战时伤病员医疗救治中医学伦理适用原则探析

根据战时伤病员的医疗后送的条件、特点和要求,对医疗救治中医学伦理的适用原则进行了初步的探讨,提出了整体最优、时效救治、优先救治、合理分流、人道主义、尊重关怀、信息共享、功利原则。     

病区对地震伤病员的救治与管理体会

目的：探讨病区在救治地震伤病员中的措施与管理。方法：回顾分析病区75例地震伤员与21例病员的救治临床资料。结果：75例地震伤员成功救治并安全转运,21例专科病员全部治愈,无死亡及交叉感染病例发生。结论：正确的组织与管理、病区应急救治措施和交叉感染的防治是救治地震伤员成功的重要因素。     

现代战伤救治系统概述及其对我军战伤救治的启示

Combat casualty care (CCC) system refers to combining a series of interconnected and constrained elements to form an organic whole to ensure order and high-efficient organization of CCC.U.S army had gradually established a sophisticated CCC system,Joint Theater Trauma System (JTTS) in recent war on terror.JTTS helped to reduce the case fatality rate from 19.1％ in World War Ⅱ to historically lowest level (6.0％) till now.The key components of JTTS include ①) administrative components;② a whole and higheffective CCC chain,of which techniques and strategies had been developed according to the demands in each point of CCC chain,such as CCC strategies,et al;③ studies on CCC,including combat theater-based human research protection program,et al.These experiences are very helpful for the construction and organization of CCC of our armed force.For example,we should further optimize the CCC chain and organization,improve our studies in the combat theater-based aspect,and promote military-civilian integration and collaboration in this subject.Thus,we can build a CCC system of our armed force under the modern war,and then improve the rescue rate of casualties in future war.     

急诊分级分诊救治模式在急性脑卒中患者中的应用效果

目的探讨对急性脑卒中患者采用急诊分级分诊模式救治的效果。方法回顾性分析罗定市人民医院急诊科2018年11月至2019年12月收治的78例急性脑卒中患者,按照急诊救治模式分为对照组和观察组,各39例。对照组接受常规急诊模式救治,观察组接受急诊分级分诊模式救治,对比两组患者救治成功率、医疗纠纷发生率、急诊救治时间、治疗等候时间与候诊时间。结果观察组救治成功率高于对照组,医疗纠纷发生率低于对照组(均P<0.05)。观察组急诊救治时间、治疗等候时间与候诊时间均短于对照组(均P<0.05)。结论在急性脑卒中患者救治中采用急诊分级分诊模式利于提高救治成功率,缩短救治时间。     

现代战伤救治与军队医院图书馆

军队医院图书馆在医院的医教研工作和中起着重要的文献信息保障作用.在现代高科技战争中,军队医院图书馆如何才能适应现代战争战伤救治的需要,这是军队医院图书馆发展中一个急待探讨和实施的十分重要的新课题.     

批量伤病员快速分类信息系统研究

基地医院战时从野战医疗救护队前接收伤病员时,单位时间内接收的伤病员数量大,伤情复杂.在大量伤病员运输车到达医院时,需要在短时间内对伤病员进行分类.因此,研发一套可行伤病员快速分类的系统能在战时提高伤病员分类的效率和准确性.     

分级分区分诊模式在急性胰腺炎急诊救治患者中的应用效果

目的：观察分级分区分诊模式在急性胰腺炎急诊救治患者中的应用效果。方法：选取78例急性胰腺炎急诊救治患者为研究对象,按随机数字表法分为研究组（n=39）和对照组（n=39）。对照组采用常规急诊分诊模式,研究组在对照组基础上采用分级分区分诊模式,比较两组急诊救治效率、救治效果、护理纠纷发生率和护理满意度。结果：研究组分诊时间、候诊时间和治疗等候时间均短于对照组,差异有统计学意义（P<0.05）;研究组分诊准确率为94.87%(37/39),高于对照组的74.36%(29/39),救治成功率为92.31%(36/39)高于对照组的71.79%(28/39),差异均有统计学意义（P<0.05）;研究组护理纠纷发生率为2.56%(1/39),低于对照组的20.51%(8/39),差异有统计学意义（P<0.05）;研究组护理满意度为94.87%(37/39),高于对照组的71.79%(28/39),差异有统计学意义（P<0.05）。结论：在常规急诊模式基础上采用分级分区分诊模式可缩短急性胰腺炎急诊救治患者的分诊时间、候诊时间和治疗等候时间,提高分诊准确率、救治成功率和护理满...     

