本文選題：抗震救災(zāi) + 醫(yī)療后送��； 參考：《第二軍醫(yī)大學(xué)》2012年博士論文

【摘要】：生命救援是抗震救災(zāi)的首要任務(wù),醫(yī)療后送作為應(yīng)急醫(yī)學(xué)救援的核心內(nèi)容,直接影響傷病員的救治效果。2008年汶川地震是過去10年中國際范圍內(nèi)發(fā)生的破壞性最強的災(zāi)害之一,2010玉樹地震震區(qū)地處高原,是近年來救援難度最大的地震之一。通過汶川、玉樹兩次地震所積累的醫(yī)療后送經(jīng)驗、對后送規(guī)律的認(rèn)識和后送能力的儲備,應(yīng)當(dāng)固化為地震應(yīng)急醫(yī)學(xué)救援知識遺產(chǎn),為全人類所共享。國際社會在應(yīng)對地震導(dǎo)致的各種醫(yī)學(xué)問題上已取得了許多顯著進(jìn)展。而抗震救災(zāi)醫(yī)療后送是一項復(fù)雜的系統(tǒng)工程,我們必須更加關(guān)注其宏觀組織指揮,提高決策效率,以取得最佳的救援效果。從復(fù)雜系統(tǒng)科學(xué)的角度探討抗震救災(zāi)醫(yī)療后送系統(tǒng)的結(jié)構(gòu)與效率成為新興熱點問題。目前我國抗震救災(zāi)醫(yī)療后送仍然建立在傳統(tǒng)戰(zhàn)時醫(yī)療后送理論的基礎(chǔ)上,依靠指揮者的經(jīng)驗判斷進(jìn)行決策,缺乏針對性的理論指導(dǎo)和基礎(chǔ)性系統(tǒng)規(guī)律研究。因此,研究抗震救災(zāi)醫(yī)療后送復(fù)雜系統(tǒng)的特點與規(guī)律,創(chuàng)新抗震救災(zāi)醫(yī)療后送機制、提高抗震救災(zāi)醫(yī)療后送能力與指揮決策水平,對于提升抗震救災(zāi)醫(yī)學(xué)救援整體效果具有重要的現(xiàn)實意義和理論意義。 本課題是全軍醫(yī)藥衛(wèi)生科研基金課題《非戰(zhàn)爭軍事行動衛(wèi)勤保障理論研究》(09MA030)的深入,是國家科技支撐計劃《嚴(yán)重戰(zhàn)創(chuàng)傷救治組織與決策技術(shù)系統(tǒng)研究》(2009BA187805)和國家自然科學(xué)基金《城市地震應(yīng)急醫(yī)學(xué)救援多主體決策建模與效能評估研究》(71103194)的分課題,并受2011年度校博士創(chuàng)新基金軍事類研究項目《地震傷病員醫(yī)療后送建模研究》資助。 研究目的： 本課題是在總課題研究理念指引下,針對抗震救災(zāi)應(yīng)急醫(yī)學(xué)救援循證決策的拓展研究�；谇捌�(1+n)醫(yī)療服務(wù)系統(tǒng)復(fù)雜模型體系與大型決策支持平臺,結(jié)合課題組汶川、玉樹地震應(yīng)急醫(yī)學(xué)救援外部評估進(jìn)展,借鑒軍隊“非戰(zhàn)爭軍事行動衛(wèi)勤保障理論研究”成果,依據(jù)對汶川、玉樹抗震救災(zāi)醫(yī)療后送的大規(guī)�，F(xiàn)場調(diào)研數(shù)據(jù),運用復(fù)雜適應(yīng)性系統(tǒng)(Complex Adapting System, CAS)理論、系統(tǒng)動力學(xué)(System Dynamics, SD)建模技術(shù),進(jìn)行系統(tǒng)的抗震救災(zāi)醫(yī)療后送理論研究,明確抗震救災(zāi)醫(yī)療后送的定位、特點、原則；通過汶川、玉樹抗震救災(zāi)醫(yī)療后送實證分析,獲得醫(yī)療后送系統(tǒng)(Medical Evacuation System, MES)結(jié)構(gòu)框架、主體行為特征與結(jié)構(gòu)演化規(guī)律；進(jìn)行抗震救災(zāi)MES的復(fù)雜性分析與問題診斷,抽象系統(tǒng)主體類別、屬性,建立抗震救災(zāi)MES概念模型,確定系統(tǒng)內(nèi)部因果反饋關(guān)系及與外部環(huán)境之間的主要回路,獲得抗震救災(zāi)MES演化過程中主體的交互作用,在此基礎(chǔ)上構(gòu)建抗震救災(zāi)MES邏輯模型與SD模型,進(jìn)行傷病員后送與救治效果與醫(yī)療后送資源利用效率的模擬,以及對醫(yī)療后送資源、傷病員后送決策值與組織指揮效率的政策干預(yù)實驗,探討抗震救災(zāi)MES動態(tài)行為特征和內(nèi)部運行機制,發(fā)現(xiàn)影響系統(tǒng)效率的問題根源,并提出針對性的政策建議,研究成果能夠輔助抗震救災(zāi)應(yīng)急醫(yī)學(xué)救援戰(zhàn)略決策,為抗震救災(zāi)醫(yī)療后送政策試驗提供平臺。 