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A Survey of the Current Status of Anesthesiology for Plastic and Cosmetic Surgery in China
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摘要:
目的 对我国医疗整形美容手术麻醉行业现状进行调查, 以期为规范行业行为、保障患者围术期麻醉安全提供参考依据。 方法 2021年11月1日至2022年1月31日, 采用线上问卷调查的方式对我国开展整形美容麻醉业务的医疗机构进行调查, 问卷内容包括医疗机构麻醉科设置, 麻醉科主任/负责人基本信息, 实施整形美容手术麻醉的人员配置, 麻醉相关设备/设施及急救药品配置, 整形美容亚专业麻醉医生工作、培训和科研情况, 整形美容手术麻醉相关不良事件6个方面, 并对公立医疗机构与非公立医疗机构调查结果进行比较。 结果 共调查了244家医疗机构, 覆盖全国31个省/直辖市。其中公立医疗机构118家, 非公立医疗机构126家。(1)麻醉科设置: 100%的公立医疗机构和98.41%的非公立医疗机构设置了麻醉科, 其中非公立医疗机构麻醉科以学组形式隶属于整形美容外科的比例显著高于公立医疗机构(32.54%比17.80%, P=0.008)。(2)麻醉科主任/负责人基本信息: 与非公立医疗机构比较, 公立医疗机构麻醉科主任/负责人为高级职称(94.07%比64.29%, P＜0.001)、研究生学历(61.02% 比26.19%, P＜0.001)、麻醉学执业年限大于15年(86.44%比38.10%, P＜0.001)的比例均更高。(3)实施整形美容手术麻醉的人员配置: 15.87%的非公立医疗机构无专职整形美容亚专业麻醉医生, 34.92%聘请了外院兼职整形美容亚专业麻醉医生; 虽然公立医疗机构每个手术间配置的专职麻醉医生数量显著高于非公立医疗机构(1.35±0.15比0.85±0.10, P=0.004), 但手术间与麻醉医生数量的比值均未达1∶1.5。关于职称和学历分布, 公立医疗机构职称为主任医师(11.14%比6.50%, P=0.009)和住院医师(28.77% 比20.42%, P=0.020), 学历为博士研究生(13.81% 比2.36%, P＜0.001)和硕士研究生(45.03% 比21.51%, P＜0.001)的专职整形美容亚专业麻醉医生占比更高。(4)麻醉相关设备/设施及急救药品配置: 公立医疗机构麻醉苏醒室设置率(92.37%比73.02%, P＜0.001)、其他多项麻醉相关设备配置率均高于非公立医疗机构。(5)整形美容亚专业麻醉医生工作、培训和科研情况: 公立医疗机构近3年需提供麻醉服务的整形美容手术占比均高于50%, 而非公立医疗机构均低于50%;关于近3年需提供麻醉业务的整形美容手术采用的麻醉方式, 公立医疗机构和非公立医疗机构均以全身麻醉(51.57%、59.93%)和静脉镇静镇痛(35.71%、36.14%)为主; 公立医疗机构中整形美容亚专业麻醉医生兼台现象的比例(12.71%比31.75%, P＜0.001)和每周工作时间＞50 h的比例(10.17%比26.19%, P=0.017)均低于非公立医疗机构, 而每年参加国家级继续教育的整形美容亚专业麻醉医生占比(51.80%比38.10%, P=0.033)、整形美容亚专业麻醉医生近3年人均发表的中文核心期刊论文[(0.66±0.14)篇比(0.36±0.12)篇, P=0.001]与SCI论文数量[(0.21±0.06)篇比(0.07±0.03)篇, P＜0.001]均高于非公立医疗机构。(6)整形美容手术麻醉相关不良事件: 公立医疗机构近3年整形美容手术麻醉相关并发症发生率均低于非公立医疗机构(P均＜0.001), 且二者均呈逐年下降趋势。 结论 开展整形美容手术麻醉服务的医疗机构存在麻醉人员配置不足的问题, 以非公立医疗机构更为严重。相较于非公立医疗机构, 公立医疗机构整形美容手术麻醉相关并发症发生率更低, 与其在麻醉学科建设、麻醉相关设施设备配置、专业技术水平、人员学历层次、专业培训和科研能力等方面更具优势相关。 Abstract:Objective To investigate the current status of anesthesiology in plastic and cosmetic surgery in China, so as to provide a basis for standardizing the regulation of this industry and ensuring the safety of patients during perioperative anesthesia. Methods From November 1, 2021 to January 31, 2022, the online questionnaires were used to investigate the anesthesia practice status of medical institutions providing anesthesia services for plastic and cosmetic surgery in China. The contents of the questionnaires included the setting of anesthesiology department, the general information of the chiefs of the anesthesiology department, the anesthesia staffing of plastic and cosmetic surgery, the configuration of anesthesia-related equipment and emergency medicine, the responsibilities, status of training and scientific research of the anesthesiologists sub-specializing in plastic surgery, and the adverse events of anesthesia in plastic and cosmetic surgery. Then, the survey results of public and non-public medical institutions were compared. Results A total of 244 medical institutions were investigated, including 118 public hospitals and 126 non-public medical institutions. (1)The setting of the anesthesiology department: 100% of public hospitals and 98.41% of non-public medical institutions have established anesthesiology departments. Among them, the proportion of anesthesiology departments in non-public medical institutions that were affiliated