心脏血管外科住院医师训练简介

1、心臟血管外科住院醫師訓練簡介一、訓練目的：對輪調住院醫師，加強疾病診斷，初級心血管疾病的處置及相關心臟疾病的加護照顧，以期未來遭遇相關疾病時有正確的處理方向。對專科住院醫師除加強心血管病理學識外，還針對個人手術案例，臨床研究施以個別輔導，以期在訓練完成後能確實執行治療計劃。二、訓練對象：輪調住院醫師為第一、二年住院醫師專科住院醫師為第三、四年住院醫師，第五年則調昇為住院總醫師。三、訓練期限：(一)輪調住院醫師：二至三個月。(二)專科住院醫師：每年至少應八個月的專科訓練。四、訓練內容：(一)針對各類疾病，在主治醫師的指導下完成病史詢問，身體檢查，各項專科檢查的判讀(如PVR、EKG、Endoca

2、rdiography、cardiac cineangiogram等) 鑑別診斷的判定、手術計劃、心臟術後的加護照顧、藥物服用及出院後門診追蹤計劃。(二)在主治醫師的帶領下，完成各項手術的啟始與終結工作(如胸骨、心包膜的切開、週邊血管的縫合)。(三)在主治醫師指導下，完成特殊案例之病情研究報告。(四)在專科住院醫師的訓練，則特別強調疾病生理，手術技術與研究企劃案的執行。五、考核：在輪調住院醫師方面，以該專責主治醫師針對其病患照顧能力、病歷寫作、檢查資料判讀、手術技術操作及文獻報告，各方面初考，再由主任複考後，留為晉升依據，在專科住院醫師的考核除上述各項外，還針對各不同手術技術施予考評，務求住院總

3、醫師訓練完成後能獨立而正確作業。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、心臟外科住院醫師訓練手術分級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