麻醉科

　　麻醉科是醫(yī)院安全高效運(yùn)行的樞紐和重要支撐平臺(tái)，在醫(yī)院的整體發(fā)展中具有舉足輕重的地位，擁有可視化技術(shù)、困難氣道管理工具、血流動(dòng)力學(xué)監(jiān)測(cè)及腦功能監(jiān)測(cè)等多項(xiàng)國(guó)內(nèi)領(lǐng)先的麻醉及監(jiān)測(cè)技術(shù)。為臨床各科各類手術(shù)麻醉及有創(chuàng)操作檢查的順利開(kāi)展提供了安全、高效的保障。作為二級(jí)學(xué)科，一級(jí)臨床科室，擁有醫(yī)師單元和護(hù)理單元。 　　在醫(yī)院快速發(fā)展的背景下，臨床麻醉及圍術(shù)期管理的綜合實(shí)力得到了快速提升，在國(guó)內(nèi)外的影響力不斷提高。近年來(lái)通過(guò)“走出去，請(qǐng)進(jìn)來(lái)”，加強(qiáng)國(guó)際交流與合作，多次參加國(guó)際學(xué)術(shù)會(huì)議大會(huì)發(fā)言， 多次主辦國(guó)際交流學(xué)術(shù)活動(dòng)，特別是在學(xué)科建設(shè)、臨床麻醉及麻醉信息系統(tǒng)的升級(jí)，多功能麻醉恢復(fù)室的運(yùn)行，高效運(yùn)轉(zhuǎn)模式下麻醉安全管理體系的建立，麻醉質(zhì)控的落實(shí)，使得臨床麻醉水平和工作效率進(jìn)一步提高，在疑難和危重患者的搶救及圍術(shù)期管理方面積累了豐富的經(jīng)驗(yàn)。麻醉科的運(yùn)行模式和工作效率得到了國(guó)內(nèi)外同行的高度評(píng)價(jià)及政府主管部門的認(rèn)可。 　　麻醉科于 2012 年入圍國(guó)家臨床重點(diǎn)專科建設(shè)項(xiàng)目，確立將建設(shè)世界一流大學(xué)附屬醫(yī)院的優(yōu)質(zhì)麻醉學(xué)科作為戰(zhàn)略目標(biāo)，根據(jù)項(xiàng)目總體目標(biāo)及建設(shè)規(guī)模，將圍術(shù)期安全體系及優(yōu)化作為學(xué)科建設(shè)核心工作。分別從危、急重癥、老年患者的圍麻醉期管理優(yōu)化、圍術(shù)期合理用血、規(guī)范化術(shù)后鎮(zhèn)痛、慢性疼痛治療、圍術(shù)期麻醉管理信息系統(tǒng)的優(yōu)化六個(gè)子項(xiàng)目大力推進(jìn)學(xué)科系統(tǒng)建設(shè)及人才培養(yǎng)。 　　1987 年麻醉科正式成為臨床二級(jí)學(xué)科，李釗首任麻醉科主任，1989 年蔣建渝任科主任，2003 年至2009 年張利萍任科主任，2009 年至今，郭向陽(yáng)任科主任?？苾?nèi)逐步完善了住院醫(yī)師培訓(xùn)學(xué)習(xí)、總住院醫(yī)師制，臨床病例術(shù)前交班、危重疑難和死亡病例討論、麻醉科工作常規(guī)和危重病人搶救處理等一系列制度。之后，進(jìn)一步規(guī)范住院醫(yī)師、主治醫(yī)師的培養(yǎng)；完善和健全有關(guān)早交班和文獻(xiàn)報(bào)告制度、臨床病例討論制度、全科業(yè)務(wù)學(xué)習(xí)制度、研究課題開(kāi)題報(bào)告和討論制度等，對(duì)提高臨床麻醉質(zhì)量、充實(shí)業(yè)務(wù)知識(shí)、提高科研和教學(xué)水平都起到了促進(jìn)作用。 　　隨著麻醉科學(xué)科建設(shè)的發(fā)展，各種麻醉方法及監(jiān)測(cè)手段不斷進(jìn)步，臨床麻醉的數(shù)量和質(zhì)量逐步提高， 目前，科內(nèi) 3 年以上住院醫(yī)師都能熟練地完成深靜脈穿刺置管、動(dòng)脈穿刺置管直接動(dòng)脈監(jiān)測(cè)技術(shù)；主治醫(yī)師以上人員不僅都能自主完成各科各類手術(shù)的麻醉管理（包括心內(nèi)直視手術(shù)、臟器移植手術(shù)等），而且還側(cè)重對(duì)某個(gè)?？坡樽砉芾磉M(jìn)行較為深入的研究。近年來(lái)，科室通過(guò)多種創(chuàng)新特色技術(shù)，如可視化技術(shù)、困難氣道圍術(shù)期綜合管理、3D 打印氣道、圍術(shù)期腦卒中防控、經(jīng)食道超聲心動(dòng)圖、經(jīng)顱多普勒、局部腦氧飽和度、床旁血栓彈力圖、漂浮導(dǎo)管監(jiān)測(cè)等技術(shù)在危重手術(shù)中的應(yīng)用；開(kāi)展產(chǎn)科大出血血液保護(hù)研究，拓寬圍術(shù)期自體血回輸應(yīng)用范疇，提供循證醫(yī)學(xué)證據(jù)；老年手術(shù)患者早期康復(fù)體系（Enhanced recovery after surgery, ERAS）建設(shè)等，優(yōu)化圍術(shù)期安全管理體系，大大提升了平臺(tái)服務(wù)能力。以麻醉質(zhì)控和并發(fā)癥、不良事件溯源（Anesthesia-event root causeanalysis）為抓手，充分發(fā)揮多功能麻醉恢復(fù)室的優(yōu)勢(shì)，緊密圍繞科室核心工作“圍術(shù)期麻醉安全和質(zhì)量管理體系的優(yōu)化”進(jìn)行學(xué)科建設(shè)。 　　教學(xué)工作和人才培養(yǎng)是教學(xué)醫(yī)院臨床科室的重要任務(wù)之一，麻醉科在人員編制嚴(yán)重不足的情況下， 不僅順利完成學(xué)校下達(dá)的本科生教學(xué)和實(shí)習(xí)任務(wù)、碩士研究生和博士研究生培養(yǎng)任務(wù)，還有多位教師榮獲校級(jí)和院級(jí)優(yōu)秀教師稱號(hào)。為基層醫(yī)療單位培養(yǎng)人才也取得了不少的成績(jī)，先后為云南西雙版納地區(qū)、思茅地區(qū)、延慶、順義和昌平等京郊縣區(qū)舉辦過(guò)系統(tǒng)的麻醉學(xué)習(xí)班，多數(shù)學(xué)員現(xiàn)在都在各自的崗位上承擔(dān)領(lǐng)導(dǎo)和骨干作用。50 年來(lái)先后培養(yǎng)進(jìn)修醫(yī)師數(shù)百名，他們?cè)诟髯缘尼t(yī)院里也都成為麻醉科的中堅(jiān)力量。20 世紀(jì) 90 年代以后，在住院醫(yī)師和研究生的培養(yǎng)和教育工作中也做了大量工作。目前，我科全體醫(yī)生中具有醫(yī)學(xué)博士學(xué)位者 36 名，具有醫(yī)學(xué)碩士學(xué)位者 37 名?，F(xiàn)有博士研究生導(dǎo)師 2 名，碩士研究生導(dǎo)師 3 名。已經(jīng)培養(yǎng)博士研究生 32 名、碩士研究生 31 名。 　　麻醉科的科研工作著重于臨床研究。20 世紀(jì) 60 年代曾對(duì)腰麻后頭痛的成因和治療進(jìn)行觀察，對(duì)普魯卡因和地卡因混合液毒性的動(dòng)物試驗(yàn)及混合液濃度的最佳配比進(jìn)行研究和觀察，配制出北醫(yī)三院自己獨(dú)有的硬膜外 I 號(hào)、II 號(hào)和 III 號(hào)。20 世紀(jì) 80 年代后，曾對(duì)硬膜外麻醉的作用部位，局麻藥 pH 值對(duì)麻醉作用的影響，主冠狀動(dòng)脈旁路手術(shù)麻醉管理，大劑量芬太尼應(yīng)用于非心臟手術(shù)危重病人的麻醉，阿芬太尼、昂丹司瓊、丙泊酚等新藥的藥理及臨床應(yīng)用作過(guò)觀察研究和總結(jié)。20 世紀(jì) 90 年代初期建立碩士學(xué)位授予點(diǎn)后，開(kāi)始招收研究生并開(kāi)展較為深入的研究工作。