中华人民共和国海洋倾废管理条例(附英文)

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中华人民共和国海洋倾废管理条例(附英文)

国务院


中华人民共和国海洋倾废管理条例(附英文)

1985年3月6日,国务院

第一条 为实施《中华人民共和国海洋环境保护法》,严格控制向海洋倾倒废弃物,防止对海洋环境的污染损害,保持生态平衡,保护海洋资源,促进海洋事业的发展,特制定本条例。
第二条 本条例中的“倾倒”,是指利用船舶、航空器、平台及其他载运工具,向海洋处置废弃物和其他物质;向海洋弃置船舶、航空器、平台和其他海上人工构造物,以及向海洋处置由于海底矿物资源的勘探开发及与勘探开发相关的海上加工所产生的废弃物和其他物质。
“倾倒”不包括船舶、航空器及其他载运工具和设施正常操作产生的废弃物的排放。
第三条 本条例适用于:
一、向中华人民共和国的内海、领海、大陆架和其他管辖海域倾倒废弃物和其他物质;
二、为倾倒的目的,在中华人民共和国陆地或港口装载废弃物和其他物质;
三、为倾倒的目的,经中华人民共和国的内海、领海及其他管辖海域运送废弃物和其他物质;
四、在中华人民共和国管辖海域焚烧处置废弃物和其他物质。
海洋石油勘探开发过程中产生的废弃物,按照《中华人民共和国海洋石油勘探开发环境保护管理条例》的规定处理。
第四条 海洋倾倒废弃物的主管部门是中华人民共和国国家海洋局及其派出机构(简称“主管部门”,下同)。
第五条 海洋倾倒区由主管部门商同有关部门,按科学、合理、安全和经济的原则划出,报国务院批准确定。
第六条 需要向海洋倾倒废弃物的单位,应事先向主管部门提出申请,按规定的格式填报倾倒废弃物申请书,并附报废弃物特性和成分检验单。
主管部门在接到申请书之日起两个月内予以审批。对同意倾倒者应发给废弃物倾倒许可证。
任何单位和船舶、航空器、平台及其他载运工具,未依法经主管部门批准,不得向海洋倾倒废弃物。
第七条 外国的废弃物不得运至中华人民共和国管辖海域进行倾倒,包括弃置船舶、航空器、平台和其他海上人工构造物。违者,主管部门可责令其限期治理,支付清除污染费,赔偿损失,并处以罚款。
在中华人民共和国管辖海域以外倾倒废弃物,造成中华人民共和国管辖海域污染损害的,按本条例第十七条规定处理。
第八条 为倾倒的目的,经过中华人民共和国管辖海域运送废弃物的任何船舶及其他载运工具,应当在进入中华人民共和国管辖海域十五天之前,通报主管部门,同时报告进入中华人民共和国管辖海域的时间、航线、以及废弃物的名称、数量及成分。
第九条 外国籍船舶、平台在中华人民共和国管辖海域,由于海底矿物资源的勘探开发及与勘探开发相关的海上加工所产生的废弃物和其他物质需要向海洋倾倒的,应按规定程序报经主管部门批准。
第十条 倾倒许可证应注明倾倒单位、有效期限和废弃物的数量、种类、倾倒方法等事项。
签发许可证应根据本条例的有关规定严格控制。主管部门根据海洋生态环境的变化和科学技术的发展,可以更换或撒销许可证。
第十一条 废弃物根据其毒性、有害物质含量和对海洋环境的影响等因素,分为三类。其分类标准,由主管部门制定。主管部门可根据海洋生态环境的变化,科学技术的发展,以及海洋环境保护的需要,对附件进行修订。
一、禁止倾倒附件一所列的废弃物及其他物质(见附件一)。当出现紧急情况,在陆地上处置会严重危及人民健康时,经国家海洋局批准,获得紧急许可证,可到指定的区域按规定的方法倾倒。
二、倾倒附件二所列的废弃物(见附件二),应当事先获得特别许可证。
三、倾倒未列入附件一和附件二的低毒或无毒的废弃物,应当事先获得普通许可证。
第十二条 获准向海洋倾倒废弃物的单位在废弃物装载时,应通知主管部门予以核实。
核实工作按许可证所载的事项进行。主管部门如发现实际装载与许可证所注明内容不符,应责令停止装运;情节严重的,应中止或吊销许可证。
利用船舶倾倒废弃物的,还应通知驶出港或就近的港务监督核实。港务监督如发现实际装载与许可证所注明内容不符,则不予办理签证放行,并及时通知主管部门。
第十三条 主管部门应对海洋倾倒活动进行监视和监督,必要时可派员随航。倾倒单位应为随航公务人员提供方便。
第十四条 获准向海洋倾倒废弃物单位,应当按许可证注明的期限和条件,到指定的区域进行倾倒,如实地详细填写倾倒情况记录表,并按许可证注明的要求,将记录表报送主管部门。倾倒废弃物的船舶、航空器、平台和其他载运工具应有明显标志和信号,并在航行日志上详细记录倾
倒情况。
第十五条 倾倒废弃物的船舶、航空器、平台和其他载运工具,凡属《中华人民共和国海洋环境保护法》第四十三条规定的情形,可免于承担赔偿责任。
为紧急避险或救助人命,未按许可证规定的条件和区域进行倾倒时,应尽力避免或减轻因倾倒而造成的污染损害,并在事后尽快向主管部门报告。倾倒单位和紧急避险或救助人命的受益者,应对由此所造成的污染损害进行补偿。
由于第三者的过失造成污染损害的,倾倒单位应向主管部门提出确凿证据,经主管部门确认后责令第三者承担赔偿责任。
在海上航行和作业的船舶、航空器、平台和其他载运工具,因不可抗拒的原因而弃置时,其所有人应向主管部门和就近的港务监督报告,并尽快打捞清理。
第十六条 主管部门对海洋倾倒区应定期进行监测,加强管理,避免对渔业资源和其他海上活动造成有害影响。当发现倾倒区不宜继续倾倒时,主管部门可决定予以封闭。
第十七条 对违反本条例,造成海洋环境污染损害的,主管部门可责令其限期治理,支付清除污染费,向受害方赔偿由此所造成的损失,并视情节轻重和污染损害的程度,处以警告或人币十万元以下的罚款。
第十八条 要求赔偿损失的单位和个人,应尽快向主管部门提出污染损害索赔报告书。报告书应包括:受污染损害的时间、地点、范围、对象、损失清单,技术鉴定和公证证明,并尽可能提供有关原始单据和照片等。
第十九条 受托清除污染的单位在作业结束后,应尽快向主管部门提交索取清除污染费用报告书。报告书应包括:清除污染的时间、地点,投入的人力、机具、船只,清除材料的数量、单价、计算方法,组织清除的管理费、交通费及其他有关费用,清除效果及其情况,其他有关证据和证明材料。
第二十条 对违法行为的处罚标准如下:
一、凡有下列行为之一者,处以警告或人民币二千元以下的罚款:
(一)伪造废弃物检验单的;
(二)不按本条例第十四条规定填报倾倒情况记录表的;
(三)在本条例第十五条规定的情况下,未及时向主管部门和港务监督报告的。
二、凡实际装载与许可证所注明内容不符,情节严重的,除中止或吊销许可证外,还可处以人民币二千元以上五千元以下的罚款。
三、凡未按本条例第十二条规定通知主管部门核实而擅自进行倾倒的,可处以人民币五千元以上二万元以下的罚款。
四、凡有下列行为之一者,可处以人民币二万元以上十万元以下的罚款:
(一)未经批准向海洋倾倒废弃物的;
(二)不按批准的条件和区域进行倾倒的,但本条例第十五条规定的情况不在此限。
第二十一条 对违反本条例,造成或可能造成海洋环境污染损害的直接责任人,主管部门可处以警告或者罚款,也可以并处。
对于违反本条倒,污染损害海洋环境造成重大财产损失或致人伤亡的直接责任人,由司法机关依法追究刑事责任。
第二十二条 当事人对主管部门的处罚决定不服的,可以在收到处罚通知书之日起十五日内,向人民法院起诉;期满不起诉又不履行处罚决定的,由主管部门申请人民法院强制执行。
第二十三条 对违反本条例,造成海洋环境污染损害的行为,主动检举、揭发,积极提供证据,或采取有效措施减少污染损害有成绩的个人,应给予表扬或奖励。
第二十四条 本条例自一九八五年四月一日起施行。

