【作者】 王德刚；

【导师】 徐新喜；

【作者基本信息】 中国人民解放军军事医学科学院 ， 生物医学工程， 2008， 硕士

【摘要】 机动卫生装备作为实施战伤救治、完成卫勤保障任务的重要物质基础,除机动性能、医疗功能、作业能力等战术技术指标应满足部队使用要求外,还应具备良好的舱室微环境。机动卫生装备多处于夏季、冬季的高温低温环境,热带潮湿、多微生物的环境,复杂的道路地形状况等野外恶劣条件下实施医疗救治作业,舱室微环境质量的好坏直接影响到医护人员的作业效果和伤病员伤情的恢复。同时,近年来国际生化恐怖袭击及突发性重大化学事故、灾害疫情时有发生,机动卫生装备在医学救援过程必须能够保证舱室内人员的安全性要求,其舱室生化防护措施及防护指标也是舱室微环境的重要内容。为保证舱室微环境质量,机动卫生装备舱室通常应采取有效的采暖通风、空气调节、振动控制乃至生化防护等措施,以调节舱室内环境参数、减少振动冲击影响、控制空气污染物浓度、防止有毒气体或气溶胶颗粒进入舱室,保证人员舒适性、安全性。本文在分析借鉴相关舱室的研究成果及国内外标准后,根据不同的功能和使用要求将机动卫生装备舱室微环境分为热环境、振动环境、空气环境、噪声、照明等其他物理环境以及极端生化环境五类,构建了舱室微环境指标体系,提出了各类微环境质量等级的指标限值和相应的测试方法,在理论分析的基础上建立了相应的评价方法。本文重点研究了机动卫生装备舱室热环境、振动环境和极端生化环境的质量要求与评价方法,并进行了生防急救车的试验研究,验证了所确立的指标限值和评价方法的合理性,具体内容如下:（1）在热环境方面,运用环境医学和生理学知识分析了热环境对人体生理参数的影响和人体的热舒适性机理,确定了影响舱室热环境的主要因素,揭示了人体热感觉与舱室热环境间的相互关系。在分析各类舱室热环境标准和综合评价指标后,确立了机动卫生装备舱室热环境的指标限值和测试评价方法。选取PMV综合评价指标开展了人体热舒适性的试验评价研究,验证了指标限值和评价方法的合理性。炎热夏季车厢经空调降温30min和1h时,分别对人员的卧姿、坐姿、站姿各测点热环境参数进行了测试,并进行加权处理,参考相关文献得出了人体代谢率和服装热阻,编写Matlab程序计算了各种姿态的PMV指标值,得出结论:在外界38.8℃环境条件下,经30min降温,车厢内温度到达28℃左右,卧姿伤病员的PMV值在-0.5⁺0.5的舒适性范围内,热舒适性较好,而医护人员和坐姿伤病员则感觉偏热;经1h降温,车厢内温度达到了25℃,医护人员和坐姿伤病员的PMV值在-0.5⁺0.5的舒适性范围内,医护人员的整体热舒适性较好,但PD指标表明其存在局部不舒适感,而卧姿伤病员则感觉偏凉。可以通过调节空调制冷档位、增加卧姿伤病员的服装热阻及改变送风口百叶方向来改善车厢内人员的热舒适性。（2）在振动环境方面,分析了人体振动特性和振动对人体的影响。在参考相关标准的基础上,确定了卫生技术车辆内坐姿、卧姿人体振动舒适性指标限值及相应的振动舒适性评价方法和评价等级。在汽车试验场对急救车内坐姿、卧姿伤病员振动舒适性进行了道路试验,运用DASP振动分析软件对测量数据进行处理,验证了指标限值和评价方法的合理性:即急救车以40km/h的速度在沥青路上行驶时,坐姿振动的总计权加速度均方根值为0.65 m/s²,在1.027m/s²的范围内;卧姿振动的两次计权加速度均方根值为0.39 m/s²,在1.250 m/s²的范围内,人体振动舒适性良好。（3）在极端生化环境方面,介绍了生化威胁的特点、生化防护措施及防护指标要求,提出了机动卫生装备舱室生化防护的指标限值和测试方法。运用数值模拟结果,结合层次分析法及模糊数学理论,建立了舱室安全性的评价方法,对手术方舱人员的安全性进行分析,得出结论:当舱室外存在5mg/L的HCN毒剂时,舱室内人员整体安全性属于“较安全”级以上的概率为65.4%,而“危险”和“较危险”的概率仅为0.67%,舱室的生化防护效果满足要求。此外,在空气环境方面,本文通过对舱室内空气污染物来源的分析总结出CO、CO₂、SO₂、NO₂、H₂S、NH₃、CH₂O、苯、总挥发性有机物（TVOCs）、可吸入颗粒物、微生物等常见空气组分,分析了各类污染物对人体健康的影响。在参考相关标准的基础上,确定了机动卫生装备舱室内空气组分浓度的指标限值,并结合热环境的研究内容确定了机动卫生装备舱室通风量的指标限值和测试方法,针对医疗舱室特点确定了机动卫生装备舱室洁净度等级。引入空气品质（IQA）的概念,介绍了客观评价、主观评价、综合评价中有代表性的方法,特别是指数评价和PDA评价指标。根据污染物的特点、污染源的强度,提出了控制舱室空气质量的措施。在噪声、照明、电磁辐射等其他环境方面,介绍了噪声、电磁辐射的来源及危害,强调了舒适光照条件的重要性。在参考相关标准的基础上,确定了机动卫生装备舱室内噪声、照度、电磁辐射的指标限值,介绍了相关的测试评价方法,特别是等效连续声级和烦恼指数等噪声评价指标。本文的研究成果被国家军用标准《野战卫生舱室微环境质量要求与评价方法》所采用。更多还原

【Abstract】 Benign microenvironment in compartment of mobile medical equipment is as important as tactics functions that can be mobile, cure the wounded and finish the service mission for meeting requirements of army. Mobile medical equipment may usually finish the medical treatment in atrocious conditions. For example, the climate of summer or winter is hot or cold, tropic zone is moist, many species of microbe exist and the condition of the roads is complicated. Quality of microenvironment in compartment of mobile medical equipment has immediately influence on efficiency of doctor and nurse and healthy of wounded. Simultaneously because it is possible that recently international BC （biologic and chemical） terrorism attack, paroxysmal chemical accident, fatal disaster and epidemic sometimes happen, mobile medical equipment must ensure people’s security during medical treatment. BC protection measures and BC protection indices of compartment are also important contents about microenvironment in compartment. It is necessary that air parameter in compartment can be regulated, concentration of air contaminants can be controlled, influence of vibration