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At the beginning of this century, breakthroughs and innovations in disruptive technologies represented by artificial intelligence have profoundly affected the development of human society and have become a central component in leading the new global military transformation. Saving the lives of the wounded and technological innovation are the driving force behind the development of military medicine. How to fight a battle and how to save people is the question that military medicine must answer. Joint all-area combat is a new military concept, representing the development direction of the future combat style, it has a strong strategic guiding significance for the future war and also puts forward higher requirements for the treatment of war injuries. "Platinum ten minutes, gold one hour" is the fundamental law of the battlefield first-line time-saving treatment, the war injury treatment must serve in the joint all-area combat demand and service requirements. This paper discusses the issue of demand or war injury treatment capacity building under the joint all-area combat pasture for criticism and correction.

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E-mail:
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21世纪初,以人工智能为代表的颠覆性技术的突破与创新深刻影响了人类社会的发展,也成为引领全球新军事变革的核心组成部分。挽救伤员生命与技术创新是军事医学发展的原动力。如何在新的作战样式和态势下成功救治伤病员,是军事医学必须回答的问题。联合全域作战是一种全新的军事理念,代表着未来作战样式的发展方向,对未来战争具有很强的战略指导意义,也对战伤救治提出了更高的要求。“白金10分钟,黄金1小时”是战场一线救治时效的根本法则,战伤救治必须服务于联合全域作战需求与勤务要求。本文就联合全域作战态势下战伤救治能力建设的需求问题进行初步探讨。

, correspAuthors=付小兵, authorNote=null, correspAuthorsNote=
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付小兵,战创伤和组织修复与再生医学专家,一级教授,少将军衔。中国工程院院士、美国工程院和法国医学院外籍院士。任解放军总医院医学创新研究部创伤修复与组织再生研究中心主任,中国医学科学院和中国中医科学院首批学部委员,第十四届全国政协委员。长期从事战创伤和组织修复与再生医学研究,在战创伤医学、组织修复和再生医学及生物治疗学三大领域取得了系统性、创造性的贡献。担任《解放军医学杂志》《军事医学研究(英文)》(Military Medical Research)主编。以第一完成人获国家科技进步一等奖1项,二等奖3项。获全国杰出专业技术人才称号、全国创新争先奖章以及何梁何利奖等多项荣誉,并荣立一等功。

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付小兵,战创伤和组织修复与再生医学专家,一级教授,少将军衔。中国工程院院士、美国工程院和法国医学院外籍院士。任解放军总医院医学创新研究部创伤修复与组织再生研究中心主任,中国医学科学院和中国中医科学院首批学部委员,第十四届全国政协委员。长期从事战创伤和组织修复与再生医学研究,在战创伤医学、组织修复和再生医学及生物治疗学三大领域取得了系统性、创造性的贡献。担任《解放军医学杂志》《军事医学研究(英文)》(Military Medical Research)主编。以第一完成人获国家科技进步一等奖1项,二等奖3项。获全国杰出专业技术人才称号、全国创新争先奖章以及何梁何利奖等多项荣誉,并荣立一等功。

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付小兵,战创伤和组织修复与再生医学专家,一级教授,少将军衔。中国工程院院士、美国工程院和法国医学院外籍院士。任解放军总医院医学创新研究部创伤修复与组织再生研究中心主任,中国医学科学院和中国中医科学院首批学部委员,第十四届全国政协委员。长期从事战创伤和组织修复与再生医学研究,在战创伤医学、组织修复和再生医学及生物治疗学三大领域取得了系统性、创造性的贡献。担任《解放军医学杂志》《军事医学研究(英文)》(Military Medical Research)主编。以第一完成人获国家科技进步一等奖1项,二等奖3项。获全国杰出专业技术人才称号、全国创新争先奖章以及何梁何利奖等多项荣誉,并荣立一等功。

