Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Palo Alto, CA, USA.
Resuscitation. 2013 Mar;84(3):369-72. doi: 10.1016/j.resuscitation.2012.07.035. Epub 2012 Aug 25.
Auscultation and palpation are recommended methods of determining heart rate (HR) during neonatal resuscitation. We hypothesized that: (a) detection of HR by auscultation or palpation will vary by more than ± 15BPM from actual HR; and (b) the inability to accurately determine HR will be associated with errors in management of the neonate during simulated resuscitation.
Using a prospective, randomized, controlled study design, 64 subjects participated in three simulated neonatal resuscitation scenarios. Subjects were randomized to technique used to determine HR (auscultation or palpation) and scenario order. Subjects verbalized their numeric assessment of HR at the onset of the scenario and after any intervention. Accuracy of HR determination and errors in resuscitation were recorded. Errors were classified as errors of omission (lack of appropriate interventions) or errors of commission (inappropriate interventions). Cochran's Q and chi square test were used to compare HR detection by method and across scenarios.
Errors in HR determination occurred in 26-48% of initial assessments and 26-52% of subsequent assessments overall. There were neither statistically significant differences in accuracy between the two techniques of HR assessment (auscultation vs palpation) nor across the three scenarios. Of the 90 errors in resuscitation, 43 (48%) occurred in association with errors in HR determination.
Determination of heart rate via auscultation and palpation by experienced healthcare professionals in a neonatal patient simulator with standardized cues is not reliable. Inaccuracy in HR determination is associated with errors of omission and commission. More reliable methods for HR assessment during neonatal resuscitation are required.
听诊和触诊是新生儿复苏时确定心率（HR）的推荐方法。我们假设：（a）听诊或触诊检测到的 HR 与实际 HR 的差异超过±15BPM；（b）无法准确确定 HR 将与新生儿在模拟复苏期间的管理错误有关。
使用前瞻性、随机、对照研究设计，64 名受试者参与了三个模拟新生儿复苏场景。受试者被随机分配到用于确定 HR 的技术（听诊或触诊）和场景顺序。受试者在场景开始时和任何干预后口头表达他们对 HR 的数值评估。记录 HR 确定的准确性和复苏中的错误。错误分为遗漏错误（缺乏适当的干预措施）或错误（不适当的干预措施）。Cochran's Q 和卡方检验用于比较方法和各场景之间的 HR 检测。
初始评估中 HR 确定的错误发生在 26-48%，随后评估中 HR 确定的错误发生在 26-52%。两种 HR 评估技术（听诊与触诊）之间以及三个场景之间的准确性均无统计学差异。在 90 次复苏错误中，有 43 次（48%）与 HR 确定错误有关。
在新生儿患者模拟器中，有经验的医疗保健专业人员通过标准化提示进行听诊和触诊来确定心率并不可靠。HR 确定不准确与遗漏和委员会错误有关。需要更可靠的新生儿复苏时 HR 评估方法。
