心臟血管外科住院醫(yī)師訓(xùn)練簡介

1、心臟血管外科住院醫(yī)師訓(xùn)練簡介一、訓(xùn)練目的：對(duì)輪調(diào)住院醫(yī)師，加強(qiáng)疾病診斷，初級(jí)心血管疾病的處置及相關(guān)心臟疾病的加護(hù)照顧，以期未來遭遇相關(guān)疾病時(shí)有正確的處理方向。對(duì)專科住院醫(yī)師除加強(qiáng)心血管病理學(xué)識(shí)外，還針對(duì)個(gè)人手術(shù)案例，臨床研究施以個(gè)別輔導(dǎo)，以期在訓(xùn)練完成後能確實(shí)執(zhí)行治療計(jì)劃。二、訓(xùn)練對(duì)象：輪調(diào)住院醫(yī)師為第一、二年住院醫(yī)師專科住院醫(yī)師為第三、四年住院醫(yī)師，第五年則調(diào)昇為住院總醫(yī)師。三、訓(xùn)練期限：(一)輪調(diào)住院醫(yī)師：二至三個(gè)月。(二)?？谱≡横t(yī)師：每年至少應(yīng)八個(gè)月的?？朴?xùn)練。四、訓(xùn)練內(nèi)容：(一)針對(duì)各類疾病，在主治醫(yī)師的指導(dǎo)下完成病史詢問，身體檢查，各項(xiàng)?？茩z查的判讀(如PVR、EKG、Endoca

2、rdiography、cardiac cineangiogram等) 鑑別診斷的判定、手術(shù)計(jì)劃、心臟術(shù)後的加護(hù)照顧、藥物服用及出院後門診追蹤計(jì)劃。(二)在主治醫(yī)師的帶領(lǐng)下，完成各項(xiàng)手術(shù)的啟始與終結(jié)工作(如胸骨、心包膜的切開、週邊血管的縫合)。(三)在主治醫(yī)師指導(dǎo)下，完成特殊案例之病情研究報(bào)告。(四)在專科住院醫(yī)師的訓(xùn)練，則特別強(qiáng)調(diào)疾病生理，手術(shù)技術(shù)與研究企劃案的執(zhí)行。五、考核：在輪調(diào)住院醫(yī)師方面，以該專責(zé)主治醫(yī)師針對(duì)其病患照顧能力、病歷寫作、檢查資料判讀、手術(shù)技術(shù)操作及文獻(xiàn)報(bào)告，各方面初考，再由主任複考後，留為晉升依據(jù)，在?？谱≡横t(yī)師的考核除上述各項(xiàng)外，還針對(duì)各不同手術(shù)技術(shù)施予考評(píng)，務(wù)求住院總

3、醫(yī)師訓(xùn)練完成後能獨(dú)立而正確作業(yè)。六、參考書籍：1.Cardiac Surgery . 2nd ed. Kirklin2.Cardiac Surgery of the Neonate and Infant . Castaneda3.Atlas of Cardiothoracic Surgery . L . Henry . Edmands.4.Cardiovascular and Vascular Disease of the Aorta Suensson Crawford5.Current Therapy in Vascular Surgery. 2ed. Calvin B. Ernst 199

4、26.Complication of Thoracic and Cardiovascular Surgery . 1992七、心臟外科住院醫(yī)師訓(xùn)練手術(shù)分級(jí)R1Basic orientation about heart disease, acquired disease, major vessel disease, peripheral artery disease. Disease in venous system. Disease in lymphatic system.Fixed resident: hemodialytic AV shunt . Stripping of Varicose

5、 vein.R2Cardiac surgery：Cannulation and de-cannulation of cardiopulmonary bypass.Sternal closure.Harvesting greater saphenous vein.Pericardial window.Peripheral vessel disease：Femoro-popliteal artery bypass.Hemodialytic AV bridge.Stripping of complicated varicose vein.R3正式固定CVS開始:Cardiac SurgeryClos

6、ure of atrial septal defectHarvesting radial artery graftPericardial windowPeripheral vessel diseaseIliao-femoro-popliteal and distal leg artery bypass.Embolectomy in peripheral arteries .Management of complication of hemodialytic AV shunt or AV bridge.Stripping of complicated varicose vein. R4Cardi

7、ac surgeryClosure of ventricular septal defect, reconstruction of partial anomalous pul. venous return, PDA ligationHarvesting internal mammary artery, Right gastroepiploic arterySingle vessel or simple CABGSingle cardiac valve replacementPeripheral vessel diseaseGraft interposition of abdominal aor

8、tic aneurysmCarotid endarterectomy, subclavian artery bypassRevascularization of foot arteriesLumbar sympathectomyCRCardiac surgeryReconstruction of endocardial cushing defect, Tetralogy of Fallot. Intra-cardiac type TAPVRPalliative shunt: Blalock-Taussing shunt. Bi-directional of cava-pul. shuntCorrection of coarctationThree vessel CABG or simple cardiac valve and one vessel CABG.Single cardiac valve replacement and maze operation. Simple double cardiac valve r