研究資料： 研究資料來源包括3部分。一是現(xiàn)場調(diào)研資料。包括課題組于2008年6月赴汶川進(jìn)行汶川抗震救災(zāi)應(yīng)急醫(yī)學(xué)救援現(xiàn)場調(diào)研的資料,2010年4月、8月、12月分別赴玉樹、國家衛(wèi)生部、青海省衛(wèi)生廳進(jìn)行玉樹抗震救災(zāi)應(yīng)急醫(yī)學(xué)救援現(xiàn)場調(diào)研資料。二是搜集整理的各類文件、報表、日志等。包括汶川抗震救災(zāi)應(yīng)急醫(yī)學(xué)救援相關(guān)文件資料；玉樹地震緊急醫(yī)學(xué)救援的相關(guān)文件、報表等資料。三是從各類期刊數(shù)據(jù)庫檢索的抗震救災(zāi)醫(yī)療后送的相關(guān)文獻(xiàn)資料140余篇。 研究方法： 包括文獻(xiàn)法、專家訪談法、現(xiàn)場調(diào)研法、系統(tǒng)思考、復(fù)雜適應(yīng)性系統(tǒng)理論、系統(tǒng)動力學(xué)建模方法等。應(yīng)用文獻(xiàn)歸納分析方法,對抗震救災(zāi)醫(yī)療后送進(jìn)行定性分析和理論研究,應(yīng)用現(xiàn)場調(diào)研、文獻(xiàn)歸納、統(tǒng)計學(xué)方法,進(jìn)行汶川和玉樹抗震救災(zāi)醫(yī)療后送實證分析；應(yīng)用文獻(xiàn)法、現(xiàn)場調(diào)研法、專家訪談法、復(fù)雜適應(yīng)性系統(tǒng)理論等方法進(jìn)行抗震救災(zāi)醫(yī)療后送復(fù)雜性分析,進(jìn)行抗震救災(zāi)MES結(jié)構(gòu)性問題診斷；應(yīng)用系統(tǒng)動力學(xué)的系統(tǒng)思考與系統(tǒng)分析、建模方法,對抗震救災(zāi)傷病員MES進(jìn)行建模設(shè)計,篩選主回路與關(guān)鍵變量并進(jìn)行量化,依次構(gòu)建概念模型,邏輯模型與系統(tǒng)動力學(xué)模型；應(yīng)用Vensim DSS軟件進(jìn)行抗震救災(zāi)傷病員醫(yī)療后送模擬與干預(yù)實驗。 主要研究結(jié)果和結(jié)論： 本研究通過抗震救災(zāi)醫(yī)療后送理論研究,探討了抗震救災(zāi)醫(yī)療后送在傳統(tǒng)醫(yī)療后送理論基礎(chǔ)上的定位轉(zhuǎn)變、職能拓展、體系機制和特點原則；通過抗震救災(zāi)醫(yī)療后送實證分析,獲得抗震救災(zāi)MES主體結(jié)構(gòu)、行為特征與系統(tǒng)演化規(guī)律；通過構(gòu)建抗震救災(zāi)MES動力學(xué)模型,為抗震救災(zāi)醫(yī)療后送政策實驗提供工具方法；通過對抗震救災(zāi)醫(yī)療后送的政策干預(yù)模擬實驗,獲得了提高優(yōu)化醫(yī)療后送體制和流程、提高抗震救災(zāi)醫(yī)療后送決策效率的政策靶點,明確了各項政策的后果和影響,據(jù)此提出了相應(yīng)的政策建議。 抗震救災(zāi)醫(yī)療后送理論研究：抗震救災(zāi)醫(yī)療后送相對于傳統(tǒng)醫(yī)療后送,呈現(xiàn)出階梯簡化、�？浦委熆壳�、軍地協(xié)同的新特征�？拐鹁葹�(zāi)醫(yī)療后送的基本目的是降低地震傷死率與傷殘率,提高治愈率。地震傷病員發(fā)生呈現(xiàn)增長期和穩(wěn)定期的“兩期”時間分布特征。醫(yī)療后送應(yīng)以時效救治指導(dǎo)分級救治為原則,協(xié)調(diào)優(yōu)化傷病員后送的組織形式與保障方式。國外應(yīng)對特大災(zāi)難應(yīng)急醫(yī)學(xué)救援中亦呈現(xiàn)后送階梯簡化趨勢�？者\是大規(guī)模傷病員后送的主要方式,以海、空后送輔助陸地后送,形成傷病員立體后送體系。 抗震救災(zāi)醫(yī)療后送實證分析：通過汶川、玉樹抗震救災(zāi)醫(yī)療后送實證分析并與國外災(zāi)難醫(yī)療后送的點對點比較,發(fā)現(xiàn)早期后送和階梯簡化的醫(yī)療后送體系與傷病員救治需求相符；兩次抗震救災(zāi)災(zāi)區(qū)一線的傷病員檢傷分類的標(biāo)準(zhǔn)化程度不夠,造成了衛(wèi)生運力等稀缺資源的浪費,延誤了�？浦委煏r間；后方醫(yī)院收治能力評估方面尚待加強；傷病員中轉(zhuǎn)站發(fā)揮重要作用,空運后送在遠(yuǎn)距離后送至具有優(yōu)勢作用,但后送飛機及后送醫(yī)護(hù)人員存在安全隱患,不符合“送治結(jié)合”標(biāo)準(zhǔn)。 