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解放军医学杂志 | 院士论坛 2024, 49(1): 1-5
联合全域作战态势下对战伤救治能力建设需求的思考
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付小兵*
作者信息
  • 解放军总医院医学创新研究部创伤修复与组织再生研究中心,北京 100853
  • 付小兵,战创伤和组织修复与再生医学专家,一级教授,少将军衔。中国工程院院士、美国工程院和法国医学院外籍院士。任解放军总医院医学创新研究部创伤修复与组织再生研究中心主任,中国医学科学院和中国中医科学院首批学部委员,第十四届全国政协委员。长期从事战创伤和组织修复与再生医学研究,在战创伤医学、组织修复和再生医学及生物治疗学三大领域取得了系统性、创造性的贡献。担任《解放军医学杂志》《军事医学研究(英文)》(Military Medical Research)主编。以第一完成人获国家科技进步一等奖1项,二等奖3项。获全国杰出专业技术人才称号、全国创新争先奖章以及何梁何利奖等多项荣誉,并荣立一等功。

通讯作者:

付小兵,E-mail:
Characteristics and development trend of war injury treatment under joint all-area combat situation
Xiao-Bing Fu*
Affiliations
  • Trauma Repair and Tissue Regeneration Research Center, Department of Medical Innovation Research, Chinese PLA General Hospital, Beijing 100853, China
出版时间: 2024-01-28 doi: 10.11855/j.issn.0577-7402.1557.2024.0117
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21世纪初,以人工智能为代表的颠覆性技术的突破与创新深刻影响了人类社会的发展,也成为引领全球新军事变革的核心组成部分。挽救伤员生命与技术创新是军事医学发展的原动力。如何在新的作战样式和态势下成功救治伤病员,是军事医学必须回答的问题。联合全域作战是一种全新的军事理念,代表着未来作战样式的发展方向,对未来战争具有很强的战略指导意义,也对战伤救治提出了更高的要求。“白金10分钟,黄金1小时”是战场一线救治时效的根本法则,战伤救治必须服务于联合全域作战需求与勤务要求。本文就联合全域作战态势下战伤救治能力建设的需求问题进行初步探讨。

战伤救治  /  联合全域作战  /  军事变革  /  军事医学

At the beginning of this century, breakthroughs and innovations in disruptive technologies represented by artificial intelligence have profoundly affected the development of human society and have become a central component in leading the new global military transformation. Saving the lives of the wounded and technological innovation are the driving force behind the development of military medicine. How to fight a battle and how to save people is the question that military medicine must answer. Joint all-area combat is a new military concept, representing the development direction of the future combat style, it has a strong strategic guiding significance for the future war and also puts forward higher requirements for the treatment of war injuries. "Platinum ten minutes, gold one hour" is the fundamental law of the battlefield first-line time-saving treatment, the war injury treatment must serve in the joint all-area combat demand and service requirements. This paper discusses the issue of demand or war injury treatment capacity building under the joint all-area combat pasture for criticism and correction.

