Article(id=1320434417294758851, tenantId=1146029695717560320, journalId=1319373162502258839, issueId=1320434416447500876, articleNumber=null, orderNo=null, doi=10.16016/j.2097-0927.202511046, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1761321600000, receivedDateStr=2025-10-25, revisedDate=1764432000000, revisedDateStr=2025-11-30, acceptedDate=null, acceptedDateStr=null, onlineDate=1792745697568, onlineDateStr=2026-10-23, pubDate=1768406400000, pubDateStr=2026-01-15, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1792745697568, onlineIssueDateStr=2026-10-23, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1792745697568, creator=13701087609, updateTime=1792745697568, updator=13701087609, issue=Issue{id=1320434416447500876, tenantId=1146029695717560320, journalId=1319373162502258839, year='2026', volume='48', issue='1', pageStart='1', pageEnd='106', issueExtLink='null', onlineDate='null', pubDate='1768406400000', pubDateStr='2026-01-15', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1792745697366, creator='13701087609', updateTime=1792749679774, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1320451119940227660, tenantId=1146029695717560320, journalId=1319373162502258839, issueId=1320434416447500876, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1320451119940227661, tenantId=1146029695717560320, journalId=1319373162502258839, issueId=1320434416447500876, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=15, endPage=23, ext={EN=ArticleExt(id=1320434417496085444, articleId=1320434417294758851, tenantId=1146029695717560320, journalId=1319373162502258839, language=EN, title=Evolving strategies for combat casualty care in cold regions under nuclear and radiological threats: Addressing the complex battlefield, columnId=1320434417353470541, journalTitle=Journal of Army Medical University, columnName=Expert Review, runingTitle=null, highlight=null, articleAbstract=

Modern warfare and military operations are increasingly dependent on advanced high-tech equipment and emerging combat doctrines, resulting in a more complex and dynamic battlefield environment. In northern regions, severe cold during winter and challenging terrain generally lead to dysfunction of the multiple rescue system for combat casualties and significant difficulties in evacuation and medical transport of casualties. In recent years, the Democratic People’s Republic of Korea nuclear tests and the nuclear deterrence dynamics observed in the Russia-Ukraine conflict have heightened concerns over combat casualty management in cold regions under nuclear radiation conditions, making it a critical focus in military medical research. In this article, considering the core demands of our military combat casualty care and focusing on the construction of medical support capabilities, we primarily analyze the characteristics of changes in multiple systems of casualties in cold regions under nuclear radiation scenarios, profoundly explore the mechanism underlying trauma’s impact on the body, and then develop countermeasures from the various aspects, such as medical rescue levels and chains, rescue equipment, nutritional support, microbiome and other new techniques, providing references for reducing the casualty rate and improving success rate of treatment.