马岛战争和二战中海战伤发生特点及其对我军海战伤救治的启示

Casualties in naval battles,such as Malvinas War and World War Ⅱ,demonstrate different characteristics from those that occur in land battles,and are characterized by higher rate of mass casualties,higher incidences of burns and inhalation injuries,and higher prevalence rates of frozen injuries,drowning,seawater immersion injuries and combat stress reaction.Enlightenments of these features for our naval combat casualties care include:①Simple and fixed procedures should be established for mass casualties.②For burns and inhalation injuries,treatment measures should be set up,and related facilities should be equipped in warships and hospital ships.③Targeted strategies should be developed for frozen injuries,drowning,seawater immersion injuries and combat stress reaction.However,because of the improved killing effect of modern weapons and the changes of our national security strategy,the characteristics of casualties in our possible naval combats in the future differ from the above-mentioned features.So,in consideration of our national security strategy,features of various ships in modern naval combat,killing characteristics of different weapons and possible combat areas,we need to establish a reliable prediction model for casualties in modern offshore and far-offshore naval battles,and develop navel combat care skills and medical support strategies.     

中国维和军医战伤救治技能培训效果评估

目的 通过调查中国部署前维和军医战伤救治能力现状,分析维和军医战伤救治技能培训中存在的问题,为完善培训内容提供借鉴.方法 采取整群抽样法,纳入部署前中国维和分队一级医院军医作为研究对象,通过问卷调查法、理论考核、桌面推演和实训演练(包括现场评估、检伤分类、胸腔闭式引流术),对35名完成战伤救治培训的维和军医进行调查.问...     

医院船海上战救不确定性的情景分析探讨

目的：通过研究,找到医院船海上战救过程中的风险因素,提出对策,提升救援效率。方法通过对7位曾在医院船执行不同任务的不同专家进行咨询,对海上战救所处内外部环境与救治流程的不同环节进行分析,在此基础上,运用情景分析方法,发现和识别可能影响救治效率的风险因子。结果根据对风险因子产生影响的因素作为情景分析的关键纬度,确定伤员因素、技术因素、运输因素和通讯因素为关键维度,依次构建不同情景,找出薄弱环节。结论提出采用智能化方法应对技术不确定性,构建医院船独立网络,协助解决通讯因素的不确定性等策略。     

Duration and predictors of emergency surgical operations - basis for medical management of mass casualty incidents

Background

Hospitals have a critically important role in the management of mass causality incidents (MCI), yet there is little information to assist emergency planners. A significantly limiting factor of a hospital''s capability to treat those affected is its surgical capacity. We therefore intended to provide data about the duration and predictors of life saving operations.

Methods

The data of 20,815 predominantly blunt trauma patients recorded in the Trauma Registry of the German-Trauma-Society was retrospectively analyzed to calculate the duration of life-saving operations as well as their predictors. Inclusion criteria were an ISS ≥ 16 and the performance of relevant ICPM-coded procedures within 6 h of admission.

Results

From 1,228 patients fulfilling the inclusion criteria 1,793 operations could be identified as life-saving operations. Acute injuries to the abdomen accounted for 54.1% followed by head injuries (26.3%), pelvic injuries (11.5%), thoracic injuries (5.0%) and major amputations (3.1%). The mean cut to suture time was 130 min (IQR 65-165 min). Logistic regression revealed 8 variables associated with an emergency operation: AIS of abdomen ≥ 3 (OR 4,00), ISS ≥ 35 (OR 2,94), hemoglobin level ≤ 8 mg/dL (OR 1,40), pulse rate on hospital admission < 40 or > 120/min (OR 1,39), blood pressure on hospital admission < 90 mmHg (OR 1,35), prehospital infusion volume ≥ 2000 ml (OR 1,34), GCS ≤ 8 (OR 1,32) and anisocoria (OR 1,28) on-scene.

Conclusions

The mean operation time of 130 min calculated for emergency life-saving surgical operations provides a realistic guideline for the prospective treatment capacity which can be estimated and projected into an actual incident admission capacity. Knowledge of predictive factors for life-saving emergency operations helps to identify those patients that need most urgent operative treatment in case of blunt MCI.     