to plastic surgery was significantly higher than that in public hospitals (32.54% vs. 17.80%, P=0.008). (2)The general information of the chiefs of the anesthesiology department: compared with non-public medical institutions, the proportion of senior title (94.07% vs. 64.29%, P < 0.001), graduate degree (61.02% vs. 26.19%, P < 0.001), and the duration of anesthesia service more than 15 years (86.44% vs. 38.10%, P < 0.001) of the department chiefs or designated persons in public hospitals were higher. (3)The anesthesia staffing for plastic and cosmetic surgery: 15.87% of non-public medical institutions didn't have full-time anesthesiologists for plastic surgery; 34.92% of non-public medical institutions employed part-time anesthesiologists to provide anesthesia services. The number of anesthesiologists in each operating room for plastic and cosmetic surgery in public hospitals was obviously higher than that in non-public medical institutions (1.35±0.15 vs. 0.85±0.10, P=0.004). However, the average ratio of operating rooms to anesthesiologists was less than 1∶1.5 in both types of institutions. In terms of the ranking of anesthesiologists, public hospitals had more chief physicians (11.14% vs. 6.50%, P=0.009) and residents (28.77% vs. 20.42%, P=0.020) than non-public medical institutions. In addition, the proportion of anesthesiologists sub-specializing in plastic surgery that have doctoral degree (13.81% vs. 2.36%, P < 0.001) and master degree (45.03% vs. 21.51%, P < 0.001) in public hospitals was higher than that in non-public medical institutions. (4)The configuration of anesthesia-related equipment and emergency medicine: the allocation rate of anesthesia recovery room (92.37% vs. 73.02%, P < 0.001) and other anesthesia-related equipment in public hospitals was higher. (5)The responsibilities, training and scientific research of anesthesiologists sub-specializing in plastic surgery: the ratio of plastic and cosmetic surgeries requiring anesthesia services in non-public hospitals was less than 50% in the past three years, while public hospitals accounted for more than 50%. Both public hospitals and non-public medical institutions adopted general anesthesia (51.57%, 59.93%), and intravenous sedation (35.71%, 36.14%) as the main anesthesia methods for plastic and cosmetic surgery. The proportion of anesthesiologists performed multiple cases of anesthesia simultaneously (12.71% vs. 31.75%, P < 0.001) and working hours > 50 hours per week (10.17% vs. 26.19%, P=0.017) in public hospitals were lower than those in non-public medical institutions. In public hospitals, the percentage of anesthesiologists engaged in plastic and cosmetic surgery who participated in national continuing education training (51.80% vs. 38.10%, P=0.033) and the per capita number of Chinese core journal papers (0.66±0.14 vs. 0.36±0.12, P=0.001) and SCI papers (0.21±0.06 vs. 0.07±0.03, P < 0.001) were more than those in non-public medical institutions. (6) The adverse events of anesthesia in plastic and cosmetic surgery: The incidence of anesthesia-related complications in plastic and cosmetic surgery in public hospitals in the past three years was lower than that in non-public medical institutions(P < 0.001), and both showed a downward trend year by year. Conclusions The lack