我国要建立独立、完整、科学的心肺复苏教育培训体系。本文对2011年以来采用美国心脏协会基础生命支持课程进行心肺复苏培训的经验进行了分析和总结。提出该课程值得借鉴的优点,包括严格的教师培训和准入机制、标准化视频和视练同步的教学方式、小班授课模式、团队合作的培训内容和单项否决的技能考核。同时也指出该课程存在的一些问题,主要包括缺少心脏骤停监测和预防的教育、缺少心脏骤停时心电波形识别的培训、仅涉及自动体外除颤器的使用、特殊人群的心肺复苏培训缺乏针对性。因此,美国心脏协会基础生命支持课程可能并不适合直接“移植”用于中国医务人员的培训。未来需要更多的探索和研究以建立符合中国特色的心肺复苏培训课程体系。
China should establish an independent, complete and scientific cardiopulmonary resuscitation education and training system. This article summarized the experience of cardiopulmonary resuscitation training with the basic life support(BLS) course of American Heart Association since 2011. The advantages of BLS course included strict trainers' training and access system, standardized video and “practice while watching” mode, small class teaching mode, team training content and line-item veto in skill testing. The weaknesses of BLS course included the lack of education on the monitoring and prevention of cardiac arrest, the insufficient training on the reading of electrocardiogram waveforms during cardiac arrest, the use of automatic but not manual external defibrillator, and the lack of specific training for special patient groups. These weaknesses made BLS course not suitable for Chinese medical staffs. In the future, more researches were needed to build a new CPR training system with Chinese characteristics.
[1] 中国研究型医院学会心肺复苏学专业委员会,中华医学会科学普及分会. 2018中国心肺复苏培训专家共识[J].中华危重病急救医学,2018,30(5):385-400. DOI: 10.3760/cma.j.issn.2095-4352.2018.05.001.
[2]张丹丹, 白雪, 万玉骁, 等. 基础生命支持在住院医师规范化培训课程中的应用与探索[J].中国继续医学教育,2021,13(3):54-58. DOI: 10.3969/j.issn.1674-9308.2021.03.017.
[3]李颜, 汪恒, 张爱京, 等. 临床教师准入及培训的启示[J].医院管理论坛,2018,35(1):8-9,16. DOI: 10.3969/j.issn.1671-9069.2018.01.002.
[4]张晖, 徐军, 朱华栋, 等. 传统培训和标准视频培训在心肺复苏中的质量效果比较[J].中华急诊医学杂志,2018,27(6):699-701. DOI: 10.3760/cma.j.issn.1671-0282.2018.06.027.
[5]王庆玲, 王长远, 孙长怡, 等. PWW教学在规培住院医师心肺复苏培训中的应用[J].中华医学教育探索杂志,2017,16(10):1053-1056. DOI: 10.3760/cma.j.issn.2095-1485.2017.10.022.
[6]曾瑞峰, 赖芳, 曾桂珍, 等. 心肺复苏培训模式在中医住院医师规范化培训中的实践与效果评价[J].医学教育研究与实践,2016,24(6):957-960. DOI: 10.13555/j.cnki.c.m.e.2016.06.042.
[7]Stewart NH, Tanksley A, Edelson DP, et al. Trainees at a resuscitation: a dual liability[J]. Clin Teach, 2018,15(1):38-43. DOI: 10.1111/tct.12623.
[8]殷晓莹, 许硕贵, 何建, 等. 美国心脏协会心肺复苏培训法在规范化培训医师中的应用[J].临床急诊杂志,2017,18(4):310-312. DOI: 10.13201/j.issn.1009-5918.2017.04.019.
[9]郑康, 马青变. 住院医师心肺复苏培训和考核新模式探讨[J].中华医学教育探索杂志,2021,20(2):213-216. DOI: 10.3760/cma.j.cn116021-20191224-00407.
[10]Shao F, Li CS, Liang LR, et al. Incidence and outcome of adult in-hospital cardiac arrest in Beijing, China[J]. Resuscitation, 2016,102:51-56. DOI: 10.1016/j.resuscitation.2016.02.002.
[11]Panchal AR, Bartos JA, Cabaas JG, et al. Part 3: adult basic and advanced life support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care[J]. Circulation, 2020,142(16_suppl_2):S366-S468. DOI: 10.1161/CIR.0000000000000916.
[12]Campbell V, Conway R, Carey K, et al. Predicting clinical deterioration with Q-ADDS compared to NEWS, Between the Flags, and eCART track and trigger tools[J]. Resuscitation, 2020,153:28-34. DOI: 10.1016/j.resuscitation.2020.05.027.
[13]Moriwaki K, Watanabe T, Yasuda M, et al. An outcome study of adult in-hospital cardiac arrests in non-monitored areas with resuscitation attempted using AED[J]. Am J Emerg Med, 2020,38(12):2524-2530. DOI: 10.1016/j.ajem.2019.12.025.
[14]Kloppe C, Jeromin A, Kloppe A, et al. First responder for in-hospital resuscitation: 5-year experience with an automated external defibrillator-based program[J]. J Emerg Med, 2013,44(6):1077-1082. DOI: 10.1016/j.jemermed.2012.11.036.
[15]陈志, 张元春, 何小军, 等. 应用自动体外除颤器现场急救54例病案分析[J].中华急诊医学杂志,2020,29(4):608-614. DOI: 10.3760/cma.j.issn.1671-0282.2020022.021.
