Department of Neonatology, VU University Medical Centre, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
Resuscitation. 2010 Aug;81(8):1000-3. doi: 10.1016/j.resuscitation.2010.03.021. Epub 2010 May 18.
Heart rate is a primary clinical indicator directing newborn resuscitation. The time taken to assess the heart rate by auscultation in relation to accuracy during newborn resuscitation is not known.
To assess both the accuracy and time taken to assess heart rate by stethoscope in simulated resuscitation scenarios.
The VitalSim((c)) manikin (Laerdal Medical, Stavanger, Norway) was used in this randomised, single blind study. Four heart rate settings (0, 40, 80, 120 beats per minute (bpm)) were randomly assigned. Participants assessed them by auscultation in three different scenarios. The first scenario was to assess the actual heart rate at birth. In the second scenario, heart rate was assessed during ventilation and assigned to standard ranges (<60, 60-100, >100bpm). In the third scenario, heart rate was assessed after three cycles of compressions and ventilation and assigned to standard ranges.
In total 61 midwives, nurses and doctors performed 183 assessments. Mean time to estimate heart rate for scenarios 1, 2 and 3 was: 17.0, 9.8 and 7.8s respectively. Heart rate assessments were inaccurate in 31% (scenario 1), 28% (scenarios 2) and 26% (scenario 3). There was a trend for assessors who were accurate to be quicker and this achieved significance in scenario 2 (p<0.02). Inaccurate assessment would have made a difference to management in 28% of all cases.
Mean time to estimate heart rate for the scenarios varied between 7.8 and 17.0s. Twenty-eight percent of all heart rate assessments would have prompted incorrect management during resuscitation or stabilization. Of incorrect assessments, 73% were overestimations. Further research is required to develop a rapid and accurate method for determining heart rate during newborn resuscitation.
心率是指导新生儿复苏的主要临床指标。在新生儿复苏过程中，听诊评估心率的时间及其准确性尚不清楚。
评估使用听诊器在模拟复苏场景中评估心率的准确性和时间。
本研究采用 VitalSim((c))模拟人（Laerdal Medical，斯塔万格，挪威）进行随机、单盲研究。将四个心率设置（0、40、80、120 次/分钟（bpm））随机分配。参与者在三种不同场景下通过听诊进行评估。第一个场景是评估出生时的实际心率。第二个场景是在通气时评估心率，并将其分配到标准范围内（<60、60-100、>100bpm）。第三个场景是在三次按压和通气后评估心率，并将其分配到标准范围内。
共有 61 名助产士、护士和医生进行了 183 次评估。场景 1、2 和 3 估计心率的平均时间分别为：17.0、9.8 和 7.8s。心率评估不准确的比例分别为 31%（场景 1）、28%（场景 2）和 26%（场景 3）。在场景 2 中，准确评估者更快，这一趋势具有统计学意义（p<0.02）。在所有情况下，不准确的评估有 28%会导致管理上的差异。
三种场景下估计心率的平均时间在 7.8 到 17.0s 之间。在所有情况下，28%的心率评估会导致复苏或稳定过程中的管理错误。在错误的评估中，73%是高估。需要进一步研究以开发一种快速准确的方法来确定新生儿复苏过程中的心率。