如：急性等容量血液稀釋臨床及實(shí)驗(yàn)研究，心肌保護(hù)及其機(jī)理的實(shí)驗(yàn)研究，異丙酚與氯胺酮復(fù)合應(yīng)用、全麻聯(lián)合硬膜外阻滯對(duì)細(xì)胞免疫功能的影響等。 　　近十年來(lái)，科室始終堅(jiān)持“以循證醫(yī)學(xué)為基礎(chǔ)（evidence-based)，機(jī)制研究為導(dǎo)向 (mechanism-guided) 的轉(zhuǎn)化醫(yī)學(xué)研究方針”。堅(jiān)持科學(xué)研究的目的是為了解決臨床問(wèn)題，提高患者的預(yù)后和轉(zhuǎn)歸，同時(shí)培養(yǎng)麻醉醫(yī)師的批判精神和銳意進(jìn)取的科學(xué)態(tài)度。以項(xiàng)目帶動(dòng)學(xué)科發(fā)展，按工程管理方式促進(jìn)科研良性發(fā)展。按照國(guó)際通用方法，建立各亞專業(yè)組，及時(shí)跟進(jìn)學(xué)科發(fā)展動(dòng)向，構(gòu)建充滿活力、富有效率、更加開(kāi)放的創(chuàng)新驅(qū)動(dòng)發(fā)展的體制，并取得明顯成效，先后累計(jì)獲得國(guó)家自然科學(xué)基金項(xiàng)目 14 項(xiàng)，參與國(guó)家科技部重大慢病研究計(jì)劃 1 項(xiàng)，省部級(jí)課題 7 項(xiàng)，院級(jí)基金多項(xiàng)。目前科室已形成麻醉與腦功能、氣道管理（超聲氣道、3D 打印氣道與氣道管理）、圍術(shù)期重要器官保護(hù)、麻醉與腫瘤、麻醉藥理學(xué)、圍術(shù)期管理與預(yù)后轉(zhuǎn)歸等穩(wěn)定的研究方向。近十年來(lái)，我科累計(jì)發(fā)表 SCI 收錄和核心期刊收錄的學(xué)術(shù)論文 368 篇，出版專業(yè)著作 7 部，申報(bào)科技專利 41 項(xiàng)目，其中授權(quán) 9 項(xiàng)。 　　在黨支部的帶領(lǐng)下，麻醉科注重發(fā)揮黨員的先鋒模范帶頭作用，積極開(kāi)展了科室文化建設(shè)，加強(qiáng)團(tuán)隊(duì)凝聚力。麻醉科工會(huì)創(chuàng)建和組織了以科室管樂(lè)團(tuán)為代表的一系列豐富多彩的文化活動(dòng)。通過(guò)這些活動(dòng)， 形成了良好的科室氛圍，凝聚和激勵(lì)了全體醫(yī)務(wù)人員銳意進(jìn)取，愛(ài)崗敬業(yè)的職業(yè)精神。2016 年 11 月， 麻醉科被授予“北京大學(xué)模范職工小家”的光榮稱號(hào)。 　　在新的時(shí)代背景下，麻醉科黨支部及工會(huì)秉承“醫(yī)學(xué)科普是新的醫(yī)患溝通”的理念，積極組織并參加形式多樣的科普活動(dòng)，例如被多家媒體廣為報(bào)道的青光眼樂(lè)隊(duì)、病友見(jiàn)面會(huì)、科普比賽、科普進(jìn)校園、組建科普公眾號(hào)、發(fā)表科普文章等，通過(guò)不同形式的科普活動(dòng)大力宣傳麻醉學(xué)相關(guān)知識(shí)，弘揚(yáng)尊重生命的文化理念。 　　麻醉科銘記“為愛(ài)托起生命的彩虹”的神圣職責(zé)，通過(guò)人才梯隊(duì)建設(shè)，努力踐行標(biāo)準(zhǔn)化、規(guī)范化、專業(yè)化、精細(xì)化和信息化的管理理念，目前已經(jīng)形成了一支高素質(zhì)、專業(yè)化、重管理、有特色的麻醉學(xué)專業(yè)隊(duì)伍。在優(yōu)質(zhì)服務(wù)、科學(xué)管理、和諧發(fā)展等各方面得到醫(yī)院的認(rèn)可和贊譽(yù)，多次榮獲醫(yī)院醫(yī)療優(yōu)秀獎(jiǎng)、優(yōu)秀管理團(tuán)隊(duì)獎(jiǎng)、教學(xué)團(tuán)隊(duì)、優(yōu)秀管理項(xiàng)目獎(jiǎng)以及優(yōu)質(zhì)服務(wù)先進(jìn)集體獎(jiǎng)等榮譽(yù)。 　　麻醉學(xué)科成為獨(dú)立的二級(jí)學(xué)科僅 30 年，相信在全科工作人員的不斷努力及院領(lǐng)導(dǎo)和兄弟科室的關(guān)心和支持下，將不斷完善規(guī)章制度，提高臨床麻醉水平，更好地滿足臨床醫(yī)療、教學(xué)、科研的需要，使北醫(yī)三院麻醉科步入北醫(yī)三院和全國(guó)麻醉界的先進(jìn)行列。 　　Anesthesiology department is a key and important supporting platform for safe and efficient operation of hospital, and plays an important role in the overall development of hospital. It has many leading anesthesia and monitoring techniques in China, such as visualization technology, difficult airway management tools, hemodynamic monitoring and brain function monitoring. It provides a safe and efficient guarantee for all kinds of surgical anesthesia and invasive operation examination. As a second-level discipline, the first-level clinical department, has the physician unit and the nursing unit. 　　Under the background of the rapid development of the hospital, the comprehensive strength of clinical anesthesia and perioperative management has been rapidly improved, and the influence at home and abroad has been continuously improved. In recent years, through "go out, please come in ", strengthen international exchanges and cooperation, participate in many international academic conference speeches, host many international exchange academic activities, especially in discipline construction, clinical anesthesia and anesthesia information system upgrade, operation of multi-function anesthesia recovery room, establishment of anesthesia safety management system under efficient operation mode, implementation of anesthesia quality control, make clinical anesthesia level and work efficiency further improved, accumulated rich experience in rescue and perioperative management of difficult and critical patients. The operation mode and work efficiency of anesthesiology department have been highly appraised by domestic and foreign counterparts and recognized by government departments. 　　