抗震救災(zāi)MES復(fù)雜性分析：抗震救災(zāi)MES的供、需方主體和決策行為特征具有復(fù)雜適應(yīng)性系統(tǒng)(CAS)的聚集特性、非線性、流特性與多樣性四種特性,其復(fù)雜行為機制可以通過微觀主體的“刺激-反應(yīng)模型”、宏觀系統(tǒng)的“回聲模型”與系統(tǒng)內(nèi)部結(jié)構(gòu)演化的模塊化“積木”機制進(jìn)行分析,是典型的多主體復(fù)雜系統(tǒng)。基于系統(tǒng)復(fù)雜性分析進(jìn)行問題診斷,發(fā)現(xiàn)抗震救災(zāi)MES的主要問題主要表現(xiàn)在抗震救災(zāi)MES機構(gòu)資源結(jié)構(gòu)障礙,抗震救災(zāi)MES主體行為障礙,子系統(tǒng)協(xié)調(diào)機制與等3個主要方面。 抗震救災(zāi)MES邏輯模型構(gòu)建：抗震救災(zāi)MES的系統(tǒng)邊界由抗震救災(zāi)MES結(jié)構(gòu)、抗震救災(zāi)MES主體和與系統(tǒng)相關(guān)的外部環(huán)境組成,系統(tǒng)的核心是傷病員在MES內(nèi)的流動�？拐鹁葹�(zāi)MES包含抗震救災(zāi)總指揮部、各級醫(yī)療后送機構(gòu)和傷病員三類主體組成。通過確定系統(tǒng)內(nèi)部因果反饋關(guān)系、影響因素及與外部環(huán)境之間的主要回路,獲得抗震救災(zāi)MES演化過程中主體的交互作用,構(gòu)建抗震救災(zāi)醫(yī)療后送邏輯模型,歸納出建模時聚焦的主要問題為：抗震救災(zāi)MES各級資源利用率與傷病員有效救治率。 抗震救災(zāi)醫(yī)療后送系統(tǒng)SD模型構(gòu)建與模擬干預(yù)：將抗震救災(zāi)MES的目標(biāo)設(shè)定為提高救治機構(gòu)資源利用率,提高后送效率和傷病員有效救治率；以Vensim軟件為平臺構(gòu)建抗震救災(zāi)醫(yī)療后送SD模型并進(jìn)行檢驗。模擬研究發(fā)現(xiàn)抗震救災(zāi)MES在震后72h內(nèi)的傷病員有效救治率低,支援力量部署效率低,而72h至震后2周內(nèi)醫(yī)療力量的低效率損失居高不下。干預(yù)實驗顯示抗震救災(zāi)醫(yī)療后送的早期后送傷員、合適的傷病員后送比例有利于傷病員有效救治,同時發(fā)現(xiàn)早期開始災(zāi)區(qū)醫(yī)療力量的調(diào)整對提高支援醫(yī)療力量配置效率的作用明顯,而提高需求判斷、醫(yī)療后送計劃、醫(yī)療后送決策及組織指揮效率,可以大幅提高傷病員有效救治率和醫(yī)療力量早期在災(zāi)區(qū)的飽和度。 政策建議： 通過以上對抗震救災(zāi)醫(yī)療后送理論研究、實證分析、建模與模擬干預(yù)研究,從創(chuàng)新抗震救災(zāi)醫(yī)療后送體制、提高醫(yī)療后送“送”、“治”連續(xù)性、加強抗震救災(zāi)醫(yī)療后送力量建設(shè)、促進(jìn)抗震救災(zāi)醫(yī)療后送組織指揮能力提升四個方面提出優(yōu)化醫(yī)療后送體制、提高醫(yī)療后送決策效率,提升醫(yī)療后送系統(tǒng)整體績效的政策建議。 本研究是復(fù)雜系統(tǒng)理論和系統(tǒng)動力學(xué)建模在抗震救災(zāi)傷病員醫(yī)療后送系統(tǒng)的首次嘗試,由于系統(tǒng)涉及面廣、影響因素多、相互關(guān)系復(fù)雜,難以全面描述,且缺少可借鑒的相關(guān)研究,研究建立的模型有待于進(jìn)一步優(yōu)化和細(xì)化,使之與實際更加貼合。
[Abstract]:Life rescue is the primary task of earthquake relief. As the core content of emergency medical rescue, medical evacuation directly affects the treatment effect of the wounded and sick people in the past 10 years is one of the most destructive disasters in the past 10 years. The 2010 Yushu earthquake area is located in the plateau, which is the most difficult earthquake in recent years. Through the medical evacuation experience accumulated in the two earthquake in Wenchuan and