附件一禁止倾倒的物质
一、含有机卤素化合物、汞及汞化合物、镉及镉化合物的废弃物,但微含量的或能在海水中迅速转化为无害物质的除外。
二、强放射性废弃物及其他强放射性物质。
三、原油及其废弃物、石油炼制品、残油,以及含这类物质的混合物。
四、渔网、绳索、塑料制品及其他能在海面漂浮或在水中悬浮,严重妨碍航行、捕鱼及其他活动或危害海洋生物的人工合成物质。
五、含有本附件第一、二项所列物质的阴沟污泥和疏浚物。

附件二需要获得特别许可证才能倾倒的物质
一、含有下列大量物质的废弃物:
(一)砷及其化合物;
(二)铅及其化合物;
(三)铜及其化合物;
(四)锌及其化合物;
(五)有机硅化合物;
(六)氰化物;
(七)氟化物;
(八)铍、铬、镍、钒及其化合物;
(九)未列入附件一的杀虫剂及其副产品。
但无害的或能在海水中迅速转化为无害物质的除外。
二、含弱放射性物质的废弃物。
三、容易沉入海底,可能严重障碍捕鱼和航行的容器、废金属及其他笨重的废弃物。
四、含有本附件第一、二项所列物质的阴沟污泥和疏浚物。

