基于核心知识和技术构建中国特色的重症医学亚专科

Core knowledge and skill-based approach to subspecialty construction in critical/intensive care medicine with distinct Chinese peculiarity

随着我国重症医学事业的快速发展，单体超大规模的重症加强治疗病房（ICU）不断涌现，如何科学管理、使其高效运行是亟待解决的问题之一，而科学构建亚专科体系是必由之路，但如何构建，历来见仁见智。欧美等国家的重症医学亚专科建设尚未开始，无经验可循，因此我们必须走自己的创新之路，构建中国特色的重症医学亚专科。病理生理学是重症医学的核心知识，而器官功能支持则是其核心技术，故应基于核心知识和技术构建重症医学亚专科，可设以下7个亚专科：①急性肺损伤及机械通气；②休克、血流动力学监测与治疗；③急性肾损伤及血液净化；④脓毒症及抗感染治疗；⑤应激、镇静及镇痛；⑥营养及代谢支持；⑦凝血、免疫及炎症。随着重症医学核心知识和技术的不断丰富与更新，亚专科设置也应不断更新。

With the rapid development of critical care medicine （CCM） in China, there are increases in the number of intensive care units （ICUs）, the scale of one center ICU and the team. Subspecialty construction of CCM is of great concerns for personnel training as well as discipline development, and is currently one of the urgent problems that need to be resolved. Experience of CCM subspecialty construction from Europe and the United States is lacking and it is necessary to propose some opinions on innovation to construct CCM subspecialties with Chinese characteristics. We believe that CCM sub-specialties construction should be based on the core knowledge （pathophysiology） and skill （organ monitoring and support）. The following 7 sub-specialties can be set up： ① acute lung injury and mechanical ventilation; ② shock, hemodynamic monitoring and treatment; ③ acute kidney injury and blood purification; ④ sepsis and anti-infective therapy; ⑤ stress, sedation and analgesia; ⑥ nutrition and metabolic support; ⑦ coagulation, immune and inflammation. The core knowledge and skills of critical care medicine will constantly be updated and enriched. Therefore, sub-specialty settings should be constantly updated as well.