Yushu, the understanding of the law of evacuation and the reserve of the ability to send back should be solidified into the knowledge heritage of earthquake emergency medical rescue and shared by all mankind. The international community has made a lot of remarkable progress in dealing with the various medical problems caused by the earthquake. Medical evacuation is a complex system project. We must pay more attention to its macro organization and command, improve the efficiency of decision making, and obtain the best rescue effect. From the perspective of complex system science, the structure and efficiency of medical evacuation system in earthquake relief and disaster relief have become a new hot issue. On the basis of the theory of medical evacuation in United Front, we rely on the experience judgment of the commanders to make decisions, lack of pertinent theoretical guidance and basic systematic law research. Therefore, we study the characteristics and laws of the complex system in the earthquake relief medical evacuation system, innovate the medical evacuation machine system for earthquake relief and disaster relief, and improve the ability and command of medical evacuation in earthquake relief and disaster relief. The level of strategy has important practical significance and theoretical significance for improving the overall effect of medical rescue in earthquake relief.
This topic is the depth of the research foundation of the military medical scientific research fund of the whole army, the theoretical research of medical service support for non war military operations (09MA030). It is the national science and technology support program < serious trauma treatment organization and decision-making technology system > Research > (2009BA187805) and National Natural Science Fund < urban earthquake emergency medical rescue multi-agent decision-making modeling and effectiveness. The sub topics of evaluation study > (71103194) were funded by the 2011 year's doctoral innovation fund military research project, medical evacuation modeling for earthquake victims.