In 2012, the Department of Anesthesiology was selected as the national key clinical specialty construction project, and established the construction of the world-class university affiliated hospitals as the strategic goal, according to the overall project objectives and construction scale, perioperative safety system and optimization as the core work of discipline construction. From the six sub-projects of optimizing perioperative management, rational use of blood during perioperative period, standardized postoperative analgesia, chronic pain treatment and optimization of perioperative anesthesia management information system, the discipline system construction and personnel training are vigorously promoted. 　　In 1987, the Department of Anesthesiology officially became a clinical secondary discipline, Li Zhao was the first director of Anesthesiology Department, Jiang Jianyu was the director of the Department in 1989, Zhang Liping was the director of the Department from 2003 to 2009, and Guo Xiangyang was the director of the Department since 2009. Kone has gradually improved a series of systems, such as resident training and study, general resident system, preoperative shift of clinical cases, discussion of critical and difficult and death cases, routine work of anesthesiology department and rescue and treatment of critical patients. After that, further standardizing the training of resident doctors and attending physicians, perfecting and perfecting the system of early shift and document reporting, clinical case discussion system, general practice study system, research topic opening report and discussion system, etc., have played a role in promoting the quality of clinical anesthesia, enriching professional knowledge, and improving the level of scientific research and teaching. 　　With the development of anesthesiology department, various anesthetic methods and monitoring methods have been improved, and the quantity and quality of clinical anesthesia have been gradually improved. At present, the residents of Kone for more than 3 years can skillfully complete the monitoring techniques of deep vein catheterization and arterial catheterization. recently, the department has been used in critical surgery through a variety of innovative features, such as visualization technology, comprehensive management of difficult airway perioperative period ,3 D printing airway, prevention and control of perioperative stroke, transesophageal echocardiography, transcranial doppler, local cerebral oxygen saturation, bedside thromboelastography, floating catheter monitoring, etc.; carrying out research on blood protection of obstetric haemorrhage, widening the scope of application of perioperative autologous blood transfusion and providing evidence-based medical evidence; and optimizing perioperative safety management system (Enhanced recovery after surgery,ERAS) construction of elderly surgical patients, greatly improving the platform service capacity. Based on anesthesia quality control and complications, adverse events traceability (Anesthesia-event root cause analysis) as the grasp, give full play to the advantages of multi-function anesthesia recovery room, closely around the core work of the department "perioperative anesthesia safety and quality management system optimization" for discipline construction. 　　