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目的通过采用前瞻、随机、对照、开放性实践性研究探讨在部队中采用标准化伤员及标准化救治流程进行吸入性损伤伤员急救训练的应用及效果评价,试图就基层作战单位中军医在战时如何快速救治吸入性损伤伤员提出简单实用的解决方案。方法在基层部队中,采用前瞻性、随机、对照、开放性实践性研究对20名军龄5年以内的军医进行配对,消除经验对于本研究结果的影响,试验组给予吸入性损伤标准操作规程的理论授课、操作实践、演练;对照组自行学习,分别在理论授课前、理论授课后、操作后、演练后进行考核,对2组各次考核总得分及完成时间进行t检验。结果第一次考核所测的基线数据为:试验组(1.95±1.50)分,对照组(2.15±1.38)分,差异无统计学意义(P=0.509);2组军医完成操作所需的时间分别为(10.00±1.49)min和(10.60±2.07)min,差异无统计学意义(P=0.153)。在2学时理论授课后,试验组得分升至(4.65±0.41)分,操作实践后(8.25±0.54)分,演练后(9.60±0.30)分;而对照组理论授课后(3.60±1.07)分,操作实践后(4.65±1.06)分,演练后(5.20±0.89)分。两组数据进行多因变量的方差分析(P=0.001)。操作和演练后,两组间同样具有显著差异。就完成时间而言,试验组总体趋势为先升后降,培训前(10.00±1.49)min,理论授课后增至(30.50±2.22)min,操作实践后则减至(24.70±2.71)min,最后演习实战时所需总时间为(21.10±1.52)min;而对照组培训前(10.60±2.07)min,理论授课后(11.20±2.44)min,操作后(15.00±3.65)min,演练后稍降为(13.90±2.42)min。两组数据进行多因素变量的方差分析(P<0.001)。结论接受标准操作规程培训的军医在吸入性损伤救治流程中表现明显优于未接受任何培训的军医。标准操作规程能够使军医在短时间内快速提高吸入性损伤的知识水平和操作技能。在吸入性损伤理论授课、操作、演练方面,如准备时间紧迫,可优先安排理论授课与操作,时间充裕则可加入演练环节。标准操作规程可弥补低军龄基层军医在经验上的不足,并且由于其接受和学习能力较高年资军医更强,因此其在标准化理论授课训练中表现反而优于高军龄军医。
OBJECTIVE: To explore the application and effect evaluation of first aid training for inhalation injuries in wounded soldiers using standardized casualty and standardized rescue procedure in prospective, randomized, controlled and open practical research. Treatment of inhaled injury casualty proposed a simple and practical solution. Methods In the grassroots units, a prospective, randomized, controlled and open practical study was conducted on 20 military doctors within 5 years of military service to eliminate the influence of experience on the results of this study. The experimental group was given standard operating procedures for inhalation injury The theory teaching, operation practice and practice were carried out. The control group studied by themselves, before the theory teaching, after the theory teaching, after the operation and after the practice. The total score and the completion time of each group were tested by t-test. Results The baseline data of the first assessment were: the experimental group (1.95 ± 1.50) and the control group (2.15 ± 1.38), the difference was not statistically significant (P = 0.509); the time required for the two groups of military doctors to complete the operation (10.00 ± 1.49) min and (10.60 ± 2.07) min, respectively, with no significant difference (P = 0.153). The score of the experimental group rose to (4.65 ± 0.41) points after the 2-hour theory teaching, it was (8.25 ± 0.54) points after practice and 9.60 ± 0.30 points after the exercise (3.60 ± 1.07 points) , After practice (4.65 ± 1.06) points, after exercise (5.20 ± 0.89) points. Two sets of data were analyzed for multiple variables (P = 0.001). After the operation and exercise, the two groups also have significant differences. In terms of the completion time, the overall trend of the experimental group first increased and then decreased after training (10.00 ± 1.49) min, and then increased to (30.50 ± 2.22) min after the theoretical training and decreased to (24.70 ± 2.71) min after the practice, (21.10 ± 1.52) min in the final exercise and 10.60 ± 2.07 min in the control group before training (11.20 ± 2.44) min after operation and 15.00 ± 3.65 min after operation Reduced to (13.90 ± 2.42) min. Two sets of data were analyzed by ANOVA (P <0.001). CONCLUSIONS: Medics trained in standard operating procedures performed significantly better in inhalation injury treatment than those who did not receive any training. Standard operating procedures enable the military surgeon to rapidly improve the knowledge and skills of inhalation injury in a short period of time. In the theory of inhalation injury teaching, operation, exercise, such as preparation time is urgent, can give priority to theory teaching and operation, time is abundant, you can join the exercise session. Standard operating procedures can make up for the lack of experience of grass-roots military doctors of low military rank, and because of their higher acceptance and learning ability, they are better equipped than military officers of high military service in standardized theoretical teaching.