combat casualty care  /  joint all-area combat  /  revolution in military affairs  /  military medicine
付小兵. 联合全域作战态势下对战伤救治能力建设需求的思考. 解放军医学杂志, 2024 , 49 (1) : 1 -5 . DOI: 10.11855/j.issn.0577-7402.1557.2024.0117
Xiao-Bing Fu. Characteristics and development trend of war injury treatment under joint all-area combat situation[J]. Medical Journal of Chinese People’s Liberation Army, 2024 , 49 (1) : 1 -5 . DOI: 10.11855/j.issn.0577-7402.1557.2024.0117
当今,由各大军事强国引领的世界新军事变革持续向深发展,伴随着作战形态、作战对手的不断变化,作战样式愈发多样,作战手段愈发丰富,作战理念愈发先进。联合全域作战是一种全新的军事理念,代表了未来作战样式的发展方向。在此作战态势下,面对极端救治环境,利用有限救治资源挽救更多生命是战伤救治的根本目标。俄乌战争呈现出人类迄今为止最接近由机械化向智能化转型的作战形态,救治技术向战场一线前伸配置,体现出智能化、无人化、模块化、集成化、分散化等鲜明特征[1]。因此,联合全域作战对战伤救治能力及颠覆性技术创新提出了更高的要求。
未来作战可能同时面临多种极端环境及地域的挑战,与之相适应的,2016年,美军首次提出多域战斗(multi-domain battle,MDB)的概念,旨在在智能化、网络化等新技术条件支撑下,突破现行作战区域的划分以及力量部署模式,形成融合度高、机动灵活性强、空天一体的作战样式。随着新军事革命的持续深入,这一概念逐渐演变成覆盖“物理域”“信息域”“社会域”及“认知域”的联合全域作战新理念。2017年11月,美军参谋长联席会议发布的《联合卫生勤务》条令[2]中,明确了国防卫生局、各军种卫勤部门应联合向作战司令部提供一体化、高质量医疗保障服务的要求[3]。2019年1月18日,美军公布“多域战战伤救治创新研究计划”,提出了在极端环境条件下多域作战的卫勤保障新理念,并通过程序优化与技术创新,以及加强战场救治能力建设,实现在极端环境下以有限资源挽救更多伤员生命的目标。
未来全域作战条件下,救治环境极端恶劣,卫勤保障可能面临分割、孤立等严酷局面[4-5]。战伤救治新装备的研发与作战样式的变化密切相关,其需求是通过提高装备的救治性能和普适性能,以弥补环境的差异和人员专业性的差异。因此,战伤救治新装备的研发重点应考虑如下几个方面:一是要提高机动性、便携性及可靠性。一级阶梯救治装备追求小型化、轻量化,便于单兵携带和使用[6];二级阶梯救治装备追求集成化、通用化及稳定性,能适应多种运载工具运输,能耐受高温、高湿、高寒等极端天气,能承受振动、高海拔、海水侵蚀等恶劣条件,并始终保证功能稳定、运行良好。二是要具有简便、智能、易操作的特点,充分考虑不同专业水平背景操作人员的需要,具备辅助决策能力,通过闭环或半闭环反馈工作模式提高装备的自动化水平,通过信号式简化输出改善人机交互,降低救治人员的使用门槛。三是要具备通配性强、易维护的特点,降低设备功耗和维护要求,提高模块化和互操作水平,实现能源模块及功能模块互换互用,并能与现有技术及装备器材高度兼容。新装备的研发应用,将成为战伤救治能力提升的基石。
俄乌战争让世界各国认识到,未来战争极有可能在实力相近的国家或联合体之间爆发,实施非对称打击或保障的可能性较低,在以强胜弱战争实践中取得的战术战伤救治(Tactical Combat Casualty Care,TCCC)经验和技术,及其依赖的强大后勤保障体系和完整救治链将受到诸多限制[7],伤员延时救治和途中救治等创新技术的发展为解决这一问题提供了良好的方案。延时伤员救治和后送途中优良救治技术的创新紧紧聚焦时效救治要求,其目标是通过强化战伤救治能力,减少可预防性死亡。联合全域作战态势下为实现这一目标,就要重点考虑以下途径:通过损伤控制性复苏和损伤控制性手术等关键救命技术的创新革新,为伤员在极端环境条件下等待确定性治疗争取时间;通过提高伤情分类能力,满足大批量伤员伤情评估和分类救治需求,提高救治策略的科学性和有效性,实现资源最大化利用;通过开发新型复苏血液制品、新型麻醉及抗感染药物,创新烧伤创面救治、非手术清创等技术,提高损伤控制干预能力[8];通过综合考虑主要致死原因的预防、创伤性脑损伤伤员的安全后送、二次损伤的控制等因素,制定延时救治重症伤员医疗后送指南,保证“上得去、救得好、送得下”;通过改进器官功能维持、离断组织保存等技术改善长期预后,为后期良好的治疗创造条件[9]。新技术的创新应用,将成为战伤救治能力提升的倍增器。
