随着胸外科的迅速发展,高难度手术比例逐渐上升,对麻醉医师的能力和技术提出了更高的要求。与之相应,住院医师的胸外科麻醉培训内容越来越复杂,涉及的理论、标准和技术也在持续更新。因此,制订规范化的胸外科麻醉专项培训内容具有重要意义。本文梳理了胸外科麻醉涉及的培训内容和培训现状,从师资队伍建设、培训实施周期、评估与反馈体系等方面进行探索和研究,形成了包含气道管理培训、通气策略培训、多模式镇痛培训和术后加速康复管理培训在内的具有科学性和可行性的培训内容。进行规范化的培训有助于培养合格的麻醉人才,提高胸外科患者围术期安全性并加速患者的术后康复,在此基础上,促进胸外科麻醉专项培训的完善和发展。
With the rapid development of thoracic surgery, the proportion of difficult operation has been gradually increasing, which stimulates staff capacity building and technology development of anesthesiology. Also, the contents of thoracic anesthesia training for residents are getting more complicated. The theory, standards and techniques involved are constantly updated, so it is of great value to establish a standardized thoracic anesthetic training program. It should include airway management, ventilation strategy, multimodal analgesia and post-operative enhanced recovery management. This paper reviews the current situation of thoracic anesthesia training to fill the gap in this field. The research focuses on the development of a competent faculty, the training cycle, evaluation and feedback mechanism. By establishing a standardized training program which may achieve the goal of training qualified anesthesiologists, improve peri-operative safety and accelerate post-operative rehabilitation.
[1] 金宝伟,郭建荣. 单肺通气肺损伤机制及保护策略研究进展[J]. 中国急救医学,2010,30(8):745-748. DOI:10.3969/j.issn.1002-1949.2010.08.020.
[2] McGrath B, Tennuci C, Lee G. The history of one-lung anesthesia and the double-lumen tube[J]. J Anesth Hist, 2017,3(3):76-86. DOI: 10.1016/j.janh.2017.05.002.
[3] Eichenbaum KD, Neustein SM. Acute lung injury after thoracic surgery[J]. J Cardiothorac Vasc Anesth, 2010,24(4):681-690. DOI: 10.1053/j.jvca.2009.10.032.
[4] Maxwell C, Nicoara A. New developments in the treatment of acute pain after thoracic surgery[J]. Curr Opin Anaesthesiol, 2014,27(1):6-11. DOI: 10.1097/ACO.0000000000000029.
[5] 王茹, 宋爱侠, 李朗, 等. 我国教学医院气道管理模拟教学现状分析与策略研究[J].中华医学教育探索杂志,2018,17(4):429-432. DOI: 10.3760/cma.j.issn.2095-1485.2018.04.024.
[6] 阚敏慧,兰飞,冯鲲鹏,等.超声引导下的神经阻滞在麻醉教学中的应用[J].北京医学,2019,41(8):757-758
[7] Nakata M, Saeki H, Yokoyama N, et al. Pulmonary function after lobectomy: video-assisted thoracic surgery versus thoracotomy[J]. Ann Thorac Surg, 2000,70(3):938-941. DOI: 10.1016/s0003-4975(00)01513-7.
[8] 姜柏林, 赵莹, 鞠辉, 等. 高仿真模拟训练在纤维支气管镜插管教学中的应用及学习曲线研究[J].中华医学教育杂志,2016,36(1):93-97. DOI: 10.3760/cma.j.issn.1673-677X.2016.01.025.
[9] 钱敏, 刘伟平, 魏滨, 等. 构建基于可视化技术的气道管理培训体系的探索[J].中华医学教育杂志,2019,39(6):441-445. DOI: 10.3760/cma.j.issn.1673-677X.2019.06.006.
[10] Koopman EM, Barak M, Weber E, et al. Evaluation of a new double-lumen endobronchial tube with an integrated camera (VivaSight-DL): a prospective multicentre observational study[J]. Anaesthesia, 2015,70(8):962-968. DOI: 10.1111/anae.13068.
[11] 弓胜凯, 艾英, 应亮, 等. 可视支气管堵塞器插管和可视双腔支气管导管插管的对比研究[J].中国内镜杂志,2019,25(11):45-50. DOI: 10.3969/j.issn.1007-1989.2019.11.006.
[12] García-Delgado M, Navarrete-Sánchez I, Colmenero M. Preventing and managing perioperative pulmonary complications following cardiac surgery[J]. Curr Opin Anaesthesiol, 2014,27(2):146-152. DOI: 10.1097/ACO.0000000000000059.
[13] 陶广华, 陈庆, 冯登, 等. 单肺通气患者肺功能保护研究进展[J].现代中西医结合杂志,2020,29(2):224-228. DOI: 10.3969/j.issn.1008-8849.2020.02.027.
[14] Reuben SS, Yalavarthy L. Preventing the development of chronic pain after thoracic surgery[J]. J Cardiothorac Vasc Anesth, 2008,22(6):890-903. DOI: 10.1053/j.jvca.2008.02.016.
[15] 张振龙, 潘小杰, 欧德彬. 加速康复外科理念在胸腔镜肺癌根治术的应用[J].中国康复医学杂志,2019,34(8):950-953. DOI: 10.3969/j.issn.1001-1242.2019.08.014.
[16] Canet J, Gallart L, Gomar C, et al. Prediction of postoperative pulmonary complications in a population-based surgical cohort[J]. Anesthesiology, 2010,113(6):1338-1350. DOI: 10.1097/ALN.0b013e3181fc6e0a.
[17] Freise H, Van Aken HK. Risks and benefits of thoracic epidural anaesthesia[J]. Br J Anaesth, 2011,107(6):859-868. DOI: 10.1093/bja/aer339.
[18]Maxwell C, Nicoara A. New developments in the treatment of acute pain after thoracic surgery[J]. Curr Opin Anaesthesiol, 2014,27(1):6-11. DOI: 10.1097/ACO.0000000000000029.