Teaching and personnel training is one of the important tasks of clinical department in teaching hospital. The anesthesiology department is understaffed, Not only successfully completed the undergraduate teaching and internship tasks, master's and doctoral graduate training tasks, There are also many teachers won the title of excellent teachers at school level and college level. The training of talents for primary medical units has also made a lot of achievements, We have held systematic anesthesia courses for the counties and districts of Xishuangbanna, Simao, Yanqing, Shunyi and Changping in Yunnan. Most of the students now assume leadership and backbone roles in their respective positions. For 50 years, we have trained hundreds of refresher physicians, They are also the backbone of anesthesiology in their respective hospitals. After the 1990s, Much has also been done in the training and education of resident and graduate students. At present, Of all my doctors ,36 have M.D. degrees, 37 with a master's degree in medicine. Two existing doctoral tutors, Master graduate tutor 3. We have trained 32 doctoral students and 31 master students. 　　The scientific research work of anesthesiology focuses on clinical research. The causes and treatment of headache after lumbar anesthesia were observed in the 1960s, and the animal test of the toxicity of procaine and dicaine mixture and the optimum ratio of mixture concentration were studied and observed. After 1980's, the effect of epidural anesthesia, the effect of local anesthetic pH on anesthesia, the anesthesia management of main coronary artery bypass surgery, the anesthesia of large dose fentanyl in critically ill patients with non-cardiac surgery, and the pharmacological and clinical application of afentanyl, ondansetron and propofol were observed and summarized. After the establishment of the Master's degree awarding point in the early 1990s, we began to recruit graduate students and carry out more in-depth research work. Such as: acute isovolumic hemodilution clinical and experimental studies, myocardial protection and its mechanism of experimental studies, propofol and ketamine combined application, general anesthesia combined with epidural block on cellular immune function. 　　For nearly a decade, Departments have always insisted on "evidence-based medicine (evidence-based), a mechanism study-oriented (mechanism-guided) approach to transformational medicine research. To stick to scientific research to solve clinical problems, To improve the prognosis and outcome of patients, At the same time, we should cultivate the critical spirit and scientific attitude of anesthesiologists. Project - driven discipline, promote the benign development of scientific research according to the way of engineering management. In accordance with the international approach, Establishment of sub-specialties, Follow up the development of discipline in time, Building dynamic, efficient and more open innovation-driven development systems, And achieved tangible results, Has obtained the national natural science foundation project 