【作者】 张凯；

【导师】 伍瑞昌；

【作者基本信息】 中国人民解放军军事医学科学院 ， 卫生防护防疫技术与装备， 2012， 博士

【摘要】 当前，军事思想、编制体制、作战行动和保障方式有了很大变化，对卫勤保障能力提出了新的要求。信息化条件下卫勤保障的基本特征是一体化的联勤保障和灵活机动的卫勤战术，卫勤力量要实现更好的机动性和更快的反应，这对卫生装备的优化配置提出了更高的要求。合理优化配置卫生装备，对于提高战时伤病员的治愈归队率，降低伤死率、病死率和残疾率，进而维护和提高整个部队的战斗力具有重要的意义。战时伤病员医疗后送及卫生装备配置问题，涉及众多的动态性和随机性因素问题，属于复杂的动态随机系统问题。而传统的解析方法通常用于处理静态的、规范的、简单几率性的问题，在处理复杂问题时，往往需要做出很强的简化假设，这影响了模型的有效性。与之相比，仿真方法可以比较真实地描述动态随机系统的运行、演变及其发展过程。因此本课题采用系统仿真技术对这一问题开展研究。本课题以医疗后送理论和系统仿真技术为基础，划分救治机构的模块和各救治模块的救治工作序列，为仿真研究提供数量化框架与依据；实现伤病员救治过程和生存过程的数量化，为仿真研究提供基础数据支撑；分析和构建伤病员医疗后送数学模型，分析模拟方法，为仿真研究提供运行逻辑支撑；以Simio仿真平台为基础，开发三维可视化仿真系统，为仿真研究提供工具；最后利用仿真系统构建仿真模型，结合仿真实验，实现卫生装备的优化配置研究。下面是课题研究的具体内容：（1）救治机构模块分组和救治工作序列研究。根据时效救治与现代分级救治理论，阐述救治机构战伤救治的分级管理，以某典型救治机构为例分析其勤务功能；结合模块化理论和方法，分析战时伤病员救治链的模块构成，区分救治机构的救治模块。在上述工作基础上，根据救治机构的救治范围、救治技术措施和救治工作流程，构建救治模块的救治工作序列，为仿真研究提供数量化框架和依据，为仿真系统运行提供结构支撑。（2）伤病员医疗后送及卫生装备配置仿真基础数据研究。参考美军伤情码，结合专家咨询，形成本课题伤病员分类方法；针对具体作战情景，获取伤病员构成结构；通过专家咨询，明确伤病员救治优先级、生命威胁程度等伤病员救治基础数据。通过对伤病员在各救治阶梯伤病情和救治措施的分析，获取伤病员救治工作序列，实现伤病员救治过程的数量化研究。通过专家咨询，获取我军战时伤病员生存概率数据，以Weibull生存函数为基础，对调研数据进行曲线拟合，构建伤病员生存模型，实现伤病员生存过程的数量化研究。该部分研究为整个仿真研究和仿真系统运行提供基础数据支撑。（3）伤病员医疗后送及卫生装备配置仿真概念模型研究。阐述面向对象仿真建模框架的基本内容和方法；根据救治链模块划分研究和仿真系统建模功能分析，构建伤病员医疗后送及卫生装备配置仿真系统建模对象的层次结构；通过分析和构建伤病员生成、救治和后送模型，提出仿真假设，分析各部分的模拟方法，实现对仿真系统建模对象行为和交互描述。该部分研究为整个仿真研究和仿真系统提供运行逻辑支撑。（4）伤病员医疗后送及卫生装备配置仿真系统开发。对众多仿真软件进行比较，选择Simio作为开发平台，并阐述其建模框架；进行数据库数据分析与设计，利用Access2007构建仿真底层数据库，并与仿真系统进行了交互，解决了仿真系统的数据输入问题；分析了三维虚拟仿真实现方法，利用三维建模工具构建三维实体库，结合Simio的虚拟现实表现能力，解决了仿真系统的三维虚拟表现问题；利用Simio仿真平台面向对象和多层次建模的优势，开发战时伤病员医疗后送及卫生装备配置仿真建模所需的一系列智能对象，形成仿真建模对象库，解决了系统的建模功能实现问题。该部分为仿真系统的开发部分，为仿真研究提供工具。（5）进行卫生装备配置仿真模型与仿真实验研究。分析了基于课题开发的仿真系统的卫生装备配置仿真研究过程；依据仿真系统，构建某救护所和包含后送对象的某救治链卫生装备配置仿真模型，模型的构建过程验证了仿真系统在卫生装备配置仿真建模方面的便捷性和有效性。利用上述仿真模型，对典型的卫生装备配置问题进行仿真实验研究，为卫勤机关和科研人员提供了卫生装备配置仿真研究方法和决策依据。该部分是典型的卫生装备配置仿真研究，为仿真系统的应用部分，也是仿真研究的案例部分。本课题研究的创新之处：（1）以救治模块、救治工作序列、伤病员生存模型研究为基础，实现了伤病员救治过程和生存过程的数量化研究，开发了伤病员医疗后送仿真底层数据库，为医疗后送和卫生装备研究领域提供了专业信息平台，对卫生勤务与装备的数量化研究具有重要的意义。（2）利用模块分组研究和仿真系统建模功能分析，划分了我军战时伤病员医疗后送及卫生装备配置仿真的建模对象，构建了相关对象的层次结构。在此基础上，构建和分析了伤病员生成模型，救治链伤病员救治模型、救治机构伤病员救治模型、救治模块伤病员救治模型，以及伤病员后送模型，并分析了各模型的模拟方法，为该领域仿真系统开发、仿真建模和实验研究提供了技术方法。（3）对Simio仿真平台进行二次开发，分别构建了仿真底层数据库，解决了以往仿真研究底层数据匮乏的问题；开发了三维实体库，结合Simio的虚拟现实表现能力，实现了三维虚拟仿真，解决了以往仿真研究视觉表现差的问题；开发了建模对象库，实现了战时伤病员医疗后送及卫生装备配置三维可视化仿真系统的开发与集成，为卫勤机关和科研人员提供了专业的仿真研究工具，解决了以往仿真研究建模方法繁琐复杂的问题，也使得决策者可从卫勤保障的整体来研究和分析卫生装备的部署、保障、评价以及发展决策，将进一步提高相关决策和研究工作的可靠性和科学性。更多还原

【Abstract】 Nowadays, military thoughts, organizational structure, operations and support modes,have greatly changed, with the new requitments for medical support capabilities, theintegrated joint support and flexible tactics involved in the future medical service in theinformationised war. Heath service support organizations should achieve better mobilityand faster response, which puts forward higher requirements for the optimal allocation ofmedical equipment. The optimal allocation of medical equipment is of great significancefor improving the rates for the casualty to return to duty after recovery, for died of wound,mortality and disability, and thus to maintain and enhance the combat effectiveness of theentire force. The wartime casualty medical evacuation and medical equipment allocation,involving a number of dynamic and stochastic factors, can be defined as the solution for acomplex dynamic stochastic system. Traditional analytical methods are typically used tohandle static, standardized, simple probability issues, and when they come to complexissues, the strong simplifying assumptions have to