为满足联合全域作战对卫勤保障提出的瞬时、及时、全时伴随要求,以更好地适应环境复杂多样、形势瞬息万变、要素多元分散的未来战场,真正做到医疗与士兵同在,需根据一体化联合卫勤保障要求,进一步优化战伤救治流程,重新定义“黄金1小时”救治概念,必须解决极端环境下1小时以外救治效能下降的瓶颈问题[10],理顺伤员救治链条中三级救治阶梯的递进衔接关系,紧紧围绕紧急救治、损伤控制、收容救治、途中救治、专科手术这五项重要能力,通过优化救治流程把最好的医疗资源前置部署,确保优质医疗资源始终面向战场,始终服从作战。新流程和新标准的优化应用,将成为战伤救治能力均质化的压舱石。
2020年11月美国兰德公司发布《平时保持部署临床技能》研究报告,指出了美陆军医务人员在平战准备中存在的问题,并针对部署前培训提出了一系列改进意见。未来战争需在极端环境条件下利用有限资源展开救治,对一线救治人员的临床技能提出了更高的要求,建立满足未来联合全域作战战伤救治需求的训练体系迫在眉睫。
首先要完善训练制度。根据不同救治阶梯和不同作战环境区分通用课目和强化课目,分级分阶段组织培训,培养具备同等专业知识背景和操作技能层级的医务人员,规范考核认证流程,确保医务人员具备满足战时高效救治要求的专业水平。其次要突出致命伤情紧急救治、损伤控制性复苏、损伤控制性手术、批量伤员评估分类、重症伤员及创伤性颅脑外伤伤员后送与途中救治等重点内容,确保在超出“黄金1小时”时间范围仍能持续提供高水平的救治[11]
此外,要深刻把握军民融合一体化培训机制,充分利用地方创伤中心、创伤数据库等宝贵资源开展基础理论研究和实战化训练,提高实战保障水平,借助军事元宇宙、数字孪生等高新技术开展虚拟与现实深度融合训练,以科技进步带动训练质效的提升。培训将成为科技创新成果向实战能力生成转化的唯一桥梁。
颠覆性技术是具有变革性意义、能够跳出现有规则框架和思维局限的先行技术,既包括创新的概念、思路、原理,也包括现有技术的创新和整合应用。随着智能化时代到来,各领域学科深度交叉融合,军事革命与科技革命交织互进,颠覆性技术已经迎来集中涌现的重要机遇期。
联合全域作战态势下,伤员短时大量产生,救治区域高度分散,后送能力相对不足,延时救治理念能够更好地适应现场急救时间被迫延长时的继续处置需要,其装备技术体系的发展也越来越聚焦于战场持续救治、先进复苏救治和远距离途中救治三大能力生成。新型血管内装置、自主容量控制与循环支持装置等新型装备大大提升了现场“黄金1小时”的救治能力;可穿戴生物传感器 、便携式生命体征监测设备和高度集成自适应的高级生命支持装备有效提升了“黄金1小时”外的救治延伸能力;新型血液用品及血浆替代制品的研发,“死亡三联症”预防、序贯性液体复苏、允许性低血压等技术的突破进展,为保存伤员生命和确定性治疗争取了更多时间;快速血液测定技术、多模态掌上超声、颅脑创伤测定与控制技术、远程医疗系统等创新技术的应用,使战伤救治等级突破了时空局限,把最好的医疗资源送到了战场一线[12-14]。这些战伤救治的前沿理念与技术,在俄乌战争中已得到初步验证。
由英国国防科学技术实验室(DSTL)和皇家国防医学中心(RCDM)军事外科和创伤学部联合开展的一项军事再生医学研究,将血液生物工程、基于机械生物学的伤口再生,以及内源性再生作为军事再生医学领域的三大研究主题,旨在开发再生解决方案,实现功能性再生,全面优化功能重建方法和康复方案,改善伤员预后。基于“高新技术在一线”“医疗与士兵同在”“整体健康”等先进救治理念,把握从致死到致残的战伤规律变化,推进再生医学的前置应用,将对战伤救治领域的发展具有变革意义[15]。利用细胞工程学原理实现“人造血液”,并主动设计其功能组成,将颠覆损伤控制性技术[16];基因工程生长因子的应用,可加速创面愈合速度、尽快封闭创面,为控制并发症和改善创面预后提供基础;原位同步修复与再生、多种组织同步修复与再生技术的创新,新型生物材料的应用,组织工程和生物3D打印技术的融合,能彻底改变“挖东墙补西墙”的传统损伤组织修复模式,实现缺损组织的完美修复与再生。再生医学前沿技术的投入,将带来战伤救治理念与实践的巨大转变,为快速恢复战斗力提供保障,实现战伤救治能力整体跃升[17-18]
未来战争的伤员可能不仅仅是机体解剖结构上的损伤,而是包含心理、精神、认知等非解剖领域的复合损伤,心理防护和应激干预对伤员战时回归岗位和战后回归社会均具有重要意义。在伊拉克战争及阿富汗战争中,美军部署了“自由恢复诊所”及类似组织,通过加强适应性训练管控军事心理应激,使受干预士兵的行为健康功能得到全面改善。2019年,美国防高级研究计划局宣布启动“聚焦制药”项目,通过开展化学结构导向的药物设计,研发全新的神经精神疾病治疗药物,为罹患抑郁症、创伤后应激障碍、焦虑症及药物滥用等疾病的士兵提供快速起效和持久作用的治疗手段。2022年,美国防高级研究计划局启动“神经证据汇集工具”项目,旨在开发新的神经认知科学工具,加强军人精神心理早期筛查,提高精神疾病和心理健康问题的预测和早发现能力。上述举措,有效降低了部队非战斗减员的比例,为提高部队战斗力发挥了重要作用。