REGULATIONS OF THE PEOPLE'S REPUBLIC OF CHINA ON CONTROL OVERDUMPING OF WASTES IN THE OCEAN

Important Notice: (注意事项)
英文本源自中华人民共和国务院法制局编译, 中国法制出版社出版的《中华人民
共和国涉外法规汇编》(1991年7月版).
当发生歧意时, 应以法律法规颁布单位发布的中文原文为准.
This English document is coming from the "LAWS AND REGULATIONS OF THE
PEOPLE'S REPUBLIC OF CHINA GOVERNING FOREIGN-RELATED MATTERS" (1991.7)
which is compiled by the Brueau of Legislative Affairs of the State
Council of the People's Republic of China, and is published by the China
Legal System Publishing House.
In case of discrepancy, the original version in Chinese shall prevail.

Whole Document (法规全文)
REGULATIONS OF THE PEOPLE'S REPUBLIC OF CHINA ON CONTROL OVER
DUMPING OF WASTES IN THE OCEAN
(Promulgated by the State Council on March 6, 1985)
Article 1
These Regulations are specially formulated for the implementation of the
"Marine Environmental Protection Law of the People's Republic of China" in
order to keep a tight control over the dumping of wastes into the ocean so
as to prevent pollution damage to marine environment, keep the ecological
balance, protect marine resources, and promote the development of ocean
undertakings.
Article 2
The term "dumping" as used in these Regulations refers to discharging
wastes and other substances into the ocean by means of vessels, aircraft,
platforms and other means of transportation. It also refers to discharge
of vessels, aircraft, platforms and other man-made structures used on the
sea. In addition, it also refers to the discharge of wastes and other
substances caused by the submarine exploration and exploitation of mineral
resources and the related maritime processing.
"Dumping" does not include the drainage from the vessels, aircraft, and
other means of transportation and equipment working under normal
conditions.
Article 3
These Regulations are applicable to the following:
1. dumping wastes and other substances into the inland sea, territorial
sea, continental shelves and other sea areas under the jurisdiction of the
People's Republic of China;
2. loading wastes and other substances on land or at harbours of the
People's Republic of China for the purpose of dumping;
3. the transport of wastes and other substances through the inland sea,
territorial sea and other sea areas under the jurisdiction of the People's
Republic of China for the purpose of dumping;
4. burning wastes and other substances within the sea areas under the
jurisdiction of the People's Republic of China;
The wastes produced in the process of offshore oil exploration and
exploitation shall be dealt with according to the Regulations of the
People's Republic of China on Administration of Environmental Protection
in the Exploration and Development of Offshore Petroleum.
Article 4
The competent departments responsible for matters concerning the dumping
of wastes are the National Oceanographic Bureau and its agencies
(hereinafter referred to as "the competent department").
Article 5
The areas for dumping shall be designated by the competent department
through consultation with relevant departments in accordance with the
principles of being scientific, rational, safe and economical and shall be
submitted to the State Council for approval.
Article 6
Units that need to dump wastes into the ocean shall apply for permission
to the competent department, and fill out according to set formula the
application forms for dumping wastes together with an examination report
on the characteristics and components of the wastes.
The competent department shall process the application within 2 months of
receipt of the application and a dumping permit shall be granted to those
approved to dump. No units, vessels, aircraft, platforms and other means
of transportation are permitted to dump wastes into the ocean without the
approval of the competent department.
Article 7
Wastes of foreign countries may by no means be brought to the sea areas
under the jurisdiction of the People's Republic of China for dumping;
these include vessels, aircraft, platforms and other man-made structure
used on the sea. Those who violate these Regulations shall be ordered to
clean the sea area within a limited time, pay for the elimination of
pollutants and compensation for losses thus incurred and be fined by the
competent department. Those who dump wastes outside the sea areas of the
People's Republic of China and cause pollution damage to the sea areas
under the jurisdiction of the People's Republic of China shall be dealt
with according to Article 17 of these Regulations.
Article 8
Vessels or other means of transportation that carry wastes through the sea
areas under the jurisdiction of the People's Republic of China for dumping
purposes must inform the competent department of China 15 days before the
vessels enter the sea areas under the jurisdiction of the People's
Republic of China.
They are also required to report the time of entry, routes, names of waste
matters, quantities and components.
Article 9
Foreign vessels and platforms in the sea areas of under the jurisdiction
of the People's Republic of China that need to dump wastes produced in the
process of offshore exploration and exploitation of mineral resources and
the related maritime processing shall get permission from the competent
department according to the stipulated procedures.
Article 10
The dumping permit shall indicate dumping units, period of validity,
quantity, the types of wastes and the method for dumping.
The issuing of certificates shall be kept under strict control according
to the relevant provisions of these Regulations. The competent department
may change or withdraw certificates in accordance with the changes in
ecological environment and the development in science and technology.
Article 11
Waste matters fall into three categories in the light of their toxicity,
content of harmful elements and the impact upon the marine environment.
The criteria used for categorization shall be worked out as annex by the
competent department and subject to amendment in the light of changes in
ecological environment, the development in science and technology and the
need in protecting the marine environment.
1. The dumping of wastes and other substances as listed in Annex I is
prohibited. In times of emergency, when wastes cannot be disposed of on
land because of its impact upon human health, emergency permits shall be
issued with the approval of the National Oceanographic Bureau to dump
wastes in prescribed ways and designated areas.
2. The dumping of wastes as listed in Annex II shall require special
permits in advance.
3. The dumping of wastes of low or no toxicity other than those listed in
Annex I and Annex II shall require ordinary permits in advance.
