Casualty Air Evacuation: Sine quo non of combat casualty

Management of combat casualties has always been a challenging task. Armed Forces world over have developed effective casualty air evacuation mechanisms. The history of casualty evacuation dates back to 1870s. The first evacuation of casualty by air was during the First World War. The paper highlights the background and evolution of air evacuation in the world and discusses the Indian Scenario of casualty air evacuation. The casualty evacuation capabilities of the aircrafts in the Indian Air Force (IAF) are highlighted. To ensure prompt casualty evacuation, the Armed Forces have a chain of casualty air evacuation, thus ensuring that the injured reach the health care center in the least possible time. An indigenously developed patient transfer unit (PTU) comprising of a trauma care recovery trolley with a complement of a portable ventilator, multipara monitor, infusion pumps and oxygen system is also discussed. In addition, the paper discusses the aeromedical considerations while evacuating casualties by air and contraindications for air evacuation. The advancements in the field of medical technology and medical care has ensured safe air evacuation of casualties and has reduced the morbidity and mortality of casualties, thus boosting the morale of the troops.     

汶川大地震成都某野战医院伤员卫勤后送特点分析

目的:分析在汶川大地震中成都市某野战医院的卫勤保障特点,总结经验.方法:该野战医院从汶川、映秀、彭州接收后送伤员,通过对前接、护送、院前拣伤分类、防疫消毒、制备紧急疏散预案及院内专科诊治的观察,分析伤员救治状况.结果:通过直升飞机空运伤员,及时保证了伤员的后送救治;第1次、第2次检伤分类确保了伤员有效、科学的救治;对车辆、担架及伤员及时防疫消毒保证了无疫情发生;制定紧急疏散方案,使伤员安全渡过余震期.结论:充分运用卫勤保障知识进行部署和组织,是保证大灾害时伤员及时、安全救治的关键.     

慢性浅表性胃炎脾胃湿热证患者胃电图与胃排空的关系

目的 探讨慢性浅表性胃炎脾胃湿热证患者胃电图与胃排空的关系。方法 采用不透X线标记物一钡条法检测胃排空,休表胃电图法检测胃电,分别对慢性表性胃炎脾胃湿热证患者（37例）、脾虚证患者（20例）及对照组（13例,无慢性消化系统疾病史,一般检查无正常者）进行检测。结果 脾胃湿热证患者胃电图各指标与对照组无明显差异（P＞0．05）,但其胃排空率低于对照组（P＜0．05）;脾虚证患者胃电波幅及频谱累加值（SUM值）在餐前、餐后都明显低于对照组及脾胃湿热证患者（P＜0．05）,其胃排空率明显低于对照组（P＜0．005）及脾胃湿热证患者（P＜0．05）。结论 脾胃湿热证患者胃电图无特殊表现,正常的胃电不能预示正常的胃排空,胃排空率低下可能与胃电波幅及SUM值低下有关。     

营养不良患儿胃运动及排空检测

为了解营养不良患儿的胃动力及排空情况，应用Ｂ型实时超声对３０例营养不良患儿液体试验餐后的胃运动与排空功能进行检测。结果：与正常组比较，营养不良患儿餐后胃体蠕动和胃窦收缩频率明显减少，液体胃排空速度明显减慢（Ｐ均＜０．０１），提示对营养不良症的治疗可应用促进胃动力药物（如吗丁林，普瑞博恩）或采取其他相应措施，以增加胃排空速度，增加能量的摄入，提高治疗效果。     

CT引导下微创清除术治疗高血压脑出血临床研究

目的：探讨微创清除术治疗脑出血的方法与疗效。方法：60例脑出血患者随机分为穿刺引流组和穿刺碎吸组，并以30例保守治疗者为对照组，分析其有效率、死亡率及再出血率等。结果：穿刺引流组有效率85．7％，死亡率11．4％，再出血率8．6％；穿刺碎吸组有效率68％，死亡率24％，再出血率20％；对照组有效率56．6％，死亡率33．3％，再出血率26．7％。各组比较有显著性差异。结论：微创清除术特别是穿刺引流术治疗脑出血简便、安全、疗效显著。     

Combat psychiatry: Indian perspective

Indian Armed Forces have been engaged in various combat duties for long. The adverse effect of prolonged and repetitive deployment of troops in these highly stressful environment leads to many combat stress behaviors as well as misconduct behaviors. Preventing, identifying and managing these disruptive behaviors are an essential part of combat psychiatry within the larger domain of combat medicine. Indian Armed Forces have a well-oiled mechanism to handle these issues and military psychiatrists are deeply engaged in providing holistic mental health care to the esteemed clientele. Relevant issues on this subject are elaborated in the article.     