of anesthesiologists in medical institutions that provided anesthesia for plastic and cosmetic surgery was obvious, especially in non-public medical institutions. Compared with non-public medical institutions, public hospitals have obvious advantages in the discipline construction of anesthesia, the configuration of anesthesia-related facilities and equipment, professional and technical level, educational background, professional training, and scientific research capabilities, which lead to the reduction of incidence of anesthesia-related complications in plastic and cosmetic surgery. -
Key words:
- plastic and cosmetic surgery /
- anesthesia /
- medical institutions /
- anesthesia safety
作者贡献：黄宇光负责研究设计；姜虹负责调查内容设计；严佳负责数据统计和论文撰写；申乐负责数据质控。利益冲突：所有作者均声明不存在利益冲突 -
图 4 我国开展整形美容麻醉业务的医疗机构麻醉体量与整形美容亚专业麻醉医生工作量
A. 需提供麻醉服务的整形美容手术占比；B.整形美容亚专业麻醉医生每年人均承担的整形美容麻醉例数；#P＜0.01;*P＜0.001
表 1 我国开展整形美容麻醉业务的医疗机构麻醉相关设备/设施配置情况[n(%)]
指标 公立医疗机构(n=118) 非公立医疗机构(n=126) P值 麻醉苏醒室 109(92.37) 92(73.02) ＜0.001 麻醉相关设备 供氧设备 118(100) 124(98.41) 0.169 多功能监护仪 118(100) 121(96.03) 0.029 加压供氧面罩、简易呼吸器 118(100) 123(97.62) 0.092 口咽或鼻咽通气道 118(100) 123(97.62) 0.092 气管插管工具 118(100) 125(99.21) 0.153 困难气道处理装置 108(91.53) 96(76.19) 0.001 吸引器和吸引管 118(100) 122(96.83) 0.051 听诊器 118(100) 124(98.41) 0.169 除颤仪 108(91.53) 113(89.68) 0.622 静脉输液和药物注射设备 118(100) 120(95.24) 0.016 微量注射泵 118(100) 122(96.83) 0.051 麻醉机 118(100) 123(97.62) 0.092 呼气末二氧化碳监测装置 107(90.68) 99(78.57) 0.009 吸入麻醉传输系统 99(83.90) 80(63.49) ＜0.001 吸入麻醉药浓度监测装置 90(76.27) 50(39.68) ＜0.001 体温监测装置 96(81.36) 73(57.94) ＜0.001 动脉内血压监测装置 95(80.51) 44(34.92) ＜0.001 肌松监测仪 68(57.63) 28(22.22) ＜0.001 脑电双频指数监测仪 80(67.80) 32(25.40) ＜0.001 
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表 2 我国开展整形美容麻醉业务的医疗机构急救药品配置情况[n(%)]
指标 公立医疗机构(n=118) 非公立医疗机构(n=126) P值 肾上腺素 117(99.15) 125(99.21) 0.963 阿托品 118(100) 124(98.41) 0.169 苯二氮卓类镇静药(用于局麻药中毒) 111(94.07) 115(91.27) 0.403 麻黄素 108(91.53) 107(84.92) 0.111 去甲肾上腺素 113(95.76) 119(94.44) 0.634 去氧肾上腺素 94(79.66) 95(75.40) 0.426 胺碘酮 100(84.75) 105(83.33) 0.764 氢化可的松 112(94.92) 114(90.48) 0.185
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表 3 我国开展整形美容麻醉业务的医疗机构麻醉方式决定权、整形美容亚专业麻醉医生兼台以及培训和科研情况
指标 公立医疗机构(n=118) 非公立医疗机构(n=126) P值 麻醉方式决定权[n(%)] 0.528 麻醉医生 46(38.98) 50(39.68) 0.911 手术医生 12(10.17) 10(7.94) 0.057 麻醉医生与手术医生协商决定 60(50.85) 64(50.79) 0.540 机构负责人 0(0) 2(1.59) 0.169 麻醉医生兼台[n(%)] 15(12.71) 40(31.75) ＜0.001 职称为主治医师及以上的麻醉医生同时负责的手术间数量[n(%)] 0.122 2个 107(90.68) 108(85.71) 0.231 3个 9(7.63) 9(7.14) 0.885 ＞3个 2(1.69) 9(7.14) 0.040 麻醉医生与同年资整形外科医生的收入比值(x±s) 1∶(2.88±0.31) 1∶(4.15±0.35) ＜0.001 麻醉医生平均每周工作时间[n(%)] ＜0.001 ＜40 h 25(21.19) 36(28.57) 0.183 40~50 h 81(68.64) 57(45.24) ＜0.001 ＞50 h 12(10.17) 33(26.19) 0.017 每年参加国家级继续教育培训班的麻醉医生(%) 51.80 38.10 0.033 近3年麻醉医生人均发表核心期刊论文数量(x±s, 篇) 0.66±0.14 0.36±0.12 0.001 近3年麻醉医生人均发表SCI论文数量(x±s, 篇) 0.21±0.06 0.07±0.03 ＜0.001
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表 4 我国开展整形美容麻醉业务的医疗机构近3年整形美容手术麻醉相关不良事件发生情况[%(n/N)]
指标 公立医疗机构(n=118) 非公立医疗机构(n=126) P值 麻醉相关并发症 2019年 0.22(131/59 355) 2.00(1641/81 974) ＜0.001 2020年 0.17(108/61 855) 1.96(1706/87 121) ＜0.001 2021年 0.16(117/71 841) 0.83(698/84 068) ＜0.001 发生麻醉并发症后需转院治疗 2019年 0.76(1/131) 2.68(44/1641) ＜0.001 2020年 0.93(1/108) 2.46(42/1706) ＜0.001 2021年 1.71(2/117) 4.44(31/698) 0.002
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