北京大學第三醫院

麻醉科

麻醉科是醫院安全高效執行的樞紐和重要支撐平臺，在醫院的整體發展中具有舉足輕重的地位，擁有視覺化技術、困難氣道管理工具、血流動力學監測及腦功能監測等多項國內領先的麻醉及監測技術。為臨床各科各類手術麻醉及有創操作檢查的順利開展提供了安全、高效的保障。作為二級學科，一級臨床科室，擁有醫師單元和護理單元。 在醫院快速發展的背景下，臨床麻醉及圍術期管理的綜合實力得到了快速提升，在國內外的影響力不斷提高。近年來通過“走出去，請進來”，加強國際交流與合作，多次參加國際學術會議大會發言， 多次主辦國際交流學術活動，特別是在學科建設、臨床麻醉及麻醉資訊系統的升級，多功能麻醉恢復室的執行，高效運轉模式下麻醉安全管理體系的建立，麻醉質控的落實，使得臨床麻醉水平和工作效率進一步提高，在疑難和危重患者的搶救及圍術期管理方面積累了豐富的經驗。麻醉科的執行模式和工作效率得到了國內外同行的高度評價及政府主管部門的認可。 麻醉科於2012 年入圍國家臨床重點專科建設專案，確立將建設世界一流大學附屬醫院的優質麻醉學科作為戰略目標，根據專案總體目標及建設規模，將圍術期安全體系及最佳化作為學科建設核心工作。分別從危、急重症、老年患者的圍麻醉期管理最佳化、圍術期合理用血、規範化術後鎮痛、慢性疼痛治療、圍術期麻醉管理資訊系統的最佳化六個子專案大力推進學科系統建設及人才培養。 1987 年麻醉科正式成為臨床二級學科，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，郭向陽任科主任。科內逐步完善了住院醫師培訓學習、總住院醫師制，臨床病例術前交班、危重疑難和死亡病例討論、麻醉科工作常規和危重病人搶救處理等一系列制度。之後，進一步規範住院醫師、主治醫師的培養；完善和健全有關早交班和文獻報告制度、臨床病例討論制度、全科業務學習制度、研究課題開題報告和討論制度等，對提高臨床麻醉質量、充實業務知識、提高科研和教學水平都起到了促進作用。 隨著麻醉科學科建設的發展，各種麻醉方法及監測手段不斷進步，臨床麻醉的數量和質量逐步提高，目前，科內3 年以上住院醫師都能熟練地完成深靜脈穿刺置管、動脈穿刺置管直接動脈監測技術；主治醫師以上人員不僅都能自主完成各科各類手術的麻醉管理（包括心內直視手術、臟器移植手術等），而且還側重對某個專科麻醉管理進行較為深入的研究。近年來，科室通過多種創新特色技術，如視覺化技術、困難氣道圍術期綜合管理、3D 列印氣道、圍術期腦卒中防控、經食道超聲心動圖、經顱多普勒、區域性腦氧飽和度、床旁血栓彈力圖、漂浮導管監測等技術在危重手術中的應用；開展產科大出血血液保護研究，拓寬圍術期自體血回輸應用範疇，提供循證醫學證據；老年手術患者早期康復體系（Enhanced recovery after surgery, ERAS）建設等，最佳化圍術期安全管理體系，大大提升了平臺服務能力。以麻醉質控和併發症、不良事件溯源（Anesthesia-event root cause analysis）為抓手，充分發揮多功能麻醉恢復室的優勢，緊密圍繞科室核心工作“圍術期麻醉安全和質量管理體系的最佳化”進行學科建設。 教學工作和人才培養是教學醫院臨床科室的重要任務之一，麻醉科在人員編制嚴重不足的情況下，不僅順利完成學校下達的本科生教學和實習任務、碩士研究生和博士研究生培養任務，還有多位教師榮獲校級和院級優秀教師稱號。為基層醫療單位培養人才也取得了不少的成績，先後為雲南西雙版納地區、思茅地區、延慶、順義和昌平等京郊縣區舉辦過系統的麻醉學習班，多數學員現在都在各自的崗位上承擔領導和骨幹作用。50 年來先後培養進修醫師數百名，他們在各自的醫院裡也都成為麻醉科的中堅力量。