and impact can be weakened, poisonous gas or aerosol can be prevented into compartment, comfort and security of people can be ensured for mobile medical equipment by effectual manual methods as heating, ventilation, regulating air ingredient and controlling pressure of air.After productions of other concerned compartments and domestic and foreign standards are used for reference in the article, microenvironments in compartment of mobile medical equipment are classified as thermal environment, vibration environment, air environment, noise and illumination environment and extreme BC environment according to different functions and requirements of mobile medical equipment. Index system of microenvironment in compartment of mobile medical equipment is established. Index limits of quality grades of microenvironments and corresponding testing methods are suggested. According to analyzing theories corresponding evaluation methods are established.It is an emphasis that quality demands and evaluation methods of thermal environment, vibration environment and extreme BC environment in compartment are studied in the article. Experiments are conducted by taking emergency ambulance for biologic protection as example for alidating rationality of index limits and evaluation methods. Concrete contents as follow:（1） In terms of thermal environment, physical parameter under the influence of different thermal environment and thermal comfort mechanism of body are analyzed using environment medicine and physiology environment. The main influencing factors for compartment are confirmed. The relation between the thermal sense of body and thermal environment is discovered. After thermal environment standards of compartments and complex evaluation indices of thermal sense are analyzed, index limits, testing methods and evaluation methods of thermal environment in compartment of mobile medical equipment are established. Experiment and evaluation of thermal comfort of body are conducted using PMV complex evaluation index for validating rationality of index limits and corresponding evaluation methods.When temperature in the carriage falls using air-conditioning in summer thermal parameters of every position as supine posture, sitting posture and stand-up posture are measured and weighted at the time of 30min and 1h. The metabolic rate and clothing insulation can be found out by reference. The values of PMV indices of postures are worked out using Matlab programs. The conclusion of thermal comfort of people is obtained. When initial outside temperature is 38.8℃, PMV of supine wounded is during the comfort range of -0.5⁰.5 ,thermal comfort of them is well and doctor,nurse and sitting wounded feel hotter at the time of temperature in the carriage falling to about 28℃by 30min. PMV of doctor, nurse and sitting wounded is during the comfort range of -0.5⁰.5 ,whole thermal comfort of doctor and nurse is well and supine wounded feel colder when temperature in the carriage falls to about 25℃by 1h. But local discomfort of doctor is verified using PD index. Thermal comfort of people in the carriage can be improved by regulating buttons of air-conditioning, increasing clothing insulation of supine wounded and transforming the direction of flow.