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目的 (1)应用系统动力学方法建立数学模型,宏观地模拟严重急性呼吸综合征(SARS)疫情在自然人群和医院内传播的过程,以及患者通过就诊和社区隔离措施移出传播链的过程。(2)通过计算机对该模型的仿真模拟,分析在突发 SARS疫情的情况下,代表主要防控措施的变量对疫情曲线的影响模式和相对强度。(3)重点分析发热监测措施对疫情的影响,根据分析结果对今后SARS防控工作提出政策建议。方法 采用面访、问卷调查、文献检索、个案分析等方式,获取SARS传播的重要参数。应用系统动力学理论及计算机仿真系统建立数学模型,并进行 What if仿真分析。结果 建立了能够反映SARS自然传播、患者就诊及医院内传播、社区隔离措施、发热监测过程的计算机仿真模型,通过宏观模拟SARS患者从发病到被移出传播链的过程得出下列结果:(1)患者从发病到就诊的时间、患者每日平均接触人数、就诊时医院内接触人数等是对 SARS的院内、院外传播过程影响最大的几个变量;(2)隔离强度、接诊医生对 SARS的警惕性、医院通风消毒、医院优化患者流动路线、医生防护强度是影响疫情控制的主要变量;(3)医院入口的体温筛查措施对疫情控制的作用不大。结论 按照目前制定的SARS防治预案,卫生系统能够快速控制突发的SARS疫情。
Objectives (1) To establish a mathematical model by using system dynamics, and to simulate macroscopically the process of SARS epidemic spreading in natural population and hospitals, and to remove the transmission chain through patient visits and community segregation measures. (2) Through computer simulation of this model, we analyze the influence pattern and relative intensity of the variables that represent the main prevention and control measures on the outbreak curve in the case of sudden SARS outbreak. (3) Focusing on the impact of fever monitoring measures on epidemic situation, and making policy recommendations on future SARS prevention and control work based on the analysis results. Methods Interview, questionnaire, literature search and case analysis were used to obtain the important parameters of SARS transmission. The application of system dynamics theory and computer simulation system to establish mathematical models, and What if simulation analysis. Results A computer simulation model was established to reflect the natural transmission of SARS, patient visits and intra-hospital transmission, community isolation measures and fever monitoring process. The following results were obtained by macroscopically simulating the process of SARS patients from onset to being removed from the transmission chain: (1) The time between onset and treatment, the average daily contact number of patients, the number of contacts within the hospital at the time of treatment are the most influential variables in the SARS in-hospital and out-of-hospital transmission process; (2) The isolation strength, Vigilantness, hospital ventilation and disinfection, hospitals optimize the flow of patients, doctor protection intensity is the main variable affecting the epidemic control; (3) The entrance of the body temperature screening measures little effect on outbreak control. Conclusion According to the current SARS prevention and control plan, the health system can quickly control the sudden SARS outbreak.