be made, which affect the validity of themodel. In contrast, the simulation methods can accurately describe the evolution anddevelopment process of the dynamic and random system. So, this thesis adopts systemsimulation technology to this issue.Based on the medical evacuation theory and system simulation technology, themedical treatment facility modules and relevant task sequences are defined, with thequantification framework offered for the whole simulation research. The casualty treatmentand survival processes are quantified, providing base data for the research. Themathematical models of casualty medical evacuation are analyzed and developed, and themodeling methods are described, and also the run logic for the research. A3D visualsimulation system is developed based on Simio simulation platform to be the tool for theresearch. At last, some simulation models are established with the simulation system abovementioned, and simulation experiments are used to achieve the optimal allocation ofmedical equipment. Here are the specific contents of the research:Research on the module classification and treatment task sequences of the medicaltreatment facility. Based on time-effect and modern classification treatment theories, thetreatment classified management of medical facilities is described, and the service functionof a typical facility is analyzed. With the modular theory and methods, the modularcomposition of the medical treatment chain is analyzed, and the facility treatment modulesare distinguished. On the basis of the above work, the treatment task sequences aredetermined based on facility treatment scopes, technology measures and treatmentworkflow. This part provides quantification framework for the simulation research and structural support for the simulation system.Research on the simulation base data of the casualty medical evacuation andequipment allocation. Based on the U.S. Army patient condition codes and expert advices,the casualty classification method in this thesis is achieved. The casualty treatment basedata, such as priorities and life-threatening levels, are obtained by expert consultation. Thecasualty treatment task sequences are determined through the analysis of condition andtreatment measures in all treatment echelons, which helps achieve the quantification ofcasualty treatment process. The survival probability data of wartime casualty are collectedusing expert questionnaires. These data are fitted using Weibull survival function, and thesurvival model is obtained, which helps achieve the quantification of casualty survivalprocess.Research on the simulation concept models of the casualty medical evacuation andequipment allocation. The contents and methods of object-oriented simulation modelingframework are described. The object hierarchy of the wartime casualty medical evacuationand medical equipment allocation simulation system are developed based on the moduledivision and analysis of the simulation system modeling capabilities. Through the analysisand developing the casualty flow generation, medical treatment and evacuation models，thesimulation assumptions are put forward, and the modeling methods are analyzed, achievingthe description of the simulation system object behaviors and interactions. This part bringsout run logic of the entire simulation research and simulation system.Development of simulation system of the casualty medical evacuation and equipmentallocation. Simio is selected as the