美国西帕洛玛医疗中心

城市建筑|设计作品|Urbanism and Architecture |Works of Design作者单位：CO建筑师事务所（www. coarchitects. com）收稿日期：2011-03-30项目设计CO 建筑师事务所在校园环境之内构建了一组集功能性与灵活性于一身的垂直花园式医院设施。

这片绿地作为75.27hm 2商业园区的一部分，仍处于开发阶段，西接住宅区，北邻轻工业开发区，东邻斯特卡多公园大道（Citracado Parkway）和森普拉（Sempra）电站，南靠未来商业园区规划用地。

设计将医院规划在基址的最北端，利用基地宽度最大的区域设置主要出入口和交通网络枢纽。

标志性的医疗大楼造型微微呈弧形，寓意张开双臂迎接患者的到来。

南侧立面中央的垂直花园俯视侧翼2层的诊疗大楼（D&T）宽阔的景观屋顶和花园露台。

这种温室花园的景观元素在建筑东、西美国西帕洛玛医疗中心■ CO建筑师事务所 钱辰伟 译 ■ CO Architects Translated by Qian ChenweiPalomar Medical Center West, Escondido, USA两端得以再现，强化了花园医院的设计理念。

将自然与建筑相融合的愿望深深影响着设计者的构思，从总体平面设计到景观规划，从不拘一格的建筑表达到建筑材料的选择，无不呈现着自然与建筑二者的完美结合，浑然天成。

灵活性CO 建筑师事务所在项目规划设计上进行了创新，满足了设施灵活、患者安全、护理质量以及环境健康等多项建筑要求。

D&T 侧翼大楼规划设计灵活，为医院运行期间设备更新、技术换代和诊疗方式革新创造了条件。

例如，方案在建筑二层设置了整合式介入治疗平台，同时二层还设有手术及介入放射治疗诊室，形成了跨学科医疗程序系统。

通过组合式规划方法对不同医疗程序的无缝衔接，必定会提升设施使用的灵活性（可根据需要变更诊室用途），精简人员配置（各项服务得到强化，减少了后勤保障人员的重复设置），促进专业医护人员的互动交流。

同时大跨度开间、大高度层间距、开放式“屋顶空间”这些基础设施元素也对灵活平台的搭建起到了积极作用。

四至十一层各病区的设计采用了非传统的患者护理设施规划设计方法。

各病区规划以循证设计研究成果为基础，提出患者病情动态护理模式，统一配置病房、划分病区，达到全科护理目标。

这一模式的引入在加州尚无先例，而且只要模式得到充分贯彻，必将大大降低甚至彻底免去患者住院期间转移病房或病区的需要，从而间接地为护理及护理团队的连续作业提供了更好的条件，减少了医疗过失和处置延误的发生，提高了医护工作效率，而且改善了患者及医护人员的满意度。

分散式的工作环境和医疗物资供应方式（物资储备靠近病房）降低了医护人员寻找相关物资的时间，相应增加了医护人员看护病患、直接参与治疗的时间。

360张床位全部由单人病房组成，病房空间设所获奖项：2006年医疗设施设计优异奖入选2007年美国建筑师协会洛杉矶NEXT LA优异奖2007年现代医疗设施设计奖入选 1 西帕洛玛医疗中心（PMCW)代表最先进水平的医疗建筑DesignCO Architects conceptualized a functional and flexible vertical garden hospital set within a campus configuration. The greenfield site part of a 186-acre business park currently under development is bounde d by reside ntial property to the west, light industrial development to the north, Citra-cado Parkway and a Sempra power plant to the east, and future business park development to the south. The plan positions the hospital at the north计宽敞，有利于昼夜护理患者的家属休息。

除此之外，患者还可以自主控制室温、照明及隐私保护设施等诸多环节要素。

可持续性帕洛玛波默拉多健康机构（Palomar Pomerado Health，简称PPH）和CO 建筑师事物所始终以建设可持续性建筑为己任，以尊重个体与环境的关系为核心驱动力。

健康的室内空气质量、令人心旷神怡的康复环境以及各种材料和方法的应用，无不体现着P PH 作为项目委托方和建筑设计方CO 建筑师事物所的共同承诺。

而该项目所呈现的正是可持续性医疗设计的两个主要方针：营造有益健康、加速康复的环境；减少施工及运营过程中对自然环境造成的影响。

高效的机械设备、照明系统以及封闭式设计必定使建筑各项指标显著提高，明显优于类似气候环境中的同类医院。

方案恪守西帕洛玛医疗中心可持续性设计的承诺，遵循《医疗保健绿色指南》（Green Guide for Healthcare）这套专门针对医疗建筑项目制定的评级体系要求，将整个医院作为一项试点工程精心设计。

指南深受最大潜能建筑研究中心（Center for Maximum Potential Building Systems）组织及无害医疗（Health Care Without Harm）组织的推崇与支持，遵照美国绿色建筑认证（LEED）模式，为整个医疗业界提供了一套最佳实践范例工具集，供设计人员使用，引导并评估设计在营造优异医疗康复环境过程中的进步。

