中华医学会麻醉学分会心胸麻醉学组2020年工作总结及专科学术进展

目前北京、河北、浙江、上海、重庆、广东等省市的麻醉学专业委员会已经成立了省级麻醉学会心胸麻醉学组，湖南心胸麻醉学组亦正在筹建待批，已经初步形成从全国向省内辐射的格局。

心胸外科微创和杂交手术的麻醉不仅需要熟悉机器人辅助、胸腔镜下微创精准手术的步骤、方法和特点，更需要熟练的麻醉操作、全面的监测技术和围麻醉期处理能力，并通过完善术前评估及麻醉预案，术中积极协调配合和术后疼痛管理以减少围术期并发症、缩短住院时间、降低死亡率及致残率。在工作目标上，不仅关注麻醉，更关注围术期医学，特别是患者最终的转归。积极应对疑难危重和再次心血管手术给麻醉带来的挑战。随着我国老龄化的社会发展进程，高龄、高危、再次心脏瓣膜及冠脉手术越来越多，手术死亡率增高。心胸学组也一直在努力使术中TEE监测为核心的术中多模式监测作为心脏麻醉常规技术，推广脉搏轮廓分析法测定心排血量技术、连续心排血量监测技术进行血流动力学监测，脑氧饱和度监测脑氧供需平衡，积极参与围术期TEE再评估手术适应症、外科治疗方案，评价外科治疗效果，监测心血管系统病理生理变化，即刻发现并发症及快速处理等一系列工作，以控制麻醉风险，改善患者预后，为围术期心胸、血管手术患者保驾护航。

随着心胸外科手术技术的飞速发展和不断革新，心胸麻醉面临专业人员紧缺问题，学组着重加强全国心胸麻醉培训基地建设。继续以单中心心脏手术量排名前列的医院为依托，学组初步选取十余所医院为首批全国心胸麻醉培训基地，以达到全国的心胸麻醉专科培训合格人员在500人/年。同时，心胸学组一直努力筹划和建立围术期心脏超声的标准化、系统化、规范化培训模式，将围术期TTE、TEE纳入心脏麻醉医师培训计划中。床旁超声用于围术期的监测为心脏病患者围术期诊疗决策和改善患者的预后提供了有力的技术支持，有助于进一步实现从麻醉医生到围术期医生的角色转变。

学组积极推动制定心胸麻醉的规范化诊疗标准，提高心胸麻醉的临床及基础科研能力，进而提升我国在国际心胸麻醉领域的影响力。时光飞逝，一晃已近年底，尽管我们经历了疫情的磨难，但我们的国家和民族变得更加坚强和团结。疫情防控常态化，我们的生活、工作和学习也在新的环境下做出相应的改变。在疫情防控期间，中华医学会麻醉学分会心胸学组在组长徐军美的代领下，积极响应中华医学会麻醉学分会举办线上2020年学术交流活动的倡议，于11月7日在线上成功举办了心胸麻醉学组视频工作研讨会。会议邀请来自全国和海外的著名麻醉学专家，通过云端在线方式，以专题讲座和病例分享的形式带给大家心胸手术围术期管理的新知识和新理念，以及丰富的临床经验，为麻醉同道搭建了一个相互学习、交流的学术平台，吸引了麻醉科、心内科，护理等专业的人员，还有大量来自基层的麻醉科医生参会，影响较大。疫情防控期间，心胸麻醉学组举办的网上学术活动做到了高质量，多层次，高水平，获得了参会同道们的一致好评。

一场突如其来的新冠肺炎疫情风暴突袭神州大地。长江之滨的九省通衢湖北省武汉市成为了风暴的中心。为了服从疫情防控大局需要，武汉封城战“疫”。关键时刻，麻醉医生从不缺席。武汉市各大医院与来自全国各地的麻醉同行一起逆行战“疫”。心胸麻醉医师不但有深厚的临床功底，更擅长气道管理，肺保护措施与急危重症患者的生命支持。一方面，心胸麻醉医生完成本职工作，坚守手术室，为急诊手术患者保驾护航。另一方面，发挥自身专业的专长，参与到新冠肺炎患者诊疗的各个环节，特别是危重症患者的救治当中。所以除了手术室，在门诊、病房、方舱医院等抗击疫情的战场上，他们的身影随处可见。

在这场战“疫”中，武汉大学人民医院麻醉科临危受命，参与到了多个战场：以心胸麻醉组副组长夏中元教授为首，建立了手术室紧急疫情应对小组处理急危重症患者的抢救；组建的气道管理小分队，承担了武汉大学人民医院（东院）26个重症病区新冠肺炎危重症患者的气道管理和呼吸机培训；定点东院麻醉科的同事们更是站在了救治的前沿；夏中元主任还多次参加湖北省专家会议，为制定缺氧预警指标、插管和气道管理规范、肺外脏器早期评估和功能维护等方面提供强有力的指导。

武汉协和医院麻醉科医生们不畏艰险，积极响应医院号召，迅速组建了急救插管突击队，重症呼吸支持团队进场，迅速投身重症患者的抢救工作中。4月24日，以心胸学组成员--协和医院麻醉科武庆平教授，及器官移植中心的协和医院十余名专家，经过五个半小时的奋战，为一位全球使用人工肺膜（ECMO）术前辅助时间最长--73天，新冠肺炎核酸转阴、不可逆肺纤维化呼吸衰竭的患者刘强（化名），成功进行双肺移植手术。而此次手术，术中和术后的难点就包括肺移植手术期和恢复期对心肺功能管理要求高。武庆平教授积极带领麻醉团队，多学科紧密合作，为患者再次打通呼吸通道。经过14天的术后管理及康复治疗，他的生命得以重生。

而且疫情期间，全国共有31个医疗队驰援武汉，4万多医护人员披甲上战场。在这场没有硝烟的战斗中，也有大量的心胸麻醉医生医生听指挥勇担当、迎严寒战风雪，义无反顾地冲上抗击疫情最前沿，为遏制疫情蔓延做出了积极贡献，涌现出一大批事迹突出、感人肺腑的先进典型。

2月4日，中南大学湘雅二医院援武汉抗疫国家医疗队前方指挥长、中南大学湘雅二医院国家紧急医学救援队领队、中南大学湘雅二医院副院长，心胸麻醉学组组长徐军美教授率队到达被命名为“武昌方舱医院”的武汉市洪山体育馆。他和团队迅速制定方案，将体育馆迅速改建成符合国家收治标准的传染病收治医院。“院感把关、医护技协同，内外同行、中西医协同，医患携手、躯体心理协同”的“新冠方舱MDT”湘雅医疗模式，也被武汉确定为所有方舱医院的模板。实现了“住院患者零死亡、医护人员零感染、出院患者零回头”目标。3月5日，57岁的徐军美教授也获“全国卫生健康系统新冠肺炎疫情防控工作先进个人”荣誉称号。

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