14 successively, To participate in the National Science and Technology Department's Major Chronic Disease Research Program, Seven provincial and ministerial projects, Academy level funds. at present, departments have formed stable research directions such as anesthesia and brain function, airway management (ultrasound airway ,3 D print airway and airway management), perioperative important organ protection, anesthesia and tumor, anesthesiology, perioperative management and prognosis outcome. For nearly a decade, I have published a total of 368 academic papers SCI and core journals, 7 publications, To apply for project 41, Of these ,9 were authorized. 　　Under the leadership of the Party branch, the Department of Anesthesiology pays attention to giving full play to the vanguard and exemplary leading role of the Party members, actively carrying out the cultural construction of the department and strengthening the cohesion of the team. Anesthesiology trade union has created and organized a series of colorful cultural activities represented by the department orchestra. Through these activities, formed a good atmosphere of departments, condensed and inspired all medical staff forge ahead, love and dedication to the professional spirit. In November 2016, the Department of Anesthesiology was awarded the glorious title of "Peking University model worker small family ". 　　Under the new era background, the Party branch of anesthesiology and the trade union, adhering to the concept of "medical science popularization is a new communication between doctors and patients ", actively organize and participate in various kinds of popular science activities, such as glaucoma bands widely reported by many media, meeting of patients, popular science competitions, popular science into the campus, setting up popular science public numbers, publishing popular science articles, etc., and vigorously propagate the relevant knowledge of anesthesiology through different forms of popular science activities, and carry forward the cultural concept of respecting life. 　　The anesthesiology department, bearing in mind the sacred duty of "supporting the rainbow of life for love ", strives to practice the management concept of standardization, standardization, specialization, refinement and informatization through the construction of talent echelon, and has now formed a professional team of anesthesiology with high quality, specialization, emphasis on management and characteristics. In the quality of service, scientific management, harmonious development and other aspects of the hospital recognition and praise, many times won the hospital medical excellence award, excellent management team award, teaching team, excellent management project award and quality service advanced collective award and other honors. 　　Anesthesiology has become an independent secondary discipline for only 30 years. We believe that with the continuous efforts of general practitioners and the concern and support of hospital leaders and brother departments, we will constantly improve the rules and regulations, improve the level of clinical anesthesia, better meet the needs of clinical medicine, teaching and scientific research, and make the anesthesiology department of the third North Medical Hospital step into the advanced ranks of the third North Medical Hospital and the national anesthetic field.