损伤控制医学理论体系建设刍议

Preliminary discussion on construction of damage control medical theory system

  • 摘要: 损伤控制(damage control,DC)理念历经30多年的发展,其内核已实现从损伤控制外科(damage control surgery,DCS)的单纯技术概念,向损伤控制复苏(damage control resuscitation,DCR)的生理管理理念演进。纵向上,损伤控制贯穿了从受伤点急救到确定性治疗的全过程;横向上,损伤控制跨越了病理生理学、多系统外科学、介入影像学等多个学科,并可应用于平时和战时双场景,其内涵和外延的不断演进推动了损伤控制医学(damage control medicine,DCM)作为一个系统性理论体系的发展。本文系统回顾了损伤控制的发展背景、发展历程和最新进展,以战场救护中“白金十分钟”“黄金一小时”“关键三小时”时效救治作为框架,与损伤控制急救(damage control emergency,DCE)、DCR、DCS相对应,探讨构建以3D为核心的DCM理论架构,并提出我军的损伤控制体系建设参考路径。

     

    Abstract: Over more than three decades of evolution, the core concept of damage control (DC) has progressed from the primarily technical notion of damage control surgery (DCS) to the physiological management approach of damage control resuscitation (DCR). Vertically, the damage control strategy spans the entire continuum of care from point-of-injury first aid through to definitive treatment. Horizontally, it integrates multiple disciplines including pathophysiology, multisystem surgery, and interventional radiology, and is applicable in both civilian and military settings. The continuous expansion of its connotation and denotation has propelled the development of damage control medicine (DCM) as a systematic theoretical framework. This article systematically reviews the background, history, and advances in damage control. Using the critical timeframes for combat casualty care—the "Platinum Ten Minutes, " "Golden Hour, " and "Critical Three Hours"—as a structural framework, which correspond to damage control emergency (DCE), DCR, and DCS respectively, it explores the construction of a 3D-core DCM theoretical architecture and proposes pathways for building our military's relevant system.

     

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