小鼠半固体糊法加活性炭测定胃排空

目的　探讨对已报道小鼠胃排空测定方法改进的科学性和可行性。方法　ICR小鼠分别给予普瑞博思、阿托品、柴枳合剂及芍甘合剂。采用营养性半固体糊加活性炭法同时测定小鼠胃内容物残留率和小肠推进比。结果　普瑞博思和柴枳合剂可明显促进胃排空和小肠推进 ,阿托品和芍甘合剂则有明显抑制作用。结论　改进法可同时测定胃排空和小肠推进 ,从而同步反映胃和肠的运动情况 ,优于原方法     

胃功能性排空障碍临床分析

目的探讨胃功能性排空障碍的治疗。方法自1995年我院共对38例胃功能性排空障碍患者进行了病因分析及治疗方法的总结。结果胃功能性排空障碍系功能性疾病,应采取非手术疗法。结论治疗胃功能性排空障碍可减轻病人痛苦,提高病人生活质量。     

微创血肿清除术治疗颅内血肿的临床应用

目的　分析微创血肿清创术治疗颅内血肿的方法 ,探讨其手术适应症、手术方法、要点及优点。方法　微创血肿清除术 ,即CT定位 ,经皮颅内血肿穿刺 ,血肿腔内注入液化剂技术清除血肿。结果　治疗 32例 ,死亡 2例 ,存活出院 30例。结论　该技术具有损伤轻微 ,不加重神经功能损伤 ,疗效明显 ,费用低 ,操作简便 ,易为患者及家属接受等优点。     

中药升降胶囊对大鼠胃排空的影响

[目的]观察中药升降胶囊对大鼠胃排空的影响,并从红细胞乙酰胆碱酯酶活性和血浆胃动素(Mot)、生长抑素(SS)方面探讨其作用机制。[方法]将8周龄的SD大鼠随机分成B组(升降胶囊高剂量组),C组(升降胶囊低剂量组),D组(枳壳白术组),A组(正常对照组)和E组(西沙比利组)。用药10d后用同位素法检测其胃排空功能,微量羟胺法检测其红细胞乙酰胆碱酯酶活性,放免法检测其血浆Mot和SS。[结果]B、C、D组30min胃排空率分别为(51.44±6.38)%、(40.82±7.24)%和(40.22±7.16%,均高于八组的(33.18±6.32)%;3组红细胞乙酰胆碱酯酶活性、MOT和SS分别为:B组(0.856±0.128)μmol/h,(124.26±25.94)ng/L和(39.42±7.%)ng/L,C组(0.726±0.164)μmol/h,(119.86±29.38)ng/L和(38.33±7.64)ng/L,均高于A组的(0.576 ± 0.150)μmol/h,(91.28±26.84)ng/L和(28.22±7.68)ng/L。[结论]升降胶囊可促进胃排空,其机制可能与增强胆碱能神经功能及提高血浆Mot和SS水平有关。     

小儿危重病例评分在儿科重症监护病房转出决策中的应用

目的探讨小儿危重病例评分(PCIS)在儿科重症监护病房(PICU)转出决策中的应用及其与患儿预后及费用的关系。方法对本院2007—2008年PICU转至普通病房的277例患儿的临床资料进行回顾性PCIS评估,根据转出PICU时的PCIS分值分成3组,分别进行预后及总费用比较。结果 70～79分组患儿重回PICU率最高(24.24%),明显高于80～89分组(7.28%)和90～99分组(6.67%),差异有统计学意义(P<0.01);80～89分组和90～99分组比较差异无统计学意义(P>0.05)。80～89分组总住院时间最短(34±13)d,总住院费用最少〔(44 151±5 662)元〕,差异均有统计学意义(P<0.05)。结论 PCIS评分在判断患儿转出PICU、降低总住院费用中效果良好,可作为PICU转出决策的重要参考标准。     

Use of an Agent-Based Simulation Model to Evaluate a Mobile-Based System for Supporting Emergency Evacuation Decision Making

Recently, mass casualty incidents (MCIs) have been occurring frequently and have gained international attention. There is an urgent need for scientifically proven and effective emergency responses to MCIs, particularly as the severity of incidents is continuously increasing. The emergency response to MCIs is a multi-dimensional and multi-participant dynamic process that changes in real-time. The evacuation decisions that assign casualties to different hospitals in a region are very important and impact both the results of emergency treatment and the efficiency of medical resource utilization. Previously, decisions related to casualty evacuation were made by an incident commander with emergency experience and in accordance with macro emergency guidelines. There are few decision-supporting tools available to reduce the difficulty and psychological pressure associated with the evacuation decisions an incident commander must make. In this study, we have designed a mobile-based system to collect medical and temporal data produced during an emergency response to an MCI. Using this information, our system’s decision-making model can provide personal evacuation suggestions that improve the overall outcome of an emergency response. The effectiveness of our system in reducing overall mortality has been validated by an agent-based simulation model established to simulate an emergency response to an MCI.     

