Anesthesia in Hangzhou,-来自美国UCLA住院医生在中国的学习汇报
Anesthesia in Hangzhou, Year 4.March 7th, 2015Theresa Lo placing arterial line in Induction room.
This marks the fourth year of the exchange rotation between UCLA and the Second Affiliated Hospital of Zhejiang University School of Medicine (SAHZU). I was very glad to have this opportunity to participate in anesthesia care in a foreign system and immerse myself in a different culture.SAHZU, established in 1885, became affiliated with the Zhejiang Medical College in 1952, is a tertiary medical center in downtown Hangzhou and houses a total of 3200 inpatient beds combining the main campus and the newly opened Bingjiang campus. There are a total of 60 ORs, and the highest number of cases per day is about 210, making it quite busy at times. Most of the attendings and residents speak English, but I also speak Mandarin fluently so I was able to learn the system quickly.Week 1I first started with activities outside of the OR:
[*]Induction room:Anesthesia residents place awake arterial lines and central venous access catheters in patients who are non-first-start OR cases or anyone requiring central access from the inpatient units. I practiced how to place an A line without using Seldinger's technique and refine my hand-eye coordination on ultrasound guided A line placement.
[*]PACU
[*]Acute Pain Service, a team following up inpatients that have a PCA or PCEA.
Weeks 2-3I spent the following two weeks in the OR and was able to choose which types of cases I wanted to participate in. There were many interesting cases, including resection for primary liver tumor with metastasis to the IVC and RA, burn patients, awake craniotomy for tumor near the central gyrus, prophylactic balloon occlusion of iliac artery placed by the anesthesia team for total lower extremity amputation due to Ewing's sarcoma, TAVIs under sedation and general anesthesia, and liver and heart transplants. OR days started with a 7:30 morning conference, 8:30 first case start time, and usually ended around 5-6pm for me.Most of the patients are admitted days prior for pre-op workup instead of having most of the workup done in an outpatient setting due to insurance reimbursement. Most patients would remain intubated and then be extubated in the PACU for faster turnover. There is a full-time TEG machine run by anesthesia residents, who are also responsible for doing intraoperative EEG, SSEP, and MEP monitoring.
Week 4I shadowed in the ER ICU for two days; this ER ICU acts as a mixed MICU and SICU. I also spent a day in the pain clinic, and then I spent the rest of the week doing various nerve blocks (upper and lower extremities nerve blocks, TAP and rectus abdominus blocks) under ultrasound guidance. There was also a Saturday nerve block workshop for residents.
Living in Hangzhou:The international office provided a spacious apartment that was less than five minute walking distance from the hospital. There are various sight-seeing opportunities in Hangzhou. The famous Westlake is 20 minute walking distance from the hospital, and public transportation is convenient. I also spent one weekend in Shanghai, which is only one hour away from Hangzhou via the high-speed rail.This rotation provided me the opportunity to experience how the Chinese healthcare system operates and how to think outside our routines and utilize other tools to maintain high quality anesthesia care. I also enjoyed the beautiful Westlake, great food in Hangzhou, and the most memorable hospitality and friendship that I will forever treasure.Westlake
Dinner with attendings and residents 随着中国麻醉学科的飞速发展，大批国内青年医生走出去学习各国先进的知识理念，同样我们也已有足够的自信迎接来自欧美的住院医生学习访问，不同国家的青年医生都应该放眼全球，互相交流学习中扩展视野和收获友谊！
加利福尼亚大学洛杉矶分校（University of California, Los Angeles，简称为UCLA）是位于美国加利福尼亚州洛杉矶市的一所公立研究大学，是美国最顶尖的综合大学之一。此文出自UCLA官方网站：http://www.anes.ucla.edu/news.php?id=209&from=singlemessage&isappinstalled=0
医学教育和培训层面上的交流意义重大！ 译文：
今年是UCLA派出住院医师到浙江大学医学院附属第二医院进行交流的第四年，我很高兴获得这个机会，不仅可以学习国外先进的麻醉体系，也体验到了另一种文化氛围。
浙江大学医学院附属第二医院的前身为广济医院，成立于1869年，在1952年成为浙江大学医学院的附属医院。这家医院是国家三甲医院，并在解放路院区和滨江院区共拥有3200余张床位和60多间手术室。手术量最高能达到每天230台，是家非常忙碌的医院。大多数的医生们都可以很流利地用英文和我交流，而我同样也能说一口流利的普通话，所以我非常迅速地学习了这里的医疗体系。
第1周
我在手术室外进行了最开始的学习。
1. 诱导室：在这里的病人是需要进行动静脉穿刺的非第一台手术病人和病房中那些需要深静脉穿刺的住院病人。我练习了如何使用超声引导下进行穿刺，提高了手眼配合的协调性。
2.复苏室。
3.APS：这是一个关注术后镇痛手术病人的团队。
第2-3周
接下来的2周时间我待在手术室中选择了我想参加的手术。这里有非常多有意思的病例，包括烧伤病人的手术，唤醒手术，球囊阻断手术，TAVI手术（经导管主动脉瓣置入术），肝脏移植和心脏移植手术。手术室的工作从早晨7点30分的晨会开始，第一台手术在8点30分左右开始，我经常下午5点至6点左右下班。
大多数病人在术前检查的前几天就被接收，而不是为了医保报销在门诊期间完成检查。所有的患者在手术结束后均会进入复苏室，这样可以加快手术的接台时间。这里的TEE（经食道超声）可以全天使用，并有专职的麻醉医生负责，同时还有专职的麻醉医生负责EEG（脑电图）、SSEP（体感诱发电位）和MEP（运动诱发电位）监测。
第4周
我在EICU（急诊监护室）学习了两天时间，这里的EICU包括MICU（内科重症）和SICU（外科重症）。我还在疼痛门诊学习了一天，并在剩下的一周时间里面操作了很多超声引导下的神经阻滞，包括上下肢的神经阻滞和TAP（腹横肌平面阻滞）。还参加了周六的一场针对住院医师开展的神经阻滞学习班。
杭州的生活:
国际办提供了一家离医院只有五分钟步行距离的宽敞的公寓给我居住。杭州有各种著名的景点。医院离西湖仅20分钟的步行距离，公共交通也很便捷。我也在上海待了一个周末，上海离杭州只有一个小时的高铁路程。
这次交流机会让我体验到了中国医疗机构是如何运行的，并如何利用其它工具来提高麻醉的质量。我非常喜欢美丽的西湖和杭州的美食，我会永远珍惜在杭州收获的热情和友情。
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