Article 12
Units which have already obtained permission to dump wastes shall notify
the competent department for verification before loading the waste.
The work of verification shall be conducted according to the items in the
permit. If the cargo is found not in conformity with the contents in the
permit, the competent department shall order the loading to be stopped
and, in serious cases, suspend or revoke the dumping permit.
The superintendency of the departure harbour or that of the nearest
harbour shall be notified for verification of the dumping of wastes by
vessels. If the cargo is found not in conformity with the contents in the
permit, the harbour superintendency administration shall not grant the
exit visa and shall immediately notify the competent department.
Article 13
The competent department shall monitor and supervise the dumping
activities. If need be, it may also send agents to supervise on board. The
dumping units shall offer facilitation for these functionaries.
Article 14
Those units with permission to discharge wastes shall carry out dumping in
the designated areas, within the time limits and on the terms specified in
the permit. They are required to fill out every detail of the discharge
into record forms and submit the forms to the competent department
following the instructions in the permit. Those vessels, aircraft,
platforms and other means of transportation shall bear conspicuous marks
and signals and make detailed entries in the Logbook of the waste dumping
activities.
Article 15
The vessels, aircraft, platforms and other means of transportation engaged
in dumping activities may, under any of the circumstances as specified in
Article 43 of the Marine Environmental Protection Law of the People's
Republic of China, be exempt from bearing responsibilities for
compensation.
For emergency or rescue purposes, vessels shall try to avoid or reduce
pollution damage when dumping wastes into ocean with no regard to terms
and areas as specified in the permit and report to the competent
department as soon as possible. The waste pumping unit and beneficiaries
of the emergency or rescue act shall make compensation for the pollution
damage.
If the pollution damage is due to the fault of a third party, the waste
dumping unit shall provide the competent department with irrefutable
evidence. The third party shall bear the responsibility for compensation
upon confirmation by the competent department. When vessels, aircraft,
platforms and other means of transportation navigating or operating on the
sea are abandoned for irresistible reasons, their owners shall report to
the competent department and the nearby harbour superintendency
administrations, and shall carry out at once the work of salvaging and
cleaning.
Article 16
The competent department shall conduct regular monitoring and testing in
the dumping areas, strengthen administration and avoid harmful effect on
fishery resources and other activities on the sea. The competent
departments may close any area when finding it no longer suitable for
waste dumping.
Article 17
Those who, in violation of these Regulations, cause pollution damage to
the marine environment may be ordered by the competent department to clean
up, pay the cost of eliminating the pollutants and compensate for the
victims' losses. A warning or a fine up to 100,000 RMB yuan shall be
imposed according to different situations and the graveness of harm done
by the waste dumping.
Article 18
Units and individuals demanding compensation shall submit a report of
pollution damage claim to the competent department as soon as possible.
The report shall include the time, place, area, object of the damage, list
of losses, technical authentication, and notarization. Relevant original
documents and photos shall be of help.
Article 19
Units entrusted with the job to eliminate pollutants shall, upon
completion of the job, submit a report of claim to the competent
department as soon as possible on expenses on eliminating pollution. The
report shall include time, place, manpower involved, equipment, vessels,
quantity of materials, unit price, methods of calculation, management fee,
transportation fee, other relevant expenses, result, other relevant
evidence and supporting materials.
Article 20
Standards for penalties on law breaking acts:
1. Anyone involved in one of the following acts shall be warned or fined
2,000 RMB yuan or less:
(1) forging inspection reports on wastes;
(2) failure to make waste dumping records according to Article 14 of these
Regulations;
(3) failure to report to the competent department and harbour
superintendency administrations in time under the situation defined in
Article 15 of these Regulations.
2. If the actual cargo does not conform
to the contents in the dumping permit and the case is serious, apart from
suspension or revoking of the permit, a fine ranging from 2,000 to 5,000
RMB yuan may be imposed.
3. Those who dump wastes without informing the competent department for
verification in accordance with Article 12 of these Regulations may be
fined from 5,000 to 20,000 RMB yuan.
4. A fine of 20,000 to 100,000 RMB yuan may be imposed for any of the
following acts:
(1) dumping wastes into the ocean without permission;
(2) failure to dump wastes according to the approved terms and in the
designated areas, excluding circumstances specified in Article 15 of these
Regulations.
Article 21
Those directly responsible for violation of these Regulations which has
caused or is likely to cause pollution damage to the environment may be
given a warning or a fine, or both, by the competent department.
Those directly responsible for violation of these Regulations which has
caused damage to marine environment resulting in serious property losses
or personal injuries and deaths, shall be dealt with by judicial organs
for their legal liabilities.
Article 22
The party concerned that does not accept the penalty imposed by the
competent department may bring a suit before the people's court within 15
days of receipt of the written decision on the penalty. If no suit is
filed, nor has the decision been carried out upon the expiration of that
period, the competent department shall petition the people's court to
enforce the decision in accordance with the law.
Article 23
Those who, on their own initiative, expose, report on and provide
evidences against acts that have violated these Regulations and caused
pollution damage to marine environment, or who have done meritorious deeds
by taking effective measures to reduce pollution damage shall be commended
or awarded.
Article 24
These Regulations shall come into force on April 1, 1985.