, authors=Yongxian ZHANG, Hui WANG, authorsList=Yongxian ZHANG, Hui WANG, authorCompany=null, correspAuthors=Yongxian ZHANG, authorNote=null, correspAuthorsNote=null, copyrightStatement=© 2026 Journal of Army Medical University, copyrightOwner=Editorial Office of Journal of Army Medical University, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1320434418238477258, articleId=1320434417294758851, tenantId=1146029695717560320, journalId=1319373162502258839, language=CN, title=面向复杂战场:寒区核辐射背景下战创伤救治的策略演进, columnId=1320434417496076879, journalTitle=陆军军医大学学报, columnName=专家述评, runingTitle=null, highlight=null, articleAbstract=

现代战争与军事行动日益依赖不断发展的高科技装备与新型作战理念,致使战场环境更加复杂多变。北部地区冬季低温严寒、地形复杂,易导致战创伤员多系统功能紊乱并增加转运难度。近年来朝鲜核试验引发的半岛安全风险、俄乌冲突中的核威慑态势,使核辐射背景下寒区战创伤救治已成为军事医学领域的关注焦点。本文基于我军战创伤救治核心需求,聚焦卫勤保障能力建设,重点分析核辐射背景下寒区战创伤中伤员多个系统变化特点,深入探究创伤对机体的影响机制并从医疗救援层级及链条、救援装备、营养支持、微生物组新技术等方面提出应对策略,为降低伤亡率、提高救治成功率提供参考。

, authors=张永先, 王晖, authorsList=张永先, 王晖, authorCompany=null, correspAuthors=张永先, authorNote=null, correspAuthorsNote=
张永先,博士,主任医师,博士研究生导师。长期从事创伤骨科临床与科研工作,如严重创伤及多发伤导致的失血性休克、骨盆骨折、骨髓炎、骨不连等,主要研究方向为骨与软骨缺损修复的组织工程学。曾参与我军首批赴苏丹维和医疗队,执行国际维和任务中的战创伤救治工作。兼任中国康复医学会修复重建外科专业委员会委员、山东省医学会手外科分会副主任委员、山东中西医结合学会骨科专业委员会副主任委员。主持军队后勤科研重点课题、实验室建设项目及与山东省立医院合作课题各1项。获军队科技进步奖三等奖1项,山东省科技进步二等奖、三等奖各1项。发表学术论文30余篇,其中SCI收录8篇。E-mail:
ZHANG Yongxian E-mail:
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面向复杂战场:寒区核辐射背景下战创伤救治的策略演进
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张永先 , 王晖
作者信息
  • 1中国人民解放军联勤保障部队第九六〇医院骨科,山东 济南
通讯作者:
张永先,博士,主任医师,博士研究生导师。长期从事创伤骨科临床与科研工作,如严重创伤及多发伤导致的失血性休克、骨盆骨折、骨髓炎、骨不连等,主要研究方向为骨与软骨缺损修复的组织工程学。曾参与我军首批赴苏丹维和医疗队,执行国际维和任务中的战创伤救治工作。兼任中国康复医学会修复重建外科专业委员会委员、山东省医学会手外科分会副主任委员、山东中西医结合学会骨科专业委员会副主任委员。主持军队后勤科研重点课题、实验室建设项目及与山东省立医院合作课题各1项。获军队科技进步奖三等奖1项,山东省科技进步二等奖、三等奖各1项。发表学术论文30余篇,其中SCI收录8篇。E-mail:
ZHANG Yongxian E-mail:
Evolving strategies for combat casualty care in cold regions under nuclear and radiological threats: Addressing the complex battlefield
Yongxian ZHANG , Hui WANG
Affiliations
  • 1Department of Orthopedics, No. 960 Hospital of Joint Service Support Force of PLA, Jinan, Shandong Province, China
出版时间: 2026-01-15 doi: 10.16016/j.2097-0927.202511046
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现代战争与军事行动日益依赖不断发展的高科技装备与新型作战理念,致使战场环境更加复杂多变。北部地区冬季低温严寒、地形复杂,易导致战创伤员多系统功能紊乱并增加转运难度。近年来朝鲜核试验引发的半岛安全风险、俄乌冲突中的核威慑态势,使核辐射背景下寒区战创伤救治已成为军事医学领域的关注焦点。本文基于我军战创伤救治核心需求,聚焦卫勤保障能力建设,重点分析核辐射背景下寒区战创伤中伤员多个系统变化特点,深入探究创伤对机体的影响机制并从医疗救援层级及链条、救援装备、营养支持、微生物组新技术等方面提出应对策略,为降低伤亡率、提高救治成功率提供参考。

军事医学  /  寒区  /  核辐射  /  战创伤

Modern warfare and military operations are increasingly dependent on advanced high-tech equipment and emerging combat doctrines, resulting in a more complex and dynamic battlefield environment. In northern regions, severe cold during winter and challenging terrain generally lead to dysfunction of the multiple rescue system for combat casualties and significant difficulties in evacuation and medical transport of casualties. In recent years, the Democratic People’s Republic of Korea nuclear tests and the nuclear deterrence dynamics observed in the Russia-Ukraine conflict have heightened concerns over combat casualty management in cold regions under nuclear radiation conditions, making it a critical focus in military medical research. In this article, considering the core demands of our military combat casualty care and focusing on the construction of medical support capabilities, we primarily analyze the characteristics of changes in multiple systems of casualties in cold regions under nuclear radiation scenarios, profoundly explore the mechanism underlying trauma’s impact on the body, and then develop countermeasures from the various aspects, such as medical rescue levels and chains, rescue equipment, nutritional support, microbiome and other new techniques, providing references for reducing the casualty rate and improving success rate of treatment.