（2） In terms of vibration environment, body vibration property and influence of vibration are analyzed. On the basis of consulting concerned standards index limits, evaluation methods and evaluation grades of sitting and supine body vibration comfort for medical vehicle are confirmed. Vibration comfort experiment of sitting and supine wounded in the emergency ambulance is conducted in the proving ground of vihecles. Datum measured is analyzed using analyzing software DASP. Rationality of index limits and evaluation methods are validated. Total acceleration square root of sitting body vibration is 0.65 m/s² and two-time acceleration square root of supine body vibration is 0.39 m/s² when emergency ambulance runs in the velocity of 40 km/h on the pitch road. Parameter of sitting body vibration is less than 1.027 m/s² and parameter of supine body vibration is less than 1.250 m/s². The demand of their vibration comfort is satisfied.（3）In terms of extreme BC environment, property of BC menace, BC protection methods and BC protection indices are introduced. Index limits and testing methods of BC protection capability in compartment of mobile medical equipment are suggested. Security evaluation methods of compartment are established using numerical simulating results, AHP methods and fuzzy math. Security of people in the operation shelter is analyzed. The conclusions show that probability of overall security of operation shelter that belong to more than“comparative safe”is 65.4% and probability of it that belong to“comparative danger”and“danger”is only 0.67%while outside poison HCN concentration is 5mg/L. BC protection capability of shelter is satisfied.Furthermore in terms of air environment ,air ingredient as CO, CO₂, SO₂, NO₂, H₂S, NH₃, CH₂O, benzene, TVOCs, absorbable particle and microbe are summarized analyzing source of air contamination in compartment. The influence of contamination for people’s healthy are analyzed. On the basis of consulting concerned standards concentration limits of air ingredient in compartment of mobile medical equipment are confirmed. And index limits and testing methods of ventilation flow in compartment of mobile medical equipment are confirmed combining with research on thermal environment. Lustration in compartment of mobile medical equipment is confirmed according to the property of medical compartments. Representative methods in objective evaluation, subjective evaluation and complex evaluation are introduced using IQA. Especially index evaluation and PDA index are important evaluation methods in them. The measures that can improve air quality are suggested according to property of contamination and intensity of source.In terms of noise, illumination and radiation environment source and harm of noise and radiation are introduced and comfortable illumination is emphasized. On the basis of consulting concerned standards index limits of noise, illumination and radiation in compartment of mobile medical equipment are confirmed. Concerned testing methods are introduced. Especially equivalent consecutive sound level and annoyance index are important evaluation methods for evaluating noise.The production of the article is adopted by national army standard“quality demands and evaluation methods of microenvironment in the field medical compartment”.更多还原