卫生列车后送伤员手术的麻醉处理

目的探讨卫生列车后送伤员手术的麻醉原则与方法。方法根据现代高技术战争条件下伤员伤情的特点,针对卫生列车医疗队的救治任务,参照《战伤救治规则（2006版）》,结合模拟训练和实车演练,探讨卫生列车后送伤员手术的麻醉方法。结果全身麻醉效果确切、完善、迅速,气管内插管可保障气道的通畅,安全性高,同时列车运行时将明显影响椎管内麻醉的实施,因此全身麻醉为卫生列车伤员手术麻醉的首选方式。结论卫生列车特殊环境增加了后送中伤员救治的难度,同时对麻醉提出了更高的要求。麻醉处理的重点在于仔细评估伤情和重要器官功能,合理选择麻醉方式,加强麻醉中的监测与管理。     

小骨窗开颅治疗高血压基底节区出血的临床研究

目的探讨小骨窗开颅治疗高血压性基底节区出血的临床效果。方法 31例高血压基底节区出血采用小骨窗开颅血肿清除术,对患者资料和治疗效果进行回顾性分析。结果 31例患者平均血肿清除率92%,术后再出血9.68%（3/31）。病死率6.45%（2/31）。术后6个月GOS评分5分7例（22.6%）,4分15例（48.4%）,3分6例（19.4%）,2分3例（9.7%）。结论小骨窗开颅术能够有效的清除血肿,改善预后,是治疗高血压性脑出血很好的手术选择。     

依托咪酯用于中期妊娠引产时清宫、钳刮术麻醉效果的观察

对９１８例中期妊娠引产的清宫、钳刮术患者应用依托咪酯作全身静脉麻醉，未发现药物对呼吸循环功能有影响及过敏反应，绝大多数病例麻醉效果良好，副反应发生率为２４．４％，常见的副反应为肢体震颤、咳嗽、呕吐等。清宫术时的麻醉效果好于钳刮术，且副反应发生率低，两者间差异有显著性（ｐ＜０．０１）。依托咪酯用于清宫、钳刮术的全身静脉麻醉安全可靠，易被病人接受，可在门诊手术应用。     

微创清除术治疗颅内血肿60例临床分析

目的探讨颅内血肿微创清除术治疗颅内血肿的疗效与操作技巧。方法对颅内血肿60例实施颅内血肿微创清除术。结果60例中生存50例,死亡10例,总有效率为83．3％。结论颅内血肿微创清除术是治疗颅内血肿的一种简单、有效的方法,但实施该技术要讲求个体化方案,要以预防各型脑疝为首要目的,以减轻偏瘫等后遗症为宗旨,以求提高生存率,改善生活质量。     

微创颅内血肿清除术潜在并发症的预见护理

目的预见微创颅内血肿清除术后的潜在并发症，探讨护理对策，提高微创术的成功率，提高生存质量。方法配合医师采用YL-I型颅内血肿粉碎穿刺针，根据CT片选择病灶面积最大层面中点为靶点，在局部麻醉下经头皮钻颅骨直达血肿腔，进行冲洗、液化、引流的过程中，预见可能发生的潜在并发症，而采取护理对策。结果有效的护理干预可及时发现和避免并发症，降低死亡率。结论微创颅内血肿清除术潜在并发症可以通过有效的护理干预来预防。     

卫生运输船伤病员快速分类研究

目的研究卫生运输船接受大批伤病员后快速分类方法，旨在使伤病员得到及时有效的救治。方法设置三种类型的伤病员分类方法，在海上模拟伤员伤情进行分类，从演练中总结经验，找出快速分类的方法。结果按照医院船方式进行分类，平均每次通过20名伤员需39．1min；按照伤情严重程度进行分类，平均每次通过20名伤员需26．4min；按照伤情是否需要医护人员处治进行分类，平均每次通过20名伤员需16．lmin。结论伤员按照伤情是否需要医护人员处治模拟进行分类，速度最快，效率最高。     

避难走道在大型医药生产楼消防逃生、防排烟设计中的应用

通过对某一大型口服固体制剂医药厂房的实际工程案例分析,探讨了运用避难走道和设计相应防排烟和喷淋系统,实现消防逃生的功能,以符合现行GB50016《建筑设计防火规范》的要求。     

Periosteal Bone Formation on Medullary Evacuation: A Bone Formation Model

Abstract

A periosteal bone formation model based on the collateral reaction of the periosteum to evacuation of the medullary cavity has been developed. With this experimental model and on the basis of the values obtained and the precise statistical findings made in this study, further investigations on the influence of pharmacological and hormonal factors on periosteal bone formation should be possible.