military medicine  /  cold region  /  nuclear radiation  /  combat trauma
张永先, 王晖. 面向复杂战场:寒区核辐射背景下战创伤救治的策略演进. 陆军军医大学学报, 2026 , 48 (1) : 15 -23 . DOI: 10.16016/j.2097-0927.202511046
Yongxian ZHANG, Hui WANG. Evolving strategies for combat casualty care in cold regions under nuclear and radiological threats: Addressing the complex battlefield[J]. Journal of Army Medical University, 2026 , 48 (1) : 15 -23 . DOI: 10.16016/j.2097-0927.202511046
我国寒区地域广阔,包括东北、西北、华北等地区,约占全部国土面积的43.5%,并有着漫长的边境线,是国防战略要地。寒区具有温度低、雨雪多、风速高、辐射强、温差大等气候环境特点,且有地形复杂、交通恶劣等地理环境特点[1],人体长时间暴露在寒冷环境中会出现一系列生理和病理改变[2]。在寒区作战环境中,战创伤员出现循环、呼吸、运动、泌尿、神经、内分泌等多个系统功能紊乱,加之地形复杂导致转运困难,严重阻碍伤员的有效救治。而在现代化战争中,高科技装备不断发展,作战理念和方式也日趋复杂[3],朝核问题使半岛的局势日趋紧张[4]。俄乌冲突中低温使伤亡人数剧增,且多个国家存在核威胁使作战更加的复杂、形势更加严峻[5],因此提升部队在核辐射背景下寒区的作战能力与战创伤救治水平,无疑是一项重要而紧迫的议题。本文主要阐述核辐射背景下寒区战创伤中多个系统损伤的特点及对损伤预防和治疗的应对策略,以期提高战创伤救治水平。
寒冷刺激对颅脑的损伤具有多维度、系统性特征,其危害不仅源于低温直接作用,更涉及血液循环、神经功能及代谢调节的紊乱,在寒区军事作业等极端环境中尤为突出。寒冷环境下神经系统对低温的敏感性显著高于其他系统,在严寒中颅脑创伤的伤员易出现低体温,可直接加重颅脑损伤程度,使救治难度与病死率同步上升[6],使得中、重度颅脑创伤伤员的病死率增加3倍[7]。研究表明,寒冷环境下会显著增加创伤性脑损伤的氧化应激水平、加重血脑屏障的破坏、促进脑水肿的形成、加剧神经元的损伤[8];王雪[9]研究证明冷暴露刺激改变脑内下丘脑、海马体、垂体中的神经肽,使机体基本代谢受损。此外寒冷刺激会对认知功能造成严重影响,尤其是在注意力、反应速度、记忆力等方面[10]。低体温被证明是颅脑创伤导致伤员死亡的独立危险因素[6]。
寒冷刺激可通过多重病理生理机制对呼吸系统造成特异性损伤,对呼吸系统的影响包括呼吸纤毛运动减少、呼吸道分泌物和黏度增加。如果体温降至25 ℃以下,机体可能发生肺毛细血管通透性改变,进而导致肺水肿的形成。在低体温早期,机体通过应激反应激活呼吸反射,表现为呼吸频率代偿性加快,随低体温程度加重,呼吸频率和潮气量降低,严重时会抑制髓质呼吸中枢,削弱气管和支气管纤毛的运动,从而对气道造成损伤[11]。对于寒区军事作战人员而言,寒冷环境中呼吸系统损伤风险尤为明显。当御寒装备保障不足时,低温可直接破坏呼吸道黏膜屏障的物理完整性与免疫功能,且南方户籍未适应寒冷气候的士兵感染风险更高,成为寒区部队创伤减员的主要原因之一。此外,寒冷空气作为强理化刺激因子,可通过激活气道平滑肌表面的瞬时受体电位通道(transient receptor potential,TRP),诱发气道高反应性,诱发阵发性咳嗽[12],持续的咳嗽不仅会分散作业人员的注意力、降低动作协调性,还可能因通气功能受限导致体力耐力下降,显著影响作战效能与应急处突能力,这将加剧极端环境下的任务执行难度。