战伤救护止血带的特性和研究进展

在近代以来的战争中,血管创伤发生率逐渐升高,在火线救治阶段利用止血带对四肢和交界区大出血止血成为挽救伤员生命的有效手段。现代战争的复杂环境对新型止血带提出了智能化、集成化、轻量化、微型化、重复使用、舒适度好、稳定性强、成本低等要求,在此背景下,本文对美军战术战伤救治指南推荐的止血带、俄军使用的止血带、我军常用止血带以及目前未正式纳入指南但对研发有启发意义的止血带进行综述,总结现有止血带的优缺点,为新型止血带的研制提供参考。     

战伤喷剂对家兔皮肤烫伤合并感染的药效学与安全性研究

目的：验证战伤喷剂在创伤早期抗感染的效果，以及战伤喷剂对战创伤感染发生的影响。方法：采用烫伤合并人工感染绿脓杆菌的家兔模型，用战伤喷剂与溶剂组于实验前和实验后第1、2、4、7、14天采集家兔血清，测量体温，检测白细胞数、血清NO2^-／NO3^-水平、血清肿瘤坏死因子水平、血清超氧阴离子等炎性因子水平以及谷丙转氨酶、碱性磷酸酶、天冬氨酸转移酶、肌苷和尿素氮等肝肾功能指标水平。结果：实验组药效学检测指标的升高比对照组缓慢，最终2组均达到较高的感染发生帮标；器官功能的安全性指标无明显变化，且2组变化大致相同。结论：战伤喷剂在创伤早期应用可以有效延迟创伤感染的发生，但并不能阻止感染的发生或减轻感染的程度。     

Research approaches to mass casualty incidents response: development from routine perspectives to complexity science

Objective To review the research methods of mass casualty incident （MCI） systematically and introduce the concept and characteristics of complexity science and artificial system,computational experiments and parallel execution （ACP） method.Data sources We searched PubMed,Web of Knowledge,China Wanfang and China Biology Medicine （CBM） databases for relevant studies.Searches were performed without year or language restrictions and used the combinations of the following key words：“mass casualty incident”,“MCI”,“research method”,“complexity science”,“ACP”,“approach”,“science”,“model”,“system” and “response”.Study selection Articles were searched using the above keywords and only those involving the research methods of mass casualty incident （MCI） were enrolled.Results Research methods of MCI have increased markedly over the past few decades.For now,dominating research methods of MCI are theory-based approach,empirical approach,evidence-based science,mathematical modeling and computer simulation,simulation experiment,experimental methods,scenario approach and complexity science.Conclusions This article provides an overview of the development of research methodology for MCI.The progresses of routine research approaches and complexity science are briefly presented in this paper.Furthermore,the authors conclude that the reductionism underlying the exact science is not suitable for MCI complex systems.And the only feasible alternative is complexity science.Finally,this summary is followed by a review that ACP method combining artificial systems,computational experiments and parallel execution provides a new idea to address researches for complex MCI.     

新型高级创伤外科机动救治力量及其培训体系的建立

未来远海环境下的舰艇编队作战将成为我海军主要作战形式。远海作战战场广阔、攻防形势转换快、所致伤情伤势复杂,易在任意时间、任意战场地点瞬间产生批量伤员,救治难度极大。本文系统介绍了一种针对远海舰艇编队作战的新型高级创伤外科机动救治队伍及其专属模块化、标准化、轻量化的手术复苏装备系统,并阐述其培训体系构想,以备卫勤研究者、参与者借鉴参考。     

内科老年患者心理护理在基层医院急诊科的创新实践

目的探讨将内科老年患者心理护理应用于基层医院急诊科质量管理中,以提高急诊科护理质量的创新护理模式。方法将100例老年患者随机分为试验组与对照组各50例,对照组予以常规护理,试验组在常规护理基础上应用内科老年患者心理护理制度,采用汉密顿焦虑量表(HAMA)评分,统计比较两组患者护理前后的焦虑总分、精神状况和躯体状况。结果试验组比对照组在焦虑总分、精神状况和躯体状况方面均有改善,差异具有统计学意义(P<0.05)。结论内科老年患者心理护理制度有助于提升基层医院急诊科服务质量的整体水平,作为一种创新护理模式值得临床实践。     

医院门（急）诊医疗费用增长因素分析

本文分析了1998-2006年某医院门（急）诊医疗费用构成比及增长速度等相关因素。     

边境难民伤病预测的影响因素量化指标体系研究

目的:为了确定影响边境地区难民伤病各因素的重要程度,为难民伤病预测提供依据.方法:通过对相关文献的检索与研究,整理概括出边境地区难民伤病的主要影响因素,并将其指标分为三级,量化指标体系的建立按照德尔菲法,即专家咨询的方法步骤进行.经过三轮咨询,根据专家反馈意见修改指标名称及内涵,并结合运用层次分析法和对比排序法确定各指标的权重.结果:构建了边境难民伤病影响因素的三级指标体系,确定了4个一级指标:自然因素、社会因素、医学因素和战争因素,12个二级指标以及37个三级指标,求得了各指标的权重.结论:本研究结果可作为难民伤病预测的依据,并为做好边境难民的卫勤保障提供参考.