近年来,我军战场一线救治能力提升取得了重要进展,但仍需清醒地认识到我军总体战伤救治水平与世界一流之间尚有差距,需要进一步提高体系建设与标准要求、加快技术装备发展速度、提升卫勤建设模块化集成化和联合保障水平,完善一体化体制机制建设,以及增加实战化保障经验。在联合全域作战态势下,需重点加强以下几方面工作:
按照促进战斗力提升的根本要求,顺应时代、立足国情,吸收并借鉴发达国家建设信息化、智能化卫勤保障体系的先进经验,持续深化编制体制调整改革[19],着力破解平战准备存在差距、标准流程难统一、目标对焦不紧密、阶段衔接留空隙等未来战争战伤救治的痛点难题,充分整合可用资源,加强军民融合一体化建设,促进军种联合一体化保障,进一步精简规模、提升效能、优化结构、理顺关系,逐步建立健全具有中国军队特色的卫勤保障体制。把握未来战争客观规律,着力建设具有模块化、体系化、自适应、可持续等特征的机动卫勤保障力量[20],为应对联合全域作战在极端救治环境条件下的大规模伤员救治做足准备。
我国地域广阔,国土周边局势复杂,面临着复杂的国家安全形势。全域作战态势下有效保障力量易分散,且卫勤保障活动需覆盖海上、岛屿、高原、寒区、高温、高湿、荒漠等不同的极端作战环境,未来战争的战伤救治必须依靠科学的救治策略、可靠的救治技术和先进的救治装备[21]。救治技术的创新应当满足时效救治、延时救治、持续救治的理念要求,为降低伤员死亡率、提高伤员归队率、维护部队战斗力服务;救治装备的创新应当突出信息化、智能化、无人化、轻量化特征,易于携带展开,便于操作使用,实现传统救治技能与远程医疗手段相结合、战场态势感知与辅助救治决策相结合、提升主动防护与强化损伤控制相结合[22],现场高效救治与良好医疗后送相结合,并进行模块化、标准化、体系化配备,显著提升战伤救治效果。
提高形势预判与任务规划能力,推动我军卫勤保障体系建设由基于问题应对的被动发展模式向基于战争设计和概念引领的主动发展模式转变。依据未来战争作战环境、作战样式及作战对手的特点,结合重要作战准备方向、突出紧急救治要点、兼顾持续高效能救治难点,持续优化适应我军战伤救治需求的救治技术体系、救治装备体系和卫勤保障模式,先于作战行动形成可靠的卫勤保障实力,树立保障打赢的信心底气。
总之,新军事变革的根本内涵是创新。如何定义联合全域作战条件下战伤综合救治体系的概念、内涵、功能及组织形式,如何确定未来战伤救治人员的能力与素质需求,是应对新形势下战伤救治任务需求的紧要任务。把握战伤救治的发展趋势,建设完善适应我军整体发展战略的战伤救治机制体系,培养和用好适应联合全域作战要求的高素质人才,做好资源充分整合与高效释能,才能将技术优势转化为战斗力优势,为实现我军战伤救治能力整体跨越式发展提供动力。
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doi: 10.11855/j.issn.0577-7402.1557.2024.0117
  • 接收时间:2023-11-24
  • 首发时间:2025-11-23
  • 出版时间:2024-01-28
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  • 收稿日期:2023-11-24
  • 录用日期:2023-12-20
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    解放军总医院医学创新研究部创伤修复与组织再生研究中心,北京 100853

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付小兵,E-mail:
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2种不同金属材料的力学参数

Family
属数
Number of
genus
种数
Number of
species
占总种数比例
Percentage of
total species (%)

Genus
种数
Number of
species
占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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