核相关危害事件中核武器(nuclear weapons,如原子弹、氢弹等)、核反应堆事故(nuclear reactor incidents,如切尔诺贝利核事故、福岛核事故)、放射性散布装置(radioactive dispersal devices,如爆炸型脏弹、非爆炸型脏弹等)均会对人体健康与生态环境构成重大且长期的危害,同时引发公共卫生应急、环境修复、社会治理等多维度挑战。其中核武器通过核裂变引爆,核爆炸释放的能量比常规炸药高出数倍,核爆炸会立即产生高温火球、热辐射、瞬时核辐射、空气冲击波、剩余核辐射、电磁脉冲等一系列危害[13]。这些效应有协同叠加性会造成大规模人员伤亡、基础设施损毁及长期环境污染。
在核事件发生期间,会存在多种形式的辐射。如电磁能的形式包括γ射线和X射线,微粒辐射包括α粒子、β粒子和中子[14]。局部或全身受到γ射线、β粒子、中子辐射污染时会引起皮肤辐射综合征(cutaneous radiation syndrome,CRS),CRS会经历前驱期、潜伏期、明显发病期、恢复期4个阶段。前驱期是身体对辐射的早期反应,皮肤出现瘙痒、刺痛感,以及出现短暂的红斑或水肿;潜伏期是一个相对“平静”的时期,可能持续数天至数周,皮肤内部的细胞和组织发生复杂的病理生理变化;明显发病期,皮肤基底层受到辐射,炎症反应加剧、红斑扩大,皮肤出现溃疡、起疱、脱毛等症状出现,严重的伤口深入肌肉和骨骼可能需要局部切除、植皮闭合或截肢,造成功能障碍;恢复期皮肤逐渐愈合,但仍会出现皮肤色素沉着异常、皮肤萎缩、角化过度等问题若处理不适将长期影响伤员生活甚至诱发皮肤癌[14]。在切尔诺贝利事故中,大量人员暴露于高剂量的核辐射环境下,237人疑似患有急性放射病(acute radiation sickness,ARS),确诊134人。在前3个月内有26名患者死亡,这些患者受到了高强度的β射线辐射,超过50%的体表面积出现损伤。幸存下来的ARS患者身体长时间遭受伤害并需长期接受康复治疗[15]。由此可知战创伤合并核辐射,会导致皮肤损伤,如果遭遇严重损伤,将导致创面迁延不愈,并易继发感染等严重并发症,其救治复杂性与病死率均大幅提升。
骨髓(bone marrow,BM)是人体中终生的造血组织,并且对电离辐射高度敏感,是核辐射损伤的主要靶器官[16]。电离辐射剂量在1~10 Gy时,主要损伤BM造血系统,出现造血功能障碍[17]。大量研究证实,核辐射诱导的造血功能障碍主要是由BM造血干细胞(hematopoietic stem cells,HSC)损伤导致的。战场核辐射诱导的骨髓造血干细胞(bone marrow hematopoietic stem cell,BM HSC)损伤会出现造血衰竭、免疫功能受损、血液系统疾病如再生障碍性贫血、骨髓增生异常综合征和白血病等严重后果[18-20]。大量研究证明,核辐射通过细胞凋亡、铁死亡、耗竭和早衰等机制直接诱导HSC损伤[21-23]。此外,它还通过影响骨髓微环境,间接影响HSC的维持和再生,长期加剧造血功能损伤[24]。核辐射通过削弱HSC造血的重建功能或耗尽造血干细胞的数量,导致BM造血功能衰竭最终导致核辐射伤员死亡。由BM HSC耗竭所导致的出血和感染,是暴露于高剂量核辐射个体的主要死亡原因。因此,采用及时干预或采用药物治疗对减轻核辐射诱导的造血系统损伤,对战场上挽救战士们的生命、降低病死率具有重要意义。
寒区低温环境下,战创伤伤员失血易出现低体温,且此类创伤相关性低体温伤员的病死率明显高于正常体温的伤员的病死率[25]。核辐射损伤可导致伤员机体代谢紊乱,产热能力进一步下降,加重低体温状况,导致形成由低体温、凝血功能障碍和酸中毒组成的“致死三联征(lethal triad of trauma)”,当环境温度低于25 ℃时,人体温度每降低1 ℃,血液黏度就会增加2%[26],再加上低温导致的血管收缩会使心肌细胞的凋亡率增加和组织灌注不足,进一步导致代谢性酸中毒,使肾脏、肝脏、肺等器官出现一系列的并发症[27],这在寒区核辐射背景下病情会更加严重,且加剧恶性循环。凝血功能障碍使伤口止血困难,出血增多又加重休克和低体温,进一步损害凝血功能和酸碱平衡,大大增加伤病员死亡风险[28]。
