麻醉科

麻醉科是医院安全高效运行的枢纽和重要支撑平台，在医院的整体发展中具有举足轻重的地位，拥有可视化技术、困难气道管理工具、血流动力学监测及脑功能监测等多项国内领先的麻醉及监测技术。为临床各科各类手术麻醉及有创操作检查的顺利开展提供了安全、高效的保障。作为二级学科，一级临床科室，拥有医师单元和护理单元。

在医院快速发展的背景下，临床麻醉及围术期管理的综合实力得到了快速提升，在国内外的影响力不断提高。近年来通过“走出去，请进来”，加强国际交流与合作，多次参加国际学术会议大会发言， 多次主办国际交流学术活动，特别是在学科建设、临床麻醉及麻醉信息系统的升级，多功能麻醉恢复室的运行，高效运转模式下麻醉安全管理体系的建立，麻醉质控的落实，使得临床麻醉水平和工作效率进一步提高，在疑难和危重患者的抢救及围术期管理方面积累了丰富的经验。麻醉科的运行模式和工作效率得到了国内外同行的高度评价及政府主管部门的认可。

麻醉科于2012 年入围国家临床重点专科建设项目，确立将建设世界一流大学附属医院的优质麻醉学科作为战略目标，根据项目总体目标及建设规模，将围术期安全体系及优化作为学科建设核心工作。分别从危、急重症、老年患者的围麻醉期管理优化、围术期合理用血、规范化术后镇痛、慢性疼痛治疗、围术期麻醉管理信息系统的优化六个子项目大力推进学科系统建设及人才培养。

1987 年麻醉科正式成为临床二级学科，李钊首任麻醉科主任，1989 年蒋建渝任科主任，2003 年至2009 年张利萍任科主任，2009 年至今，郭向阳任科主任。科内逐步完善了住院医师培训学习、总住院医师制，临床病例术前交班、危重疑难和死亡病例讨论、麻醉科工作常规和危重病人抢救处理等一系列制度。之后，进一步规范住院医师、主治医师的培养；完善和健全有关早交班和文献报告制度、临床病例讨论制度、全科业务学习制度、研究课题开题报告和讨论制度等，对提高临床麻醉质量、充实业务知识、提高科研和教学水平都起到了促进作用。

随着麻醉科学科建设的发展，各种麻醉方法及监测手段不断进步，临床麻醉的数量和质量逐步提高，目前，科内3 年以上住院医师都能熟练地完成深静脉穿刺置管、动脉穿刺置管直接动脉监测技术；主治医师以上人员不仅都能自主完成各科各类手术的麻醉管理（包括心内直视手术、脏器移植手术等），而且还侧重对某个专科麻醉管理进行较为深入的研究。近年来，科室通过多种创新特色技术，如可视化技术、困难气道围术期综合管理、3D 打印气道、围术期脑卒中防控、经食道超声心动图、经颅多普勒、局部脑氧饱和度、床旁血栓弹力图、漂浮导管监测等技术在危重手术中的应用；开展产科大出血血液保护研究，拓宽围术期自体血回输应用范畴，提供循证医学证据；老年手术患者早期康复体系（Enhanced recovery after surgery, ERAS）建设等，优化围术期安全管理体系，大大提升了平台服务能力。以麻醉质控和并发症、不良事件溯源（Anesthesia-event root cause analysis）为抓手，充分发挥多功能麻醉恢复室的优势，紧密围绕科室核心工作“围术期麻醉安全和质量管理体系的优化”进行学科建设。

教学工作和人才培养是教学医院临床科室的重要任务之一，麻醉科在人员编制严重不足的情况下，不仅顺利完成学校下达的本科生教学和实习任务、硕士研究生和博士研究生培养任务，还有多位教师荣获校级和院级优秀教师称号。为基层医疗单位培养人才也取得了不少的成绩，先后为云南西双版纳地区、思茅地区、延庆、顺义和昌平等京郊县区举办过系统的麻醉学习班，多数学员现在都在各自的岗位上承担领导和骨干作用。50 年来先后培养进修医师数百名，他们在各自的医院里也都成为麻醉科的中坚力量。20 世纪 90 年代以后，在住院医师和研究生的培养和教育工作中也做了大量工作。目前，我科全体医生中具有医学博士学位者36 名，具有医学硕士学位者 37 名。现有博士研究生导师 2 名，硕士研究生导师3 名。已经培养博士研究生 32 名、硕士研究生 31 名。

