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太空护理

泰然健康网
2024-12-15 19:56

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1 INTRODUCTION

This year marked 60 years since Russian cosmonaut Yuri Gagarin became the first human in space, part of the initial space race between the Soviet Union and the United States. Spaceflight and space exploration have seen a resurgence in recent years with the National Aeronautics and Space Administration (NASA)’s mission to return humans to the moon and ultimately continue to Mars, and the emergence of a new space race in the commercial sector with companies like Virgin Galactic, Blue Origin and SpaceX. This has led to extraordinary developments in relevant engineering and technology, as well as a new group of space travellers paying to fly commercial flights, unconstrained by the rigorous screening and training historically required of professional astronauts. With these breakneck advances, a new segment of the healthcare system should emerge to address the unique challenges of human health in space, moving beyond primarily suborbital flight and low-earth orbit, to lunar settlement and long-duration spaceflight.

Nurses are uniquely poised in the current healthcare profession to provide critical insight and develop systems and protocols to keep our astronauts and citizen space travellers healthy (Rogers, 1992). The need for healthcare development for space is a reality. We have moved beyond science fiction, and the nurse's training, skills, and experience will be valuable in designing and developing healthcare and policies for humans in space.

2 PHYSIOLOGICAL ALTERATIONS WITH SPACE TRAVEL

2.1 Now

2.1.1 Overview

A great deal of research has been performed—and is currently underway—on human adaptation to space flight. Nevertheless, compared to much biomedical research on Earth, data and information pertaining to human health in space are relatively limited and disparate, with fewer than 600 humans having travelled to space to date. Space travel thus far has included suborbital flights, like the recent commercial flights with Richard Branson and Jeff Bezos, flights to low-earth orbit, which includes the International Space Station, and lunar missions, like the Apollo moon landings. Much of the research medical has concentrated on the issues inherent to these relatively short-duration flights (up to 1 year on the International Space Station). Attention is now being paid to longer and more ambitious missions like one to Mars, which would entail extreme crew autonomy from Earth assistance, but several key issues for such flights remain crucially under-studied.

2.1.2 Health issues

Humans have performed at a very high level in space, especially considering the demands of the environment. Still, some primary health risks and adverse health outcomes have emerged as key concerns. NASA has identified five key hazards to human health and performance in space: altered gravity, radiation, isolation and confinement, distance from earth, and a hostile and closed environment (on the spacecraft). These factors can cause a variety of health issues, including heart and muscle atrophy and fluid shift out of the lower extremities due to weightlessness, neuro-ocular alterations and other difficulties possibly due to increased intracranial pressure, development of renal stones, urinary tract infections, alterations in the gut microbiome, loss of bone mass and muscle strength, and depressed or altered mood (Comfort et al., 2021; Demontis et al., 2017; Shen & Frishman, 2019). These issues can not only interfere with functioning and productivity in flight, but they can also cause long-term problems after flight.

2.1.3 Treatment and care

With proximity to Earth of space mission to date, astronauts are constantly monitored, and those who have a health problem can directly and immediately consult with specialists on Earth. If there is a true emergency, astronauts can be transported back to Earth for direct medical care in a matter of hours. Furthermore, astronauts endure a comprehensive screening process to identify potential health issues that would disqualify them from space flight.

2.2 Future

2.2.1 Overview

When considering long-duration or deep space flights (e.g. 3-year missions to Mars), we have no direct data to consult. Instead, NASA and other organisations will rely on predictive healthcare modelling, by drawing on a variety of resources, including what we know so far, information collected from analog environments, and consultation with a wide group of professionals in the field of human health and space.

2.2.2 Health issues

Astronauts will continue to experience the same healthcare issues they currently do, in addition to an increased risk for emergency problems (i.e. burns, broken bones, infection), all of which will need to be addressed independent of direct Earth consultation or support.