寒冷环境会使免疫细胞内的酶活性降低,使促炎细胞因子如IL-6、IL-1β等水平升高,影响细胞的代谢和功能[29],而核辐射可损伤免疫细胞的DNA,使其活性降低,如巨噬细胞的吞噬和杀菌能力减弱,T细胞的免疫调节功能下降,使伤口处的感染风险增加。低温刺激会使皮肤血管收缩,血流减少,导致皮肤组织缺氧、营养缺乏,皮肤的屏障功能减弱。核辐射会直接损伤皮肤细胞的DNA,使细胞发生变性、坏死,损害皮肤基底层,使炎症反应加剧,出现放射性皮炎、溃疡等,使得外界病原体更容易侵入机体,增加感染风险,延缓伤口愈合。寒冷刺激可使呼吸道、消化道等黏膜组织的血管收缩,核辐射会对黏膜细胞造成损伤,使其更新和修复能力减弱,黏膜的分泌功能紊乱,伤口渗出物增多且长时间聚集,且免疫球蛋白急剧减少,无法有效抵御病原体,呼吸道、消化道等部位感染的风险大幅增加,最终使伤员创面愈合延迟、康复周期明显延长[30]。
核爆炸辐射范围广,释放的能量是常规炸药的数倍,短时间内会造成严重伤害,当出现大批核辐射伤员时要及时进行前接、分类、洗消、医疗救助及转运后送、治疗等一系列流程[31]。然而在寒区核战争的救援中常面临更大的挑战,如严寒中伤员出现冻伤和低体温使病情急剧恶化;极低温使洗消用水冻结,洗消供水困难,并且恶劣环境时道路受阻使物资的补给不能及时到达;低温使救援的仪器设备灵敏失调,导致精度不准,出现仪器设备故障;医护人员的肢体、手部精细操作也受温度影响,灵敏度下降;恶劣的条件常会对心理也构成一定的障碍,伤员易出现极度恐惧和绝望,因此完善的医疗救助模块对极寒条件下及时救助尤为重要[32]。
为提高救援效率通常将医疗救治模块划分为轻伤救治组、重伤救治组、医疗装备车;为防止辐射的持续影响,根据风向在上风或侧风向建立分类组、医疗救治组、洗消组、心理指导组、后送组,在极寒环境下要对人员和物资进行保温,可设置防寒洗消舱[33],心理指导组要宣讲提高伤员和救援人员的心理素质,进行心理疏导克服恐惧和不安。
完善人员配置和工作职能,通常要具备外科、内科、麻醉医师、护师、污染检测员等;为避免核污染的传播,医护人员要穿戴C级防护服,戴防护眼罩和N95口罩,同时戴3层橡胶手套,耗材采用一次性用品,所用仪器用保护膜包裹,用后进行清洗消毒至检测合格。
必要时及时进行药物干预,如当污染物中含有放射性碘时,立即给予碘化钾服用阻断身体对污染物的吸收[34]。医疗救助模块在寒区核辐射救援中发挥重要作用,是提高战斗力的一部分,因此模块需要不断完善,逐渐实现合理高效,减少作战人员的伤亡率。
对所有创伤伤员防止进一步温度降低是不可少的关键步骤,脱掉潮湿的衣服可使用防潮层、绝缘箔、或毯子、干燥衣物等进行自我复温,使用热袋、复温担架、发热装置等进行体外复温[35]。在伤员出现创伤出血时要及时采用快速止血装置止血,并在失血早期尽快进行输血,2022年在GURNEY等[36]的工作报告中称,在受伤后30 min内开始输血与24 h、30 d的生存率提高密切相关。APRIL等[37]对预测战斗创伤人员24 h病死率最佳阈值的研究得出结论,输注2 U的浓缩红细胞(packed red blood cells,PRBC)是预测病死率的90%敏感性阈值,输注33 U PRBC是预测病死率的90%特异性阈值。然而,如果无法及时有效在低温的环境中给药,早期血液的益处可能会受到影响,通过输液加热器给药的血液制品,加热器可以使静脉输液的速率提高至150 mL/min,输出的温度为38 ℃[38],这在有限的资源环境中提供及时有效的救助非常重要。
