使用錄影帶輔助學習心室顫動處置之有效性評估：一個隨機分派單盲研究

Evaluate the Efficacy of Video-assisted Learning in Ventricular Fibrillation Training: A Prospective Randomized Single-blind Study

李宜恭(Yi-Kung Lee) ； 莊欽翔(Chin-Hsiang Chuang) ； 黃俊卿(Chun-Hing Wong) ； 楊忠憲(Chung-Hsien Yang) ； 施中岳(Chung-Yueh Shih)

《Journal of Emergency Medicine, Taiwan》 7卷3期 (2005/09) Pp. 154-162

摘要

本研究的目的為評估第一次接受高級心臟救命術(advanced cardiac life support, ACLS)訓練的護理人員，於心室顫動(ventricular fibrillation, VF)課程中，使用傳統標準與錄影帶輔助兩種不同教學方法，評估兩組學員在處理病患操作上之差異及常犯的錯誤。以作為未來ACLS教學的參考。本研究採取隨機分派(randomized assignment)方法，於ACLS課程前，利用問卷調查學員的基本資料，將從未參與ACLS、去顫術訓練課程的護理人員隨機分派為A、B、C、D四組。其中A、C兩組為實驗組，B、D兩組為對照組。在VF課程中，實驗組使用錄影帶輔助教學，對照組則使用標準教學方式。並評估其學習成效。實驗組（觀看錄影帶）與對照組（傳統教法）在操作流程完全正確的比例分別為40.9%與37.8% (P=0.641)。實驗組除了在操作呼吸道－呼吸－循環步驟的正確率為(90.4%)明顯高於對照組的77.5%(P=0.008)外，實驗組與對照組在其他各項操作步驟－檢查反應(99.1%、100%)、求救(79.l%、83.8)、快速觀看電擊板的使用(67.0%、65.8%)、去顫(89.6%、87.4%)、心肺復甦CPR(70.4%、62.2%)、藥物－電擊順序(80.9%、77.5%)的操作正確率，均不分上下，沒有明顯統計上的差別。心肺復甦術及快速觀看電擊板的使用，是實驗組與對照組共同操作正確率最差的兩個操作步驟，其正確率分別為70.4%與62.2%，及67.0%與65.8%。使用錄影帶輔助VF課程教學，其立即的效果與傳統單純講員上課相似，甚至更好，應可做為未來ACLS上課的一種模式。使用快速觀看電極板，與CPR（包含建立輸液途徑，心電圖監視、氣管內插管，CPR）是本研究中學員在處理病患時最易犯的錯誤。ACLS教育工作者在上課時可，可特別注意學員在上述兩項流程之練習。

關鍵字

高級心臟救命術 ； 心室顫動 ； 錄影帶輔助教學 ； 去顫術 ； 護理人員

並列摘要

Nurses are often the first responders when patients are collapsed in hospitals. The resuscitation ability of nurses is related to the prognosis of patients in arrest. The core content of Advanced Cardiac Life Support (ACLS) programs is to educate health professionals to get the skills and knowledge required for managing ventricular fibrillation (VF). Video-assisted learning has applied to education in cardiopulmonary resuscitation (CPR) successfully. There are few studies to investigate the improvement of knowledge and skills in the inexperienced nurses after completing VF training courses by video-assisted learning. The objective of this study is to compare the efficacy of different teaching methods (video-assisted vs. traditional method) after completing VF training courses. This prospective, randomized, single- blind study assigned the inexperienced nurses into four subgroups (A, B, C, D) in each ACLS course. The A, C subgroups and B, D subgroups were assigned to the experiment (video-assisted) group and the control (traditional) group, respectively. We compared the ability of management of ventricular fibrillation (VF) in participants educated by video-assisted and traditional teaching methods. The result of this study revealed that the ability of experiment group was similar, even superior than, with the control group in managing VF patients. In both groups, the poorest performance skills in managing VF were quick-look paddle usage and secondary ABCD. The video-assisted learning may be an acceptable alternative learning method in VF training for inexperienced nurses.

並列關鍵字

ventricular fibrillation VF ； advanced cardiac life support ACLS ； defibrillation ； video-instructed learning ； nurse