2.2.3 Treatment and care

Before launch, astronauts on these early long-duration missions will likely receive the highest and most sophisticated level of personalised and predictive medicine, including genetic mapping to screen for diseases and pharmacodynamics. Even with this level of proactive care, we can assume that astronauts may encounter serious or emergent health issues in flight. Treatment and care will largely be crew-directed and executed. Without the ability for real-time contact with Earth, the crew will need to be prepared to diagnose, treat and care for an injured crewmember on their own using what is available on the spacecraft. This will entail a need for more frequent and robust health assessments, long-term care, or even palliative care if one of the crew experiences a medical emergency for which they are unequipped to resolve. The healthcare burden on astronauts in these missions will be larger than in the past, and they will need to be physically and mentally prepared for the most extreme adverse consequences.

2.2.4 Commercial space flight

The Federal Aviation Administration (FAA) requires commercial space flights to provide a minimum of fourteen hours of pre-flight training for all space travellers. Flight fitness testing, physical and psychological, remains up to the company's discretion, which means standards for space flight could be drastically different from those of astronauts. As commercial flight and the ‘space tourism’ industry evolve past suborbital flight to include moon landings and space hotels, healthcare support will be needed to assist those travellers with lower levels of fitness and flight training than in their professional counterparts. This could include managing chronic health issues like high blood pressure or diabetes or addressing acute care needs like infections, bone fractures or unidentified cardiac arrhythmias. As commercial spaceflight becomes more common, companies may begin to distinguish themselves with high-quality customer care, which will include comprehensive medical support.

3 SPACE NURSING

Nurses have been involved in aerospace medicine even before the existence of human spaceflight. Delores (Dee) O’Hara was the first nurse to assist with health maintenance of astronauts on the ground, and she receives special recognition because astronauts in some cases entrusted her with their medical problems rather than the flight surgeons (physicians). In the early days of American space flight, nurses were considered to be assistants to physicians. Over the years, nurses have been involved in research at space centres. Commercial sectors like SpaceX are now seeking space operations nurses to work with a multidisciplinary team, including the areas of human spaceflight public health and occupational medicine. Space nursing could be defined as a specialty in which nurses use critical thinking and judgement to integrate objective data with subjective experience taking a holistic approach to managing symptoms and improving the well-being of individuals travelling into space. This may involve educating space travellers on self-care, health promotion and disease prevention, under circumstances where they may not easily be able to return to Earth. In addition, nurses can help space travellers to build resiliency amidst isolation and extreme environmental conditions.

4 TRANSFORMING HEALTH CARE FOR SPACE FLIGHTS

Nurses have unique patient-centred clinical expertise that positions them well to transform the current healthcare provided to space travellers (Rogers, 1992). Expertise in primary care, health promotion, mental health, disease prevention and palliative care can aid in managing pre-existing comorbidities, increasing personal resilience, controlling the spread of infection, and facilitating end-of-life care while access back to Earth might be limited. Nursing specialties, including critical care, flight, wilderness, psychiatric, public health, palliative and home-care nurses, have unique clinical decision-making and skillsets that can advance healthcare in space and make space travel more accessible for civilians. Nurses can also educate crewmembers on how to apply critical care nursing for their crewmates in case of an emergency, or, in extenuating medical circumstances, palliative care skills that may be needed in the limited-resource setting of a space shuttle. Nurse managers and administrators could not only assist with healthcare needs but also assume operational leadership roles overseeing the tasks for the crew launch and recovery.

5 FUTURE OF NURSING IN SPACE

Data suggesting that nursing is the most trusted profession in the healthcare industry should encourage both NASA and commercial sectors to include nurses in the health screening, education on self-management of comorbidities, promotion of mental health, and acute and palliative care of space travellers. It is imperative that nursing schools and nurse educators incorporate space health into nursing curricula to ensure that nurses are ready for future healthcare needs. Discussions need to begin on how space health can be incorporated into the curricula in the form of a certificate programme or an entire specialty as space traffic builds momentum. In addition, nurses need to expand research in understanding the symptoms associated with changes in gravity and how they can be managed efficiently. This will require reprioritising funding goals in nursing. Finally, nurses must have a seat at the healthcare decision for space flight to optimise decisions and plans established to make space travel safe and appealing, and nurses need to take the lead in promoting space travellers’ health.