伤员需要呼吸支持时普通简易的呼吸球囊面罩会将寒冷的空气输送到肺部,近年来由美国健康科学统一服务大学研发的热原性紧急气道管理系统,轻便手持由电池供电,可连接到如简易呼吸球囊面罩的正压源上,能将环境空气加热并加湿到生理水平[39-40],减少冷空气对肺部的刺激,抑制创伤性低体温的进展。在寒区核辐射的救援中医疗团队应储备专业的防护设备至少包括:眼罩、头罩、全罩式空气净化呼吸器,一次性外套、手套、鞋套等[41]。使用辐射监测仪仔细检查伤员伤口,一旦确认伤员受到污染,首先用净化口罩保护伤员气道和口腔,以防止在净化过程中摄入和吸入颗粒。去除伤员的衣物,用干燥的超细纤维布擦拭伤员,特别是头发和裸露的皮肤。可以在面部和头发等区域使用稍微湿润的布或湿巾擦拭,用温水冲洗伤口,去污完成后应对伤员再次进行检查,并在处理过程中帮助伤员恢复体温,并根据情况尽快给伤员服用镇静、止痛药物,必要时给予碘化钾、乙二胺四乙酸、碳酸氢钠、亚铁氰化铁等解毒剂[13]。总之要采取尽早复温、早期诊断、早期积极治疗相结合的策略。
在寒冷环境作战如雪地中行走或翻越雪山前进,人体需要摄取更多的能量,通常的能量需要高达5 000~7 000 kcal/d(1 kcal=4.184 kJ)[42]。能量缺乏时会导致作战人员的身体功能如体温调节、免疫系统、心血管系统等受到严重影响,认知能力也会下降[43-44]。然而在作战环境中进食时间限制和食物储备的不足对保障能量摄入常造成一定的阻碍。因此在寒冷环境中的营养支持及替代策略更值得进一步探究。如一些微量元素维生素A、D、C、E、B6和B12、叶酸、锌、铁、铜和硒,对于维持免疫系统的正常功能至关重要。
在军事严酷的环境中缺乏维生素和矿物质会增加创伤人员感染的风险[45]。相关研究表明,在严寒环境中,军队人员建议每天补充1 500~2 000 U复合维生素,当膳食摄入量低时建议每天摄入高于4 000 U[46]。除此之外,不饱和脂肪酸、紫锥菊、益生菌等都免疫系统有关[47-48]。还有一些营养物质具有产热特性,例如生姜、L-薄荷醇、钙、多酚化合物等能刺激机体产热,抵御寒冷[49-50]。咖啡因、络氨酸等营养素化合物对专注力、警觉性、反应速度、思考判断、疲劳、嗜睡等方面有显著改善作用,可增强战斗人员的认知功能[51],在寒冷刺激前补充300 mg/kg的络氨酸可改善记忆和认知功能[52]。肌酸补充剂对剧烈运动后肌肉力量的恢复有重要作用,同时对认知功能也有重要作用,8 g/d持续服用5 d可减少战斗训练期间的精神疲劳感[53]。因此寒冷背景下战斗人员的食物中可以添加多种营养物质,增加能量和多种微量元素的摄入,制定长期营养支持策略。
在严酷环境中接受艰苦训练的军事人员需重点增加增强免疫力的微量营养素包括铁、锌、维生素D和维生素C。①铁:支持先天和适应性免疫功能;在氧气运输和细胞能量生产中起核心作用。铁储备耗竭会影响认知和身体功能;在炎症状态下,铁调素升高会减少铁吸收,可能导致“炎症性贫血”并损害免疫[54-58]。②锌:在先天和适应性免疫细胞的生长、发育和功能中起关键作用;影响肠道黏膜免疫;抑制自由基产生,增加抗氧化活性。锌缺乏会显著增加对病毒和寄生虫感染的易感性;预防性用锌能有效降低腹泻的流行率和发病率[59-63]。③维生素D:通过内分泌、旁分泌和自分泌机制作用于免疫细胞;具有抗感染作用,有利于肠道健康;上调抗菌肽(如cathelicidin)的mRNA表达。缺乏时会显著增加对病毒和寄生虫感染的易感性;预防性用锌能有效降低腹泻的流行率和发病率[63-66]。④维生素C:支持先天性和适应性免疫细胞的生长和功能,维持上皮屏障的完整性,促进吞噬作用和抗体产生。限制剧烈运动诱发的免疫抑制,降低感染风险;抗氧化作用对经常运动的人群尤为重要;可提高下肢力量发展速度[57,67-69]。
相关研究证明,肠道微生物群及其代谢物在核辐射诱导的肠道损伤中的发挥了重要作用,如通过调节免疫系统抑制炎症反应来维持稳态,减轻对胃肠道屏障的损伤,也可以通过调节机械屏障使肠道受核辐射的影响减小[70]。目前用到的基于肠道微生物群及其代谢物的治疗方法如益生菌,主要包括干酪乳杆菌、乳杆菌属细菌、嗜酸乳杆菌、双歧杆菌以及放线菌等会缓解辐射造成的胃肠道损伤[71];从健康人的粪便中提取微生物群进行粪菌移植,重建新的胃肠道菌群抵抗辐射的危害[72]。总之,肠道微生物群可通过直接作用于肠上皮细胞或通过影响免疫反应来发挥对辐射的抵抗作用。这些发现为开发基于微生物组的放射防护剂提供了新思路。