The purpose of the study is:
Under the guidance of the general topic research concept, this topic is based on the development of the evidence-based decision-making of emergency medical rescue in earthquake relief. Based on the complex model system of the early (1+n) medical service system and the large decision support platform, the development of the external assessment of the emergency medical rescue in Yushu earthquake is combined with the project group Wenchuan, and the military "non war military action" is used for reference. On the basis of the large-scale field survey data of Wenchuan and Yushu earthquake relief medical treatment in Wenchuan and Yushu, and using the complex adaptive system (Complex Adapting System, CAS) theory and the system dynamics (System Dynamics, SD) modeling technology, the theoretical research on the earthquake relief medical evacuation theory of the system is carried out to clarify the earthquake relief medicine. The positioning, characteristics and principles of the treatment after treatment; through the empirical analysis of Wenchuan and Yushu earthquake relief medical evacuation, the structure framework of Medical Evacuation System (MES), the main behavior characteristics and the structural evolution law, the complexity analysis and the problem diagnosis of the earthquake relief MES, the abstract system main body category, the attribute, and the establishment of the anti earthquake disaster relief MES are carried out. The MES concept model of earthquake relief, the internal cause and effect feedback relationship and the main circuit between the system and the external environment are determined, and the interaction of the main body in the process of earthquake relief MES evolution is obtained. On this basis, the MES logic model and the SD model for earthquake relief and disaster relief are constructed, and the results of the evacuation and rescue effect of the wounded and the utilization efficiency of the medical evacuation resources are simulated. As well as the policy intervention experiments on the medical evacuation resources, the casualty evacuation decision value and the organizational command efficiency, the dynamic behavior characteristics and internal operating mechanism of the earthquake relief MES are discussed, and the root of the problems affecting the efficiency of the system are found, and the pertinent policy suggestions are put forward, and the research results can help the emergency medical rescue strategy decision of the earthquake relief. It provides a platform for the earthquake relief medical evacuation policy test.
Research information:
The research data sources include 3 parts. One is the field survey data, including the data of the field research on the emergency medical rescue of Wenchuan earthquake relief in June 2008, in April 2010, August, December, Yushu, the Ministry of health and the Qinghai Department of health for emergency medical rescue in Yushu. All kinds of documents, reports, logs, etc., including the relevant documents of emergency medical rescue in Wenchuan earthquake relief, related documents and reports of emergency medical rescue of Yushu earthquake, three are more than 140 documents of relevant documents of earthquake relief medical treatment from various periodical databases.
Research methods:
It includes literature, expert interview, field investigation, systematic thinking, complex adaptive system theory, system dynamics modeling method and so on. It applies the method of literature induction to the qualitative analysis and theoretical study of earthquake relief medical evacuation, and applies the field investigation, literature induction and statistical method to carry out the earthquake relief medical treatment in Wenchuan and Yushu. An empirical analysis is carried out with the methods of literature, field investigation, expert interview, and complex adaptive system theory to carry out the complexity analysis of earthquake relief medical evacuation, and to diagnose the MES structural problems in earthquake relief. System dynamics and system analysis, modeling methods are applied to the construction of MES in earthquake relief and disaster relief. The model is designed, the main loop and the key variable are screened and quantized, and the conceptual model, the logical model and the system dynamics model are constructed in turn, and the Vensim DSS software is applied to the medical evacuation simulation and the intervention experiment of the earthquake relief and the sick and wounded.
The main results and conclusions are as follows:
Based on the theoretical research of earthquake relief medical evacuation, this paper discusses the positioning transformation, function expansion, system mechanism and characteristic principles on the basis of the traditional medical evacuation theory, and obtains the structure of the MES host, the behavior characteristics and the system evolution law through the earthquake relief medical evacuation. The MES dynamic model for earthquake relief and disaster relief is set up to provide a tool for the policy experiment of medical evacuation for earthquake relief. Through the policy intervention simulation experiment on the medical evacuation of earthquake relief, the policy targets are obtained to improve the system and process of medical evacuation and improve the efficiency of decision making in earthquake relief medical evacuation, and the consequences of various policies are clearly defined. Accordingly, the corresponding policy suggestions were put forward.
Research on medical evacuation of earthquake relief and disaster relief: in earthquake relief medical evacuation compared with traditional medical evacuation, it presents a new feature of simplified staircase, pre specialist treatment and military land coordination. The basic purpose of earthquake relief medical evacuation is to reduce the death rate and disability rate of earthquake injury and improve the cure rate. The "two phase" time distribution characteristics. Medical evacuation should be based on the principle of timed treatment and treatment guidance, coordinate and optimize the organizational form and guarantee mode of the injured patients. The foreign response to emergency medical rescue also presents the simplified trend of the evacuation ladder. Air transportation is the main way of the evacuation of the large wounded, with the sea and air evacuation auxiliary. It helps the land to be sent back to form the system of three-dimensional evacuation of the wounded and sick.
