中国与北美麻醉学住院医师培训制度的比较

麻醉学住院医师培训制度是培养合格麻醉学医师的保证.由于我国规范化住院医师培训制度起步较晚,与北美的住院医师培训制度相比还存在一些不足,因此,需要借鉴发达国家成熟的经验,不断提高我国麻醉学医师的全面能力.本文从住院医师培训概况,住院医师培训基地标准,住院医师培训目标、培训方式和考核方式,住院医师培训后分配去向,以及住院医师培训过程中对教学意识、表达能力和领导能力的培养等方面,对中国与北美的麻醉学住院医师培训制度进行了怂详细的比较;最后,总结了7名中国麻醉学医师在加拿大进行临床麻醉学专科进修的情况.     

中国与北美麻醉学住院医师培训制度的比较

麻醉学住院医师培训制度是培养合格麻醉学医师的保证.由于我国规范化住院医师培训制度起步较晚,与北美的住院医师培训制度相比还存在一些不足,因此,需要借鉴发达国家成熟的经验,不断提高我国麻醉学医师的全面能力.本文从住院医师培训概况,住院医师培训基地标准,住院医师培训目标、培训方式和考核方式,住院医师培训后分配去向,以及住院医师培训过程中对教学意识、表达能力和领导能力的培养等方面,对中国与北美的麻醉学住院医师培训制度进行了怂详细的比较;最后,总结了7名中国麻醉学医师在加拿大进行临床麻醉学专科进修的情况.     

麻醉学住院医师培训的发展思路与建议

本文主要分析了麻醉学专科医师培训的国际模式,结合我国国情和学科现有基础,探讨了我国麻醉学住院医师培训面临的问题及发展思路,并提出了建议和意见,其目的在于促进我国麻醉学住院医师培训规范化、制度化和法律化。     

改良Mini-CEX在麻醉学住院医师规培教学查房中的应用

教学查房是住院医师规范化培训的主要教学方式之一，然而麻醉学住院医师规范化培训的特殊性决定了其难以应用其他学科的教学查房模式。本研究结合麻醉专业特色，改良设计迷你临床演练评估（Mini-Clinical Evaluation Exercise，Mini-CEX）七项核心内容，并将其应用于麻醉学住院医师规范化培训的教学查房中，由此推动麻醉教学查房标准化，在一定程度上提升了麻醉教学查房质量。     

Seminar教学在麻醉学住院医师培训中的应用

Seminar是培养麻醉学住院医师独立思维及科研能力的一种有效的教学方法。通过简要介绍seminar教学的基本概念,讨论了seminar教学在麻醉学住院医师培训中的应用及其意义。seminar教学在培养麻醉学住院医师主动探索和学习知识,加深对麻醉学基本理论知识的理解及提高其综合素质等方面都具有促进作用。     

我国麻醉学专科医师培训工作设想

麻醉学专科医师（以下称麻醉医师）的培训，和所有临床专科医师培训一样，总的含义是：作为一个专科医师，必须在医学院校毕业后经过4年左右有计划、有目标的住院医师培训阶段，按照规定或法定的程序被认为符合要求，才能成为合格的专科医师并发给证书。这种做法称为“麻醉学专科医师培训”。这在发达国家已经规范化、法律化。在我国，由于国情和现有条件的限制，这一工作尚处于探索阶段。为促进发展，现就我国麻醉学专科医师培训提出看法，以抛砖引玉。培训基地承担麻醉学医师培训任务的医院，涉及3个基本问题：（1）必需具备的条件；（2）…     

住院医师培训标准化探析

本文针对我国住院医师培训模式、标准不统一，培训基地水平各异等问题，提出了实现住院医师培训标准化的观点。首先，应当制定全国统一的规范化住院医师培训标准和培训基地认可标准；其次，建立住院医师培训评估标准；再次，建立新型的人事管理制度。只有做到标准化、规范化，才能使我国住院医师培训工作整体水平得到进一步提高。     

我国住院医师培训制度的历史演变

我国住院医师培训制度是医学生毕业后教育的重要组成部分。本文从历史的视角，揭示了我国住院医师培训制度在政治、经济制度转型下，大致经过了萌芽、试验、建立和完善四个阶段。从发展趋势看，我国住院医师培训制度正向专科医师培训制度发展。     

