与之前几位远道而来的医生们不同，Sepehr Rejai是一位美籍伊朗人，年幼时随父母移居美国。没有任何的中国文化背景的他，第一次到访中国便是来到杭州这座美丽的城市。作为G20的举办地，杭州早已美名远播，Rejai医生也对此次杭州之行充满期待。
我院麻醉科为Sepehr Rejai制定了详细的培训计划，在这短暂的4周时间里，Rejai参与了心脏外科、神经外科、烧伤科外科、胸外科等各个科室患者的麻醉术中管理，进行了超声引导下神经阻滞、TEE等麻醉操作；详细了解了科室运行的方式和麻醉管理常规，其中包括复苏室管理和APS管理；参与了多项疼痛诊疗的相关操作包括经皮三叉神经射频热凝术。在为期一周的中医科的学习中，了解了包括“阴阳”、“气”在内的许多基本概念，进行了针灸的操作。在这里，每天的学习生活让Rejai收获颇丰。
Rejai也为我们在晨会上做了题为Perioperative Management of Cardiovascular Implantable Electronic Devices的精彩讲课并通过网络向我院多家协作医院同步播放。
回到UCLA后，Rejai医生在UCLA官网上撰文叙述了此次在我院进行住院医培训的体会，详细介绍了在我院培训的经历，对我院的住院医培训做出了高度评价。（浙医二院麻醉科报道）
February 1st, 2017
This photograph was taken in SAHZU in the early 20th century. The scene captures Dr. David Duncan Main, a British physician and the first hospital president, greeting a pediatric patient.
Every year for the past six years, a CA-3 resident has visited Hangzhou, China as part of a clinical exchange program at the Second Affiliated Hospital of Zhejiang University School of Medicine (SAHZU). This year, I had the opportunity to go to China for four weeks and learn from a very welcoming team of anesthesiologists at this busy teaching hospital with over 3,200 beds and a volume of over 60,000 surgical cases per year. Founded in 1869, SAHZU is one of the largest and earliest Western medicine hospitals of Zhejiang province.
The core of the rotation was main OR, neurosurgical, and cardiac anesthesia. This is where I spent most of my time learning from Chinese anesthesiologists as they cared for patients. I observed anesthetic techniques tailored to manage patients with familiar surgical diseases in an unfamiliar (to me) Chinese healthcare system, with different resources and patient attitudes.
The three OR floors, multiple procedure rooms, and PACU are very busy. Efficiency and lean workflow are crucial for managing the high volume of patients. There are strategies in place to streamline processes outside the OR to reduce turnover time. For example, the preoperative procedure room is dedicated to placing awake central lines, arterial lines, and peripheral nerve blocks prior to surgery. While ultrasound is available and actively taught, residents use anatomic landmarks to guide needle placement in preparation for practice in more rural areas of the country. Postoperatively, patients emerge from anesthesia in the PACU and await extubation there.
I was given the flexibility to focus the rotation on two areas of interest: pain medicine, which will be my subspecialty area of training, and Traditional Chinese Medicine (TCM).
Pain medicine is still an emerging field in most developing countries, but at SAHZU the anesthesia pain team has been managing a busy clinic and performing advanced interventional pain procedures for several years. This group first described a novel approach to treating trigeminal neuralgia, and I saw the procedure performed to help a patient with intractable facial pain. [1]
On the other end of the spectrum is TCM, China's most ancient medical art dating back several thousand years. TCM is very much an active part of the Chinese healthcare system, sought out by patients and incorporated into the multimodal treatment model of the hospital. Lectures on TCM introduce concepts such as the "Yin and Yang" doctrine, and the flow of "qi" (or "chi" the energy that animates and imbues all things) through the body's meridians and collaterals. Acupuncture is widely practiced, and a long list of other therapies such as herbal, mineral, and animal medicines are prescribed for patients. On rounds, I saw these concepts translate to treatments. A carefully palpated pulse or closely examined tongue, taken in the context of the patient's illness, would inform the next TCM remedy.