Empirical analysis of earthquake relief medical evacuation: through the empirical analysis of Wenchuan, Yushu earthquake relief medical evacuation and comparison with foreign disaster medical evacuation point to point, it is found that the early evacuation and stepped simplified medical evacuation system coincide with the treatment needs of the injured and sick people; the standardization of the classification of the wounded and the wounded in the two earthquake disaster relief area Lack of degree, resulting in the waste of scarce resources such as health transportation, delay the specialist treatment time; the assessment of the capacity of the rear hospital is still to be strengthened; the transfer station of the wounded is playing an important role and the air transport is sent to the hospital with the advantages of a long distance, but the evacuation of the aircraft and the post delivery medical staff is not in accordance with the "delivery and treatment". Combined with the standard.
The MES complexity analysis of earthquake relief: the supply of earthquake relief MES, the main body and the decision behavior characteristics have four characteristics of complex adaptive system (CAS), nonlinear, flow characteristics and diversity, its complex behavior mechanism can pass the "stimulus counter model" of the micro body, and the "echo model" of the macro system and the system within the system The modular "block" mechanism of the structural evolution of the Ministry is a typical multi-agent complex system. Based on the system complexity analysis, the problem diagnosis is carried out. The main problems of the earthquake relief MES are mainly manifested in the barrier of the resources structure of the earthquake relief MES mechanism, the behavior obstacle of the MES host in the earthquake relief and disaster relief, the subsystem coordination mechanism and the other 3 main factors. On the side.
The construction of MES logic model for earthquake relief: the system boundary of the earthquake relief MES is composed of the earthquake relief MES structure, the earthquake relief MES main body and the external environment related to the system. The core of the system is the flow of the wounded in the MES. The earthquake relief MES includes the general command department of the earthquake relief and disaster relief, the three main types of medical evacuation agencies and the wounded and sick members. By determining the internal causal feedback relationship of the system, influencing factors and the main circuit between the environment and the external environment, the interaction of the main body in the MES evolution process of earthquake relief and disaster relief is obtained, and the logical model of the earthquake relief medical evacuation is constructed, and the main problems of the focus are summarized as follows: the utilization rate of the resources at all levels and the effective rescue of the wounded and the sick and wounded in the earthquake relief and disaster relief The rate of treatment.
SD model construction and simulation intervention for earthquake relief medical evacuation system: setting the target of earthquake relief MES to improve the utilization rate of resources of rescue organizations, improving the efficiency of evacuation and the effective cure rate of the wounded, constructing the SD model of earthquake relief medical evacuation with the Vensim software as the platform and testing it. The simulation study found that the earthquake relief MES in earthquake relief was in earthquake. The effective treatment rate of the injured patients in the post 72h was low, the efficiency of the support force was low, and the low efficiency of the medical force was high within 2 weeks after the earthquake. The intervention experiment showed that the early evacuation of the wounded in the earthquake relief medical evacuation, the proportion of the appropriate wounded and the sick and sick people were beneficial to the wounded and the medical force in the early disaster areas. The adjustment of quantity has a significant effect on improving the efficiency of supporting medical force allocation, and the improvement of demand judgment, medical evacuation plan, medical evacuation decision and organization command efficiency can greatly improve the effective cure rate of the wounded and the medical force in the early stage of the disaster area.
Policy recommendations:
Through the above analysis of medical evacuation theory, empirical analysis, modeling and simulation intervention research, from innovative earthquake relief medical evacuation system, improve medical evacuation "send", "treatment" continuity, strengthen the construction of medical evacuation force in earthquake relief, and promote four aspects of improving the ability of medical evacuation organization and command. The policy recommendations of improving the efficiency of medical evacuation and improving the overall performance of the medical evacuation system are put forward.
This study is the first attempt of the complex system theory and system dynamics modeling in the medical evacuation system of the wounded and wounded in earthquake relief. Because the system involves a wide range, many factors are involved, the relationship is complex, it is difficult to fully describe it, and the related research is short of reference. The model set up needs to be further optimized and refined to make it more practical. Add up.

【學(xué)位授予單位】：第二軍醫(yī)大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2012
【分類號】：R82

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本文編號：1817273