hundred and one(41.77%)responders routinely implemented T-CPR.Among them,237(24.68%)responders always did and 164(17.08%)responders often did.⑶Multivariate logistic regression analysis showed that male(OR=1.787,95%CI:1.235-2.587,P=0.002),age(OR=1.025,95%CI:1.004-1.047,P=0.020),clinical medicine background(OR=2.926,95%CI:1.387-6.171,P=0.005),dispatcher(OR=5.305,95%CI:3.463-8.126,P<0.01),using medical priority dispatch system(MPDS)system(OR=1.941,95%CI:1.418-2.656,P<0.01),and T-CPR policy or procedure(OR=3.879,95%CI:2.652-5.674,P<0.01)were favorable factors for T-CPR.⑷The top three reasons for implementing T-CPR in the routine T-CPR group were that they had received T-CPR training(67.08%),believed that T-CPR could improve survival rate(63.59%),and had standard T-CPR process(63.09%).The top three reasons for not implementing T-CPR in the control group were that worrying about bystander compliance(42.04%),worrying about the quality of bystander cardiopulmonary resuscitation(CPR)(38.28%),and worrying about medical dispute(36.14%).Conclusions The awareness and implementation of T-CPR among emergency medical service staffs need to be improved.The implementation of T-CPR depend on telephone dispatchers with clinical medicine background,clear T-CPR policy,standardized operation procedure,and professional assistant tools.To improve the public's awareness of cardiac arrest and cardiopulmonary resuscitation,and to improve the supporting legal system are also conducive to the implementation of T-CPR.