全文翻译（仅供参考）

1 介绍

今年是俄罗斯宇航员尤里·加加林成为第一个进入太空的人类 60 周年，这是苏联和美国之间最初的太空竞赛的一部分。近年来，随着美国国家航空航天局 (NASA) 的使命是将人类送回月球并最终继续前往火星，以及商业领域与公司的新太空竞赛的出现，太空飞行和太空探索已经复苏比如维珍银河、蓝色起源和SpaceX。这导致了相关工程和技术的非凡发展，以及一群新的太空旅行者支付商业飞行费用，不受专业宇航员历来所需的严格筛选和培训的限制。有了这些突如其来的进步，

护士在当前的医疗保健行业中处于独特的地位，可以提供重要的洞察力并开发系统和协议，以保持我们的宇航员和公民太空旅行者的健康（罗杰斯，1992 年）。对太空医疗保健发展的需求是一个现实。我们已经超越了科幻小说，护士的培训、技能和经验将在为太空人类设计和制定医疗保健和政策方面很有价值。

2 太空旅行带来的生理变化

2.1 现在

2.1.1 概述

已经进行了大量关于人类适应太空飞行的研究，目前正在进行中。然而，与地球上的许多生物医学研究相比，与太空人类健康有关的数据和信息相对有限且各不相同，迄今为止，只有不到 600 人前往太空。迄今为止的太空旅行包括亚轨道飞行，例如最近与理查德布兰森和杰夫贝索斯的商业飞行，飞往低地球轨道的飞行，包括国际空间站，以及月球任务，如阿波罗登月。许多医学研究都集中在这些相对短时飞行（在国际空间站长达 1 年）固有的问题上。现在人们开始关注更长时间和更雄心勃勃的任务，比如去火星，

2.1.2健康问题

人类在太空中的表现非常高，特别是考虑到环境的要求。尽管如此，一些主要的健康风险和不利的健康结果已成为关键问题。NASA 已经确定了人类在太空中的健康和表现的五个主要危害：改变的重力、辐射、隔离和限制、与地球的距离以及敌对和封闭的环境（在航天器上）。这些因素会导致各种健康问题，包括心脏和肌肉萎缩以及由于失重导致下肢体液转移、神经眼部改变和其他可能由于颅内压升高、肾结石形成、尿路感染、肠道微生物组的改变、骨量和肌肉力量的丧失，以及情绪低落或改变（Comfort 等，2021 年；Demontis 等人， 2017 年；沉和弗里斯曼， 2019 年）。这些问题不仅会干扰飞行中的功能和生产力，而且还会在飞行后导致长期问题。

2.1.3治疗和护理

迄今为止，由于太空任务离地球很近，宇航员会受到持续监测，那些有健康问题的人可以直接和立即咨询地球上的专家。如果真的发生紧急情况，宇航员可以在几个小时内被运回地球接受直接医疗。此外，宇航员还要接受全面的筛查过程，以确定可能导致他们无法参加太空飞行的潜在健康问题。

2.2 未来

2.2.1 概述

在考虑长期或深空飞行（例如，为期 3 年的火星任务）时，我们没有可参考的直接数据。相反，NASA 和其他组织将依靠预测性医疗保健建模，通过利用各种资源，包括我们目前所知道的、从模拟环境收集的信息以及与人类健康和空间领域的广泛专业人士的协商.