20 世紀 90 年代以後，在住院醫師和研究生的培養和教育工作中也做了大量工作。目前，我科全體醫生中具有醫學博士學位者36 名，具有醫學碩士學位者 37 名。現有博士研究生導師 2 名，碩士研究生導師3 名。已經培養博士研究生 32 名、碩士研究生 31 名。 麻醉科的科研工作著重於臨床研究。20 世紀 60 年代曾對腰麻後頭痛的成因和治療進行觀察，對普魯卡因和地卡因混合液毒性的動物試驗及混合液濃度的最佳配比進行研究和觀察，配製出北醫三院自己獨有的硬膜外 I 號、II 號和 III 號。20 世紀 80 年代後，曾對硬膜外麻醉的作用部位，局麻藥 pH 值對麻醉作用的影響，主冠狀動脈旁路手術麻醉管理，大劑量芬太尼應用於非心臟手術危重病人的麻醉，阿芬太尼、昂丹司瓊、丙泊酚等新藥的藥理及臨床應用作過觀察研究和總結。20 世紀 90 年代初期建立碩士學位授予點後，開始招收研究生並開展較為深入的研究工作。如：急性等容量血液稀釋臨床及實驗研究，心肌保護及其機理的實驗研究，異丙酚與氯胺酮複合應用、全麻聯合硬膜外阻滯對細胞免疫功能的影響等。 近十年來，科室始終堅持“以循證醫學為基礎（evidence-based)，機制研究為導向 (mechanism-guided) 的轉化醫學研究方針”。堅持科學研究的目的是為了解決臨床問題，提高患者的預後和轉歸，同時培養麻醉醫師的批判精神和銳意進取的科學態度。以專案帶動學科發展，按工程管理方式促進科研良性發展。按照國際通用方法，建立各亞專業組，及時跟進學科發展動向，構建充滿活力、富有效率、更加開放的創新驅動發展的體制，並取得明顯成效，先後累計獲得國家自然科學基金專案 14 項，參與國家科技部重大慢病研究計劃1 項，省部級課題 7 項，院級基金多項。目前科室已形成麻醉與腦功能、氣道管理（超聲氣道、3D 列印氣道與氣道管理）、圍術期重要器官保護、麻醉與腫瘤、麻醉藥理學、圍術期管理與預後轉歸等穩定的研究方向。近十年來，我科累計發表 SCI 收錄和核心期刊收錄的學術論文 368 篇，出版專業著作 7 部，申報科技專利 41 專案，其中授權 9 項。 在黨支部的帶領下，麻醉科注重發揮黨員的先鋒模範帶頭作用，積極開展了科室文化建設，加強團隊凝聚力。麻醉科工會建立和組織了以科室管樂團為代表的一系列豐富多彩的文化活動。通過這些活動，形成了良好的科室氛圍，凝聚和激勵了全體醫務人員銳意進取，愛崗敬業的職業精神。2016 年 11 月， 麻醉科被授予“北京大學模範職工小家”的光榮稱號。 在新的時代背景下，麻醉科黨支部及工會秉承“醫學科普是新的醫患溝通”的理念，積極組織並參加形式多樣的科普活動，例如被多家媒體廣為報道的青光眼樂隊、病友見面會、科普比賽、科普進校園、組建科普公眾號、發表科普文章等，通過不同形式的科普活動大力宣傳麻醉學相關知識，弘揚尊重生命的文化理念。 麻醉科銘記“為愛托起生命的彩虹”的神聖職責，通過人才梯隊建設，努力踐行標準化、規範化、專業化、精細化和資訊化的管理理念，目前已經形成了一支高素質、專業化、重管理、有特色的麻醉學專業隊伍。在優質服務、科學管理、和諧發展等各方面得到醫院的認可和讚譽，多次榮獲醫院醫療優秀獎、優秀管理團隊獎、教學團隊、優秀管理專案獎以及優質服務先進集體獎等榮譽。 麻醉學科成為獨立的二級學科僅30 年，相信在全科工作人員的不斷努力及院領導和兄弟科室的關心和支援下，將不斷完善規章制度，提高臨床麻醉水平，更好地滿足臨床醫療、教學、科研的需要，使北醫三院麻醉科步入北醫三院和全國麻醉界的先進行列。 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.