Annex I Substances Forbidden to be Dumped
1. Wastes containing halogen element and its compounds, chemical compounds
mercury, mercury compound, cadmium and cadmium compounds are forbidden;
but negligible content or that which soon changes into harmless substance
in the sea water are excluded.
2. Wastes with strong radioactivity and other substances that are strongly
radio active.
3. Crude oil and oil waste, refined oil products, residual oil and such
oil mixtures.
4. Fishing net, ropes, plastic products and other artificial synthesis
which can float on the surface or suspend in the water; and thus seriously
affect navigation, fishing and other activities endanger the ocean life.
5. Sewer mud and dredged stuff containing substances as listed in 1 and 2
of this Annex.

Annex II Substances to be Dumped only with Special Permits
1. Wastes that have a high content of the following substances:
(1) arsenic and its chemical compounds;
(2) lead and its chemical compounds;
(3) copper and its chemical compounds;
(4) zinc and its chemical compounds;
(5) chemical compounds of organic silicon;
(6) cyanides;
(7) fluorine chemicals;
(8) beryllium, chromium, nickel, vanadium and their chemical compounds;
(9) pesticides and their by-products which are not listed in Annex I,
excluding those which are harmless or can soon dissolve into harmless
substances in the sea.
2. Wastes that contain weak radioactive matters.
3. Containers, waste metals and other heavy waste materials that will
easily sink to the bottom of the sea and might seriously hinder fishing or
navigation.
4. Sewer mud and dredged stuff containing substances listed in 1 and 2 of
this Annex.


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刑法修正案(八)修改了数罪并罚中的有期徒刑上限,规定数罪并罚总和刑期小于35年的,上限仍为20年;而总和刑期大于或者等于35年的,上限为25年,也即由于刑法修正案(八)规定了不同的总和刑期对应不同的法定最高刑期,有期徒刑的数罪并罚就由原来的单一上限变为双重上限。刑法第70条规定,判决宣告以后,刑罚执行完毕以前,发现被判刑的犯罪分子在判决宣告以前还有其他罪没有判决的,应当对新发现的罪作出判决,把前后两个判决所判处的刑罚,依照本法第69条的规定,决定执行的刑罚。

从罚当其罪来说,一人犯数罪的情形,宣告前数罪均已发现的量刑要轻于宣告后发现漏罪的情形。因为如一人犯数罪,如宣告后发现漏罪的量刑可能相比于宣告前均已发现的量刑更轻,将会使犯罪人产生侥幸心理,隐藏自己的罪行,不利于司法机关及时侦破案件。如果将前一个判决所判处的刑罚理解为数罪并罚后决定执行的刑罚,而不是前一个判决数罪宣告刑的刑期总和。判决宣告前均已发现的一人犯数罪的量刑,则可能重于前一判决为数罪且宣告后发现漏罪的情形。

譬如,某人在判决宣告以前犯有甲乙丙丁四罪,法院审判之前只发现了甲乙两罪,于是判决甲罪5年有期徒刑、乙罪7年有期徒刑,决定合并执行10年,服刑期间又发现漏罪丙和丁,法院判处丙罪10年有期徒刑,丁罪14年有期徒刑。