麻醉科的科研工作着重于临床研究。20 世纪 60 年代曾对腰麻后头痛的成因和治疗进行观察，对普鲁卡因和地卡因混合液毒性的动物试验及混合液浓度的最佳配比进行研究和观察，配制出北医三院自己独有的硬膜外 I 号、II 号和 III 号。20 世纪 80 年代后，曾对硬膜外麻醉的作用部位，局麻药 pH 值对麻醉作用的影响，主冠状动脉旁路手术麻醉管理，大剂量芬太尼应用于非心脏手术危重病人的麻醉，阿芬太尼、昂丹司琼、丙泊酚等新药的药理及临床应用作过观察研究和总结。20 世纪 90 年代初期建立硕士学位授予点后，开始招收研究生并开展较为深入的研究工作。如：急性等容量血液稀释临床及实验研究，心肌保护及其机理的实验研究，异丙酚与氯胺酮复合应用、全麻联合硬膜外阻滞对细胞免疫功能的影响等。

近十年来，科室始终坚持“以循证医学为基础（evidence-based)，机制研究为导向 (mechanism-guided) 的转化医学研究方针”。坚持科学研究的目的是为了解决临床问题，提高患者的预后和转归，同时培养麻醉医师的批判精神和锐意进取的科学态度。以项目带动学科发展，按工程管理方式促进科研良性发展。按照国际通用方法，建立各亚专业组，及时跟进学科发展动向，构建充满活力、富有效率、更加开放的创新驱动发展的体制，并取得明显成效，先后累计获得国家自然科学基金项目 14 项，参与国家科技部重大慢病研究计划1 项，省部级课题 7 项，院级基金多项。目前科室已形成麻醉与脑功能、气道管理（超声气道、3D 打印气道与气道管理）、围术期重要器官保护、麻醉与肿瘤、麻醉药理学、围术期管理与预后转归等稳定的研究方向。近十年来，我科累计发表 SCI 收录和核心期刊收录的学术论文 368 篇，出版专业著作 7 部，申报科技专利 41 项目，其中授权 9 项。

在党支部的带领下，麻醉科注重发挥党员的先锋模范带头作用，积极开展了科室文化建设，加强团队凝聚力。麻醉科工会创建和组织了以科室管乐团为代表的一系列丰富多彩的文化活动。通过这些活动，形成了良好的科室氛围，凝聚和激励了全体医务人员锐意进取，爱岗敬业的职业精神。2016 年 11 月， 麻醉科被授予“北京大学模范职工小家”的光荣称号。

在新的时代背景下，麻醉科党支部及工会秉承“医学科普是新的医患沟通”的理念，积极组织并参加形式多样的科普活动，例如被多家媒体广为报道的青光眼乐队、病友见面会、科普比赛、科普进校园、组建科普公众号、发表科普文章等，通过不同形式的科普活动大力宣传麻醉学相关知识，弘扬尊重生命的文化理念。

麻醉科铭记“为爱托起生命的彩虹”的神圣职责，通过人才梯队建设，努力践行标准化、规范化、专业化、精细化和信息化的管理理念，目前已经形成了一支高素质、专业化、重管理、有特色的麻醉学专业队伍。在优质服务、科学管理、和谐发展等各方面得到医院的认可和赞誉，多次荣获医院医疗优秀奖、优秀管理团队奖、教学团队、优秀管理项目奖以及优质服务先进集体奖等荣誉。

麻醉学科成为独立的二级学科仅30 年，相信在全科工作人员的不断努力及院领导和兄弟科室的关心和支持下，将不断完善规章制度，提高临床麻醉水平，更好地满足临床医疗、教学、科研的需要，使北医三院麻醉科步入北医三院和全国麻醉界的先进行列。

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.