“育人”为国——访四川大学华西医院麻醉科主任刘进

2000年,从美国学成归来的麻醉学专家刘进被四川大学华西医院（下称“华西医院”）作为优秀人才引进,担任麻醉科主任。在与华西医院商谈工作安排时,刘进提出了一个与麻醉专科发展并不完全相关的条件——在华西医院开展“住院医师规范化培训”（下称“住院医师培训”）,华西医院院长石应康欣然应允。     

麻醉专业住院医师规范化培训的探索和思考

住院医师规范化培训是培养高水平医学专业人才的重要手段和必经之路，我国麻醉专业住院医师的培训尚处于起步摸索阶段。本文对我国麻醉专业住院医师培养的现状和本院麻醉科住院医师规范化培养的现状进行了分析，并提出了一些相关的思考和启示。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

Development on Adjustable Calibration Marker for Shock Wave Focus

Shock wave lithotripsy （SWL） is a treatment of choice for upper urinary stones. However, this procedure is inappropriate for obese patients because the focus is often unable to reach the target owing to the limited focal distance in shock wave source. Although treating such patients in a blast path may increase the application length of shock wave source, it＇s difficult to find this path on the lithotripter monitor. For this reason, we invented an adjustable calibration marker in order to set an effective focus in the shock wave hath.     

Study on the TCM Pathogenesis of Angiopathic Complications of Type II Diabetes

Excess production of reactive oxygen species(ROS)of mitochondrion mediated by hyperglycemia is the common pathogenesis of angiopathic complications of diabetes.TCM holds that the damp from the dysfunction of spleen.kidney and liver is the causative factor of complications of diabetes.This is similar to the mechanism of Ros resulting in angiopathic complications of diabetes.When the angiopathic complications of type II diabetes mellitus(T2DM)are difierentiated as caused by turbid damp in TCM can be explained as ROS.Since the obstruction of pathogenic damp in channels and collaterals is said to be the main pathogenesis,the treating principle should be dissolving the damp to remove the obstruction.     

Leptin, Ghrelin and TNF-α before and after Hypo-caloric Traditional Chinese Diet and Auricular Acupuncture

INTRODUCTION Obesity is a complex emergent problem, which can be possibly solved not only by the diet but also by the life style and promotion of a constant physical exercise. 1, 2 No doubt careful attentions must be given to the nutritional condition of obese people, the dietary habits, the somatic build (i.e. distribution of fat mass) and the organic functions linked to formation of the fat mass. All the parameters should be constantly monitored before, during and after a diet treatment. 3, 4, 5     

Relationship between Dysglycemia and Carotid Atherosclerosis in Tibetan Population

People with dysglycemia are at high risk for atherosclerotic diseases. This study aims at investigating the atherosclerotic vascular damage in dysglycemia and its metabolic origin in Tibetan population.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

CLINICAL SIGNIFICANCE OF SERUM CYTOKINES IL-1β,sIL-2R,IL-6,TNF-α,AND IFN-v IN ACUTE CORONARY SYNDROME

Objectives To explore serum cytokines levels (including IL-1 β, sIL-2R, IL-6, TNF-α, and IFN-v) and their significance in patients with acute coronary syndrome (ACS) and the subsequent follow-ups, with attempt to estimate the role of various serum inflammatory markers in the diagnosis and assessment of ACS.Methods The study population include 40 patients with acute myocardial infarction (AMI), 40 patients with unstable angina pectoris (UAP), and 40 controls. Among the 80 patients, 60 patients attended a follow up 4 months later. Serum inflammatory markers including IL-1 β, sIL-2R, IL-6, TNF-α, and IFN-v were measured by enzyme linked immunosorbent assay.Results Serum IL- 1 β, sIL-2R, IL-6, TNF-α were significantly higher in AMI group or UAP group compared to the control group and became significantly lower 4 months later in the follow-up patients. Serum levels of IFN-v shows no significant difference between AMI group or UAP group and controls, also showing no significant change when measured in follow up patients. There was no correlation between serum creatine kinase-MB isoenzyme levels and serum inflammatory markers either in UAP or AMI group. Furthermore, when divided into two subgroups using Wagner's QRS scoring system in the AMI group, there is no difference of each serum inflammatory marker between ≤ 6 scores group and ＞ 6 scores group.Conclusion Serum levels of certain inflammatory markers may have some diagnostic value for ACS, and can be a useful marker reflecting disease stability.