依照通说观点,发现漏罪的总和刑期34年,宣告前确定刑罚10年十丙罪10年十丁罪14年,法定刑最高限制为20年;可是在判决宣告以前数罪均已发现时,总和刑期为36年,甲罪5年十乙罪7年十丙罪10年十丁罪14年,数罪并罚的法定刑最高限制为25年。

不难发现,如若一人所犯数罪的宣告刑总和刑期超过35年的,且宣告前均已发现,一般应在20年以上判处有期徒刑;但是宣告后发现漏罪且犯罪人有两罪以上已被宣判的,确定总和刑期有可能低于35年,由于刑法规定的最高法定刑的限制,犯罪人最终确定的刑期不能超过20年,这显然违背了罪责相适应原则。

再如犯同样的数罪,与宣告前数罪实施完毕的相比,宣告后再犯的由于无视以往刑罚的体验而再次犯罪,基于特殊预防的考虑,其处罚力度应高于宣告前数罪实施完毕的。这种情形下并罚的总和刑期的确定也会涉及与上述情况类似的问题。

比如,A犯罪人犯甲、乙、丙三罪,分别被判处有期徒刑11年、13年和12年,如若宣告前A犯罪人甲、乙、丙三罪都已实施且被发现,因为总和刑期超过35年,可能在13年与25年之间量刑;如果A犯罪人先犯甲、乙两罪,确定刑罚15年,后又犯丙罪,这时由于总和刑期(确定刑罚15年十丙罪12年=27年)不到35年,可能在15年以上20年以下量刑,反倒轻于宣告前数罪实施完毕的情形。

为了改变上述不合理情况,笔者认为,对前一判决为数罪并罚,后发现漏罪和犯新罪的情况,确定总和刑期时,应强调各罪单独的宣告刑,以漏罪的宣告刑与前一判决宣告前数罪的宣告刑来计算总和刑期。

这样仅是确定法定刑最高刑的限制,并未撤销前一判决,一则不会破坏前一判决的严肃性,二则确保了量刑不致失当。

(作者单位:西南政法大学;重庆市人民检察院第三分院)

小儿肺炎防治方案

卫生部


小儿肺炎防治方案
卫生部

前言
根据1974年至1976年全国12省市儿童死亡回顾调查和近期我国第一批10个妇幼卫生示范县的儿童死亡回顾调查,表明肺炎为我国小儿第一位死亡原因。小儿肺炎死亡占整个儿童死亡的1/5以上,尤其婴幼儿死亡率更高。世界卫生组织已将小儿肺炎列为3种重要儿科疾病
之一。由于本病严重威胁儿童生命及健康成长,因而是我国儿童保健工作中重要任务之一。为了深入开展肺炎的防治工作,提出以下方案。

一、预 防
(一)婴幼儿应尽可能避免接触呼吸道感染的病人。宣传儿童有呼吸道感染时不出门,流行季节少串门,不到公共场所去。父母感冒时应尽可能少接触年幼子女,接触时应带口罩。
小儿患病要做到早诊早治,要求家长当患儿仅有发热、咳嗽时可在家中及村内治疗;当患儿有呼吸增快、轻度呼吸困难时在村内应用青霉素或中药治疗;如出现鼻扇、三凹征等明显呼吸困难时,应在村内注射1次青霉素和适当剂量的强心剂(毒毛旋花子甙K或西地兰)后送乡卫生院或
县医院治疗。注意不要包裹太严密,要使患儿呼吸通畅,以免窒息。
(二)做好儿童的计划免疫,特别是麻疹活疫苗和百白破混合制剂的注射,以减少继发肺炎的发生。积极提倡母奶喂养,合理添加辅食。积极预防佝偻病、营养不良等。提倡户外活动,多晒太阳。培养良好的饮食及卫生习惯,小儿衣着不过厚或过薄,婴儿不要包裹过紧,平时居室内要
每日定期开窗换气。加强早产儿及体弱儿(包括先天性心脏病患儿)的保护和护理。
(三)已患肺炎的婴幼儿抵抗力弱,易染他病,应积极预防可能引起严重预后的并发症,如脓胸、脓气胸等。在病房中应将不同病因的患儿尽量隔离,特别是发现腺病毒肺炎患儿,应争取单间隔离。恢复期及新入院患儿也应分开,医务人员接触不同患儿时,应带口罩、接触每一患儿后
都应用肥皂洗手。