2.2.2健康问题

除了紧急问题（即烧伤、骨折、感染）的风险增加之外，宇航员将继续面临与目前相同的医疗保健问题，所有这些问题都需要独立于直接的地球咨询或支持来解决。

2.2.3治疗和护理

在发射之前，执行这些早期长期任务的宇航员可能会接受最高和最复杂的个性化和预测医学，包括用于筛查疾病和药效学的基因图谱。即使有这种程度的主动护理，我们也可以假设宇航员在飞行中可能会遇到严重或紧急的健康问题。治疗和护理将主要由船员指导和执行。如果没有与地球实时联系的能力，机组人员将需要准备好使用航天器上可用的设备自行诊断、治疗和照顾受伤的机组人员。如果其中一名船员遇到他们无法解决的医疗紧急情况，这将需要进行更频繁和有力的健康评估、长期护理，甚至姑息治疗。

2.2.4商业航天

美国联邦航空管理局 (FAA) 要求商业太空飞行为所有太空旅行者提供至少 14 小时的飞行前培训。飞行健康测试，身体和心理，仍然由公司自行决定，这意味着太空飞行的标准可能与宇航员的标准大不相同。随着商业飞行和“太空旅游”行业从亚轨道飞行发展到包括登月和太空旅馆，将需要医疗支持来帮助那些体能和飞行训练水平低于专业同行的旅行者。这可能包括管理高血压或糖尿病等慢性健康问题，或解决感染、骨折或不明身份的心律失常等急性护理需求。

3 空间护理

甚至在载人航天飞行之前，护士就已经参与了航天医学。Delores (Dee) O'Hara 是第一位在地面协助宇航员健康维护的护士，她得到了特殊的认可，因为在某些情况下，宇航员将他们的医疗问题委托给了她，而不是飞行外科医生（医师）。在美国太空飞行的早期，护士被认为是医生的助手。多年来，护士一直参与太空中心的研究。SpaceX 等商业部门现在正在寻找太空运营护士与多学科团队合作，包括载人航天公共卫生和职业医学领域。太空护理可以定义为护士使用批判性思维和判断将客观数据与主观经验相结合的专业，采用整体方法来管理症状并改善进入太空的个人的福祉。这可能涉及对太空旅行者进行自我保健、健康促进和疾病预防方面的教育，因为他们可能无法轻易返回地球。此外，护士可以帮助太空旅行者在与世隔绝和极端环境条件下建立弹性。在他们可能无法轻易返回地球的情况下。此外，护士可以帮助太空旅行者在与世隔绝和极端环境条件下建立弹性。在他们可能无法轻易返回地球的情况下。此外，护士可以帮助太空旅行者在与世隔绝和极端环境条件下建立弹性。

4 改变太空飞行的医疗保健

护士拥有独特的以患者为中心的临床专业知识，可以很好地改变当前提供给太空旅行者的医疗保健 (Rogers, 1992）。在初级保健、健康促进、心理健康、疾病预防和姑息治疗方面的专业知识可以帮助管理先前存在的合并症、提高个人复原力、控制感染的传播以及促进临终关怀，同时返回地球有限的。护理专业，包括重症监护、飞行、荒野、精神病学、公共卫生、姑息治疗和家庭护理护士，拥有独特的临床决策和技能组合，可以促进太空医疗保健并使平民更容易进行太空旅行。护士还可以教育机组人员如何在紧急情况下为他们的机组人员应用重症监护护理，或者在有情有可原的医疗情况下，在航天飞机资源有限的环境中可能需要姑息护理技能。

5 太空护理的未来

数据表明，护理是医疗保健行业最值得信赖的职业，应鼓励 NASA 和商业部门将护士纳入健康筛查、合并症自我管理教育、促进心理健康以及太空旅行者的急性和姑息治疗。护士学校和护士教育工作者必须将空间健康纳入护理课程，以确保护士为未来的医疗保健需求做好准备。需要开始讨论如何随着空间交通的发展势头以证书计划或整个专业的形式将空间健康纳入课程。此外，护士需要扩大研究以了解与重力变化相关的症状以及如何有效管理这些症状。这将需要重新确定护理资助目标的优先级。最后，护士必须在太空飞行的医疗保健决策中占有一席之地，以优化为使太空旅行安全和有吸引力而制定的决策和计划，护士需要带头促进太空旅行者的健康。

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