在冻伤治疗领域,美国食品药品监督管理局(Food and Drug Administration,FDA)在2024年2月首次批准伊洛前列素注射液用于治疗成人严重冻伤,这种技术可有效治疗穿透皮肤造成肌肉、肌腱和骨骼损坏的深冻伤。如果伤员在冻伤后72 h内静脉注射该药,其手指或脚趾截肢的可能性就会大大降低[73]。近年,美国陆军环境医学研究所研发了一套冷气候全套服装决策辅助系统(cold weather ensemble decision aid,CoWEDA),见图1。该系统可以预测-40~0 ℃皮肤和核心体温情况,评估寒冷天气行动中可能出现的冻伤和低体温症风险,并根据预期任务、环境条件、体力活动等,指导选择在寒冷条件下最合适的作战套装[74]。总之,随着技术进步,应综合运用多种干预策略与防护方案,以提升对寒冷与核辐射复合伤伤员的救治效果,降低病死率,并促进其康复、重返正常生活。
寒区环境与核辐射的双重作用会显著加剧机体多系统损伤,增加低体温及相关并发症的发生风险、延缓伤口愈合、严重影响伤员的身心健康(图2),亟待开展深入系统研究,建议从以下两方面进行研究与实践。
首先,需深入揭示寒冷与辐射双重因素对循环、神经及免疫系统的相互作用机制,为靶向干预提供理论依据。其次,应致力于发展集保温、辐射屏蔽与生命体征监测于一体的智能化防护装备,提升个体防护能力。在临床救治层面,构建以“保温优先”为指导、兼顾辐射损伤与冻伤特点的特殊急救流程与综合治疗方案,并高度重视士兵心理疾病的早期识别与干预,结合人工智能、情感计算、脑认知神经科学等高新技术,研究战斗应激心理损伤的早期识别工具。最终,通过将研究成果转化为智能决策支持系统与标准化训练方案,并将其深度整合于作战策略与卫勤保障体系,从而构建一个从基础到应用、从技术到体系的完整解决方案,为最大限度降低人员在极端环境下的伤亡率提供坚实支撑。

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2026年第48卷第1期
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doi: 10.16016/j.2097-0927.202511046
  • 接收时间:2025-10-25
  • 首发时间:2026-10-23
  • 出版时间:2026-01-15
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  • 收稿日期:2025-10-25
  • 修回日期:2025-11-30
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    1中国人民解放军联勤保障部队第九六〇医院骨科,山东 济南

通讯作者:

张永先,博士,主任医师,博士研究生导师。长期从事创伤骨科临床与科研工作,如严重创伤及多发伤导致的失血性休克、骨盆骨折、骨髓炎、骨不连等,主要研究方向为骨与软骨缺损修复的组织工程学。曾参与我军首批赴苏丹维和医疗队,执行国际维和任务中的战创伤救治工作。兼任中国康复医学会修复重建外科专业委员会委员、山东省医学会手外科分会副主任委员、山东中西医结合学会骨科专业委员会副主任委员。主持军队后勤科研重点课题、实验室建设项目及与山东省立医院合作课题各1项。获军队科技进步奖三等奖1项,山东省科技进步二等奖、三等奖各1项。发表学术论文30余篇,其中SCI收录8篇。E-mail:
ZHANG Yongxian E-mail:
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2种不同金属材料的力学参数
科
Family
属数
Number of
genus
种数
Number of
species
占总种数比例
Percentage of
total species (%)
属
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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