If you walk a few miles west of the hospital, you escape the traffic and noise of the city and arrive at the famous West Lake, surrounded by misty hills, bamboo forests, and ancient Buddhist temples. One of my most memorable trips was hiking to the steep tea terraces of Longjing village and buying tea from the farm. Here, on the last weekend of the trip, I realized that the month spent at SAHZU had not only given me the opportunity to deepen my clinical understanding of anesthesiology, but it also allowed me to meet new colleagues from across the world and form valuable friendships.
- Huang, Bing, et al. "CT-Guided Percutaneous Infrazygomatic Radiofrequency Neurolysis Through Foramen Rotundum to Treat V2 Trigeminal Neuralgia." Pain Medicine 15.8 (2014)
译文如下：
杭州麻醉轮转
2017年2月1日
图注：这张照片摄于20世纪早期的浙医二院，摄像头捕捉了浙医二院的首位院长，暨英国籍的David Duncan Main医生向一位儿童患者鞠躬的画面。
在过去的6年中，每年都会有1位三年级的住院医师参加UCLA与位于中国杭州的浙江大学医学院附属第二医院之间合作创办的国际交流临床项目，今年，我有幸成为这个项目的一员，到这家拥有逾3200张床位和每年实施60000余台手术的忙碌的教学医院进行为期4周的学习和访问。浙医二院成立于1869年，是浙江省规模最大和成立最早的西医院之一。
轮转的主要内容是手术室，尤其是神经外科和心脏手术麻醉，我花大量时间向中国的麻醉医生学习这方面的麻醉管理。我见习了用娴熟精湛的麻醉技术管理我熟悉的外科疾病以及我不熟悉的中国的医疗系统，包括不一样的资源和不一样的患者态度。
三层楼的手术室、多个操作室以及PACU都非常忙碌，为管理大量的手术患者，简洁高效的工作流程就显得尤为关键，为减少接台时间浙医二院手术部有他们的方法。例如，设立术前操作室，这里可以进行清醒患者术前的中心静脉穿刺、动脉穿刺以及外周神经阻滞。他们有超声机器并且积极地带教住院医师，但有时住院医师仍然使用解剖标记来指导进针位置和方向，因为中国偏远地区有些医院没有超声，他们需要掌握不使用超声的穿刺技术。术后，患者带着气管插管进入PACU并在那里清醒和拔除气管导管。
此外，我有幸依照自己的兴趣去两个学科轮转，其一是疼痛医学，是我未来进一步培训的亚专科，另外一个是传统的中医。
疼痛医学在大多数的发展中国家仍然是一个新兴领域，但在浙医二院忙碌的疼痛门诊和先进的介入治疗技术已开展多年，这个麻醉疼痛团队首次描述了一种新的方法来治疗三叉神经痛，我参观了采用这种方法治疗1例顽固性面神经痛的患者。1
另一方面是传统中医，中国最古老的医学艺术可以追溯到几千年前。中医是中国医疗系统的一个重要组成部分，能够被患者接收并已整合入医院的多模式治疗方案中。传统中医的讲座介绍了一些概念，如阴阳理论和“气”在全身经络的流动。针灸广泛实施，其他治疗如草药、矿物质及动物医药都可以用在患者身上，总之，我看到了这些概念转化成了医疗实践。医生通过仔细触诊患者的脉搏和观察舌苔，结合患者的病情，会制定接下来的中医治疗方案。
自医院往西走数英里，就可以远离拥堵的交通和城市的喧嚣，到达著名的西湖，周围云雾缭绕，群山环立，翠竹古庙，美不胜收。我记忆最深的一次旅行是拾阶而上，到达龙井村，并在农场买了龙井茶，在这里，也是到杭州访问交流的最后一周的周末，我意识到在浙医二院的一个月不仅仅让我有机会加深对麻醉的理解，同时让我认识了来自不同国家的新同事并建立了珍贵的友谊。
1. Huang, Bing, et al. "CT-Guided Percutaneous Infrazygomatic Radiofrequency Neurolysis Through Foramen Rotundum to Treat V2 Trigeminal Neuralgia." Pain Medicine 15.8 (2014)
Sepehr Rejai, MD
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