二、诊 断
(一)病理病因分类
1.临床
(1)支气管肺炎
1)细菌性:主要由肺炎球菌、流感杆菌、金黄色葡萄球菌、大肠杆菌等引起。
2)病毒性:主要由腺病毒、呼吸道合胞病毒、流感病毒或副流感病毒引起。
诊断依据:
①急性发病。
②发热(热度可高可低,部分可无发热)。
③咳嗽。
④可有呼吸困难(如鼻扇、三凹、点头呼吸、呻吟等症状,幼婴、体弱儿及营养不良儿可表现不明显)及发绀。
⑤听诊肺部有中细湿罗音。
(2)毛细支气管炎:也是一种病毒肺炎,主要由呼吸道合胞病毒、腺病毒或副流感病毒引起。
诊断依据:
①2岁以内发病,多发生于6个月以内。
②急性发病,突然发作性喘憋为本病的特点,发病前常先有感冒。
③发作时烦躁不安,呼吸、心率增快,有鼻扇、三凹征,发绀明显。
④可有高热,但多在38℃以下或不发热。
⑤两肺听诊有广泛哮鸣音,不喘时可听到中细湿罗音或捻发音。
(3)大叶肺炎:一般由肺炎球菌引起。
诊断依据:
①急性发病。
②发热或不发热。
③咳嗽和/或胸痛。
④肺局部叩诊浊音,呼吸音减弱,或胸部呼吸运动一侧减弱,语音震颤增强。
(4)支原体肺炎:由肺炎支原体引起,诊断依据与大叶肺炎近似。
(5)其他:真菌性肺炎,衣原体肺炎、原虫性肺炎、吸入性肺炎、坠积性肺炎等。
2.X线
(1)支气管和其他肺炎:胸片或胸部透视有斑片状阴影。毛细支气管炎还常有肺透明度增加。
(2)大叶肺炎:胸片或胸部透视有节段或大片阴影。支原体肺炎有大片状阴影或两侧片状阴影。
(注:在基层X线不是必备条件,但县以上医院应进行X线检查)
3.病因(县以下多不易做到,写在这里,供参考):
(1)痰培养或胸腔穿刺液培养有致病菌生长。
(2)血培养致病菌阳性。
(3)死后肺穿刺肺组织病毒分离或细菌培养阳性。
(4)咽拭子病毒分离阳性(或快速诊断例如萤光抗体检查阳性),双份血清特异抗体恢复期4倍以上升高。
(二)病程分类
1.急性:病程在1个月以内。
2.迁延性:病程在1~3个月。
3.慢性:病程在3个月以上。
(三)病情分类:
1.轻症:呼吸系统症状为主。
2.重症:除呼吸系统症状之外,合并有心力衰竭、呼吸衰竭、弥漫性血管内凝血、超高热或体温不升、中毒性脑病或伴有较严重的先天性心脏病。
附一、几种特殊肺炎的临床诊断参考依据
一、新生儿肺炎
(一)全身反应差(如软弱、吃奶差等)
(二)1.口周青紫和/或口吐白沫,
2.安静时呼吸持续增快>60次/分,
3.点头呼吸或三凹症,
4.有羊水吸入史和/或反复呛奶。
上述4条中任何2条者。
二、金黄色葡萄球菌肺炎
(一)多数有不规则高热,常表现为弛张热。
(二)中毒症状重,少数病例可有中毒性休克,可能出现多形易变性皮疹(猩红热或麻疹样皮疹等)。
(三)肺部以外有金黄色葡萄球菌病灶。
(四)一般白细胞数增高,中性粒细胞百分数增高,少数病例白细胞明显减低。
(五)X线检查可能在短时间内发现肺大泡或肺脓肿。
(六)肺炎伴有脓胸,穿刺液培养或涂片证明有金黄葡萄球菌。
三、婴幼腺病毒肺炎(注)
(1)多发生在6个月至2岁。
(2)骤然发热,高热稽留或弛张,抗生素治疗无效。
(3)嗜睡、萎靡等神经症状比较明显,且出现较早。
(4)面色苍白、发灰,重者肝肿大明显,易有心力衰竭。
(5)肺部体征出现较迟,发热第3—5日后肺部开始出现湿罗音,以后肺部实变逐渐增大,可有叩浊,呼吸音减低及管状呼吸音。
(6)白细胞偏低,多在1万以下,中性粒细胞一般不超过70%。
注:6个月以下婴儿腺病毒肺炎病情多很轻。
附二、肺炎主要并发症临床诊断参考依据
(一)心力衰竭临床诊断参考依据:
(1)心率突然超过180次/分;
(2)呼吸突然加快,超过60次/分;
(3)突然发生极度烦躁不安;
(4)明显发绀,面色、皮肤苍白、发灰、发花、发凉,指(趾)甲微血管再充盈时间延长,尿少或无尿。
(5)有奔马律、心音低钝、颈静脉怒张。X线检查示心脏扩大。指纹延至命关或气关,并由红色转蓝色等。
(6)肝脏迅速增大。
(7)颜面、眼睑或下肢水肿。
如果出现1—4项,作为疑似心力衰竭,第5项供参考,先用氧及镇静剂(复方氯丙嗪或安定),20—30分钟后如能入睡,1—4项症状缓解,即可间断停氧。如仍不好转,或出现肝脏增大和/或水肿,即可确诊为合并心力衰竭。应即用速效洋地黄剂、利尿剂等。
注:以上标准不包括新生儿和毛细支气管炎患儿。
(二)呼吸衰竭诊断参考依据
(1)临床诊断参考依据:
1)轻症呼吸衰竭:呼吸困难,三凹征明显,呼吸加快,偶有呼吸节律改变。口唇发绀,轻度烦躁或精神萎靡。
2)中症呼吸衰竭:呼吸困难、三凹征加重,呼吸浅快,节律不整,偶有呼吸暂停。口唇发绀明显(有时呈樱红色),嗜睡或躁动,对针刺反应迟钝。
3)重症呼吸衰竭:呼吸困难,三凹征明显或反而不明显,呼吸由浅快转为浅慢,节律紊乱,常出现下颌呼吸和呼吸暂停,呼吸音减低。口唇发绀加重,四肢末端发绀、发凉。昏睡或昏迷,甚至惊厥。此时可能出现脑水肿、脑疝表现(如球结膜水肿、视神经乳头水肿、瞳孔及肌张力改
变等)。
(2)血气指标:
1)Ⅰ型呼吸衰竭(轻症呼吸衰竭):非高原地区吸空气时Pa O2 ≤6.65kPa(50mmHg)。
2)Ⅱ型呼吸衰竭:Pa O2 ≤6.65kPa(50mmHg)及Pa CO2 ≥6.65kPa(50mmHg)(中症:Pa CO2 为6.65—9.18kpa(50~69mmHg);重症Pa CO2 ≥9.31kpa(70mmHg)。

