麻醉科住院医师规范化培训——Stanford A型主动脉夹层麻醉管理带教体会

Standardized Training of Resident Anesthesiologists——Clinical Teaching Experience in the Anesthesia Management of Stanford A Aortic Dissection

Stanford A型主动脉夹层患者病情危重,需急诊行主动脉弓置换术,该手术操作难度大,其麻醉管理也具有高风险和高挑战性等特点,且麻醉相关操作较普通麻醉复杂,初学者往往由于缺乏临床经验而学习曲线较长。南京医科大学第一附属医院是一所三级甲等教学型医院,每年开展近200例Stanford A型主动脉夹层手术。论文针对麻醉专业规范化培训的住院医师及专科医师,就近年来在心血管麻醉亚专业带教的教学体会,从Stanford A型主动脉夹层手术麻醉的麻醉前评估、麻醉前准备、麻醉有创操作、循环管理及凝血管理等方面进行总结和分析,探讨麻醉教学的新模式,促进麻醉专科医师综合能力的提升。

Stanford Type A aortic dissection is an acute critical condition associated with significant morbidity and mortality,and the suffering patients need to receive an emergency aortic arch replacement surgery.Not only does the difficulty of surgical procedures pose risks and challenges for anesthesia management,but also the anesthetic procedures are more complex than general anesthesia,which is tougher for inexperienced beginners to accommodate.The First Affiliated Hospital of Nanjing Medical University is a tertiary Class A teaching hospital,in which there are nearly 200 Stanford Type A aortic dissection surgeries performed per year.Through the authors'exchange experience with residents in the standardized training of anesthesia of cardiovascular anesthesia subspecialty in recent years,this article explores the new models of anesthesia teaching and improves the comprehensive ability of residents,with the summary and analysis of pre-anesthesia evaluation,pre-anesthesia preparation,invasive anesthetic procedures,the circulation and coagulation management of Stanford Type A aortic dissection surgery.