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| 中国维和军医战伤救治技能培训效果评估 |
| 汤林宁1,2,李民1,黄海东3,全勇4,李宾5,贾文荣6,杨勇1* |
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(1. 陆军军医大学大坪医院医研部, 重庆 400042;
2. 火箭军广州特勤疗养中心, 广州 510515;
3. 海军军医大学(第二军医大学)长海医院呼吸与危重症医学科, 上海 200433;
4. 解放军联勤保障部队990 医院医务部, 信阳 464000;
5. 解放军 31636 部队卫生连, 昆明 650000;
6. 解放军陆军949 医院五官科, 阿勒泰 836500
*通信作者) |
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| 摘要: |
| 目的 通过调查中国部署前维和军医战伤救治能力现状，分析维和军医战伤救治技能培训中存在的问题，为完善培训内容提供借鉴。方法 采取整群抽样法，纳入部署前中国维和分队一级医院军医作为研究对象，通过问卷调查法、理论考核、桌面推演和实训演练（包括现场评估、检伤分类、胸腔闭式引流术），对35名完成战伤救治培训的维和军医进行调查。问卷条目采用Likert 5级评分法评估，理论考核与桌面推演分别使用知识点错误率与推演合理率评估，现场评估和检伤分类使用联合国医疗队模拟训练5分法评估，胸腔闭式引流术操作考核使用百分制评分。结果 问卷调查结果显示，35名维和军医的掌握程度、授课质量、任务需求、个人需求的维度均分分别为（3.99±0.68）、（4.48±0.64）、（4.55±0.54）和（4.41±0.60）分，差异有统计学意义（F=26.65，P<0.01），其中掌握程度的维度均分最低。理论考核结果显示，7个知识点错误率比较差异有统计学意义（χ2=167.65， P<0.001），其中战伤急救基本技术（止血原理）错误率最高，伤票与伤标错误率最低。桌面推演结果表明，35名维和军医均能完成21道题目的措施推演，其中2道题目推演合理率为100.00%，6道题目推演合理率低于60%， 3道题目存在不合适推演措施。现场评估结果显示，装备准备、现场处理、伤员后送均分为3.00分，安全意识均分为2.89分，伤员查体顺序及重点均分为2.78分，伤员查体内容均分为2.67分；检伤分类评估结果显示，整体分类观念均分为3.00分，救治分类（二次评估）、伤员查体顺序及重点均分为2.89分，伤员查体内容均分为2.11分，伤势与处置顺序、手术方式、伤员流向均分为1.00分。胸腔闭式引流术操作考核成绩为77～97（91.33±5.84）分。结论 部署前维和军医整体伤员救治能力仍存在一些弱项。未来维和军医战伤救治技能培训应加强武器伤救治、损伤控制手术和批量伤员救治等方面的培训，提高实训课程比重，增加综合能力训练课程。 |
| 关键词: 战伤救治 培训 军医 调查 维和 |
| DOI：10.16781/j.0258-879x.2021.01.0085 |
| 投稿时间：2020-07-20修订日期：2020-12-18 |
| 基金项目: |
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| Combat casualty care training of Chinese peacekeeping military doctors: an evaluation of effectiveness |
| TANG Lin-ning1,2,LI Min1,HUANG Hai-dong3,QUAN Yong4,LI Bin5,JIA Wen-rong6,YANG Yong1* |
(1. Department of Medical Research, Daping Hospital, Army Medical University, Chongqing 400042, China;
2. Guangzhou Special Service Convalescent Center of Rocket Army, Guangzhou 510515, Guangdong, China;
3. Department of Respiratory and Critical Care Medicine, Changhai Hospital, Naval Medical University(Second Military Medical University), Shanghai 200433, China;
4. Department of Medical Affairs, No. 990 Hospital of Logistics Support Force of PLA, Xinyang 464000, Henan, China;
5. Hygienic Company, No. 31636 Troop of PLA, Kunming 650000, Yunnan, China;
6. Department of Ophthalmology and Otorhinolaryngology, No. 949 Hospital of PLA Army, Aletai 836500, Xinjiang Uygur Autonomous Region, China
*Corresponding author) |
| Abstract: |
| Objective To investigate the status quo of combat casualty care capability in Chinese peacekeeping military doctors before deployment, and analyze the problems in the training of combat casualty care, so as to provide reference for improving the training content. Methods The cluster sampling was used to recruit the peacekeeping military doctors from Chinese peacekeeping LevelⅠhospitals before deployment. A total of 35 peacekeeping military doctors who completed the training of combat casualty care were investigated through questionnaire, test, desktop simulation and practical training (including on-site assessment, triage and closed thoracic drainage). Likert 5-grade scoring method was used to evaluate the questionnaire items. The error rates of knowledge points and reasonable deduction rates were used to evaluate the test and the desktop simulation, respectively. The on-site assessment and the triage were assessed with five-point method of medical simulation training of the United Nations medical team, and the closed thoracic drainage was graded using percentage. Results The results of the questionnaire on the 35 peacekeeping military doctors showed that the average score of mastery level (3.99±0.68), teaching quality (4.48±0.64), task demand (4.55±0.54) and personal demand (4.41±0.60) were significantly different (F=26.65, P<0.01), with the average score of mastery level being the lowest. The test results showed that the error rates of seven knowledge points were significantly different (χ2=167.65, P<0.001), and the error rate of the basic skill (hemostasis principle) of combat casualty first aid was the highest, and the error rate of injury ticket and injury label was the lowest. The results of the desktop simulation indicated that all the 35 participants were able to complete the deduction of the 21 items, the reasonable rates of two items were 100.00%, the reasonable rates of six items were less than 60%, and three items had inappropriate deduction measures. The average scores of on-site assessment were as follows:3.00 points for the equipment preparation, on-site treatment and casualty evacuation; 2.89 points for the safety awareness; 2.78 points for the sequence and key points of physical examination of casualty; and 2.67 points for the contents of physical examination of casualty. The average scores of triage were as follows:3.00 points for the overall classification concept; 2.89 points for the treatment classification (secondary assessment) and the sequence and key points of physical examination of casualty; 2.11 points for the physical examination contents of casualty; 1.00 point for the injury severity and treatment order, surgical methods and casualty flow; and 77-97 (91.33±5.84) points for the closed thoracic drainage. Conclusion There are still some weaknesses in overall casualty treatment capacity of peacekeeping military doctors before deployment. In the future, the training of combat casualty care should be strengthened in weapon wound treatment, damage control surgery and mass casualty treatment; the proportion of practical training courses should be increased, and comprehensive ability training courses should be added. |
| Key words: combat casualty care training military doctors survey peacekeeping |