三、冶 疗
(一)一般治疗:保持室温在18℃左右,相对湿度65C%,每日定期室内换气(注意避免穿堂风)保证饮食及水分入量,加强护理。
(二)抗生素的应用:肺炎球菌肺炎或链球菌肺炎,用青霉素(5—10万单位/千克(公斤)/日,分两次肌注,或用复方新诺明。
流感杆菌肺炎:用青霉素或复方新诺明,或用氨苄青霉素。
金黄色葡萄球肺炎:用红霉素、新青霉素Ⅱ、先锋霉素Ⅱ等一种或二种联合应用(亦可慎用氯霉素)。
大肠杆菌肺炎:氨苄霉素、庆大霉素、羧苄青霉素等二种联合应用。
支原体肺炎:用红霉素、四环素、白霉素、乙酰螺旋霉素等一种即可。
对于病因诊断不够明确,根据临床考虑细菌性肺炎可能性大,可首先采用青霉素治疗。
(三)中医治疗:诊断为病毒肺炎,不怀疑有细菌继发感染者,可应用中医治疗。
(四)给氧:必须正确掌握给氧方法。一般鼻管给氧,氧流量每分钟500~1000毫升,氧气必须通过水增加湿度。
(五)保持呼吸道通畅:适当地吸痰,喘憋严重时使用支气管解痉及镇静药(非那根或冬眠灵),保持足够的液体入量,有利于痰液的排出。患儿口服量不足者,应谨慎地进行输液,对液量、电解质、点滴速度均应特别注意。
(六)对活动性佝偻病患儿给维生素D时,根据情况可选用口服,或用突击疗法,D3 40万单位肌注,并服钙剂。
(七)肺炎合并心力衰竭的治疗:主要为强心,或并用利尿及血管扩张剂。强心剂首选西地兰(或毒毛旋花子甙)或地高辛。西地兰剂量为每次0.01—0.015mg/千克(公斤)体重,静推或加入点滴小壶中,必要时2—3小时可重复一次,以后改为地高辛洋地黄化。不太急
的病例,一开始就可以应用地高辛,口服化量<2岁0.04—0.06mg/千克(公斤)体重,>2岁0.03—0.04mg/千克(公斤)体重,首次用化量的2/5,以后每6—8小时给1/5量。末次给药12小时后开始用维持量,维持量每日为化量的1/5,分2次服。静
脉注射为口服量的3/4。
(八)肺炎合并呼吸衰竭的防治
1.积极治疗原发病。
2.保持呼吸道通畅,清除分泌物,用中西药(必嗽平、痰易净、竹沥水等),液化痰液及排痰,并应及时吸痰。超声雾化吸入,每次15—20分钟,每日3次,雾化后要吸痰。足够的液体供给对痰液液化也有帮助。
3.及时正确给氧,此时需用雾化口罩给氧,每分钟用氧3—5升。
4.如患儿已有心力衰竭,应及时治疗。
5.如同时有代谢性酸中毒,则可用适量碳酸氢钠。
6.中药人参注射剂可试用。
7.呼吸兴奋剂一般效果不大。
8.必要时应用人工呼吸器。



1986年5月25日