development platform from many simulation softwares,and its modeling framework is described. The simulation underlying database is developedusing Access2007, based on database data analysis and design, which solves the data inputissues of the simulation system. The3D virtual simulation theory is described. The3Dentity library, including the scenes, is developed using3D modeling tool, which is used for3D virtual display with Simio. Using the advantages of object-oriented and multi-levelmodeling of Simio, a series of smart objects, which are necessary for the modeling ofcasualty medical evacuation and equipment allocation, are developed, achieving asimulation object library and the modeling functions of the simulation system. This partdevelops the simulation system and provides tool for the simulation research.At last, research on the simulation models and experiments for the allocation ofmedical equipment. The simulation study process based on the tool developed is elaboratedand analyzed. An aid station and a treatment chain, involving the evacuation object,medical equipment allocation simulation models are developed. The model building workshows the convenience and effectiveness of the simulation system. The typical issues ofthe allocation of medical equipment are analyzed using simulation experiments, whichprovides research method and decision making data for health service agencies andresearchers. That part is the typical applications of medical equipment allocation simulation tool, and also the case study of the simulation research.Innovations of this research:（1）Based on research of the treatment modules, treatment task sequences andcasualty survival model，the casualty treatment and survival processes are quantified，andthe casualty medical evacuation simulation underlying database is developed，whichprovides a professional information platform for the research on medical evacuation andmedical equipment, and is great significance for the quantitative study of the health serviceand equipment.（2）Based on the module division and analysis of the simulation system modelingcapabilities, the object hierarchy of the wartime casualty medical evacuation and medicalequipment allocation simulation system are developed. Through the analysis anddeveloping the casualty flow generation, medical echelon treatment, facility treatment,moule treatment and evacuation models, the modeling methods are analyzed. This partbrings out technical methods for the simulation system development, modeling andexperiment research.（3）Based on Simio simulation platform, the simulation underlying database aredeveloped, which solves the issues of lack of data in the previous study. The3D entitylibrary, including the scenes, is developed, which combinates with the virtual realityperformance ability of Simio, solving the visual performance issues in the previous study.The modeling object library is developed, achieving the development and integration of thewartime casualty medical evacuation and equipment allocation3D visual simulationsystem, which provide a professional simulation tool for health service agencies andresearchers, solves the modeling method issues in the previous study, and makes decisionmakers may study and analyze the deployment, support, evaluation, and developmentdecisions of medical equipment from the overall analysis of the heath service support,enhancing the reliability and scientificity of related decision-making and research work.更多还原