侧翼外科大楼的绿化屋顶栽种了耐旱的肉质植物，为身处医疗大楼的患者建立了与自然环境的直接联系，也成为建筑结构及力学性能的重要部分。

另外，屋顶还减少了地面反射和室内的日照热能吸收，提高了能源效率，而且它还是暴雨水量控制系统的构成要素。

露天庭院直插这座2层侧楼中央，为很多由于功能设计而深藏于楼面之内的空间带去了自然照明。

患者大楼每层中央和两端都设有温室花园，除为身处垂直大厦中的全体患者和医护人员带去花园景观之外，还为毗邻的全玻璃公共空间平添了附加的日照保护。

患者大楼朝向经特别安排，最大程度地减少了干燥内陆凹地环境下东西向、低角度日光的直射，同时保证充足的日照。

南侧立面安装穿孔金属幕墙系统，为病房提供了荫蔽和良好的眩光控制，而且将幕墙对视线以及日照的遮挡降至最低。

幕墙融汇了诸多设计元素，主要由与幕墙平行的二层蒙皮以及防夏季日照的水平气窗两部分组成，在幕墙与花园平台的交汇处还起到了高层露天空间防风的作用。

此外，为进一步提高建筑能效，该项目还安装了强大的能源管理系统，采取了多余热量回收利用、高效照明策略、日照控制、多种空气流通控制手段、建筑试运行以及精心挑选节能医疗设备等多项举措。

■end of the site, where there is the greatest width to accommodate necessary access points and circu-lation.The signature patient tower building with its gently curving form figuratively opens its arms to welcome patients. A vertical garden at the center of the south facade overlooks the extensive land-scaped roof and garden terraces above the two-story diag nostic and tre atme nt wi ng. The co n-servatory element is repeated at the east and west ends to reinforce the garden hospital concept. Site planning, landscaping, non-institutional architectural expression, and materials selection are all strongly influenced by the desire to merge nature and build-ing, with each aspect informing the other to create a unified whole. FlexibilityCO Architects created an innovative plan that fulfills the requirements for flexibility, patient safety, quality care, and a healthful environment.The flexible plan of the Diagnostic and Treat-ment wing accommodates the changes to equip-ment, technology, and treatment that are expected through the lifetime of the hospital. For example, an Integrated Interventional Platform was developed on the Second Level where a co-location of Surgi-cal and Interventional Radiology procedure roomscreates an interdisciplinary approach to procedural me dicine. This seamless integratio n of various types of procedures through a modular planning approach will increase flexibility (ability to change use of the rooms over time), reduce staffing re-quirements (consolidation of service eliminates duplication of support personnel), and will promote interaction among the specialists. The systems in-frastructure elements of long-span structural bays, high floor-to-floor heights with interstitial capacity,2 六千平方米的绿色屋顶边缘的走道引导向医院入口3 “花园医院”的设计理念贯穿内部和外部空间城市建筑|设计作品|Urbanism and Architecture|Works of Designand open ‘loft space’ contribute to the flexible plat-form.The design of the nursing units located on Lev-els 4 through 11 represents a non-traditional ap-proach to the programming and design of patient-care facilities. Driven by the research that stemmed from Evidenced Based Design planning principles, the units enable an Acuity Adaptable Patient Care model, which accounts for the provision of patient rooms and units to be commonly sized to accom-modate the full spectrum of care. This will be the first attempt to install such a model in California, and, if fully realized, will minimize or eliminate the n e e d to t r a n s f e r p at i e nt s to o t h e r ro o m s/u ni t s during hospital stays. This, in turn, will potentially provide better continuity of care and care teams, reduce medical errors, reduce treatment delays, improve operational efficiencies, and improve pa-tient and staff satisfaction.Decentralized staff work areas and supplies (adj ace nt to the patie nt rooms) will re duce the amount of staff time spent searching for supplies, and thus will increase time for patient supervision and direct care.All of the 360 beds are in private rooms de-signed with sufficient space for in-room proce-dures, including accommodating ‘rooming-in’ of family members. Additionally, patients are given in-dividual control of as many environmental elements as possible, including temperature, lighting, and privacy.SustainabilityIt is the missio n of PPH and the impulse ofCO Architects to honor the relationship of the in-dividual to the environment and maintain the hall-marks of sustainable building. Healthy indoor airquality, a soothing and healing environment, andthe materials and metho ds employe d all reflectthe commitment of the client and architect. Thus,PMCW embodies two main directives of sustain-able healthcare design: 1) Create an environmentthat promotes health and healing; 2) Reduce theimpact on the natural environment in constructionand operations. Because of efficient mechanicalequipment, lighting systems, and envelope design,the building will perform significantly better than atypical hospital would in a similar climate.PMCW is designed as a pilot project using theGreen Guide for Healthcare (GGHC), a rating sys-tem specifically designed for healthcare projects.Under the auspices of the Ce nter for MaximumPotential Building Systems and Health Care With-out Harm, and following the LEED model, the guideprovides the healthcare sector with a voluntary,self-certifying toolkit of best practices that design-ers can use to guide and evaluate their progresstoward high-performance healing environments.The surgical wing’s green roof, planted withdrought-tolerant succulents, provides a connectionto nature for patients in the nursing tower and is in-tegrated into the building’s structural and mechani-cal performance. The roof contributes to energyefficiency by reducing ground reflectance and solarheat gain in the tower’s interiors and is integratedinto the storm-water management system. Outdoorcourts cut into the two-story wing, bringing natu-ral light to the functionally determined deep floorplates.Conservatory gardens are located at the centerand at both ends of each patient floor. In additionto bringing landscaped gardens to all the inhabit-ants of the vertical building, they also provide anadditional layer of solar protection for the fullyglazed adjoining public spaces.The patient tower is oriented to minimize east/west exposures in its arid, inland valley context,and is designe d to take maximum advantage ofdaylight. A perforated metal screen system on theso ut h f a c a d e pro v i d e s s h a d e to p at i e nt ro o mswhile allowing maximum views and natural light.The screen unifies the building’s projecting ele-ments and consists of two components: a secondskin that sits parallel to the curtain-wall enclosure,and horizontal louvers that address summer sunangles. Where the screens extend to the gardenterraces, they serve as wi nd prote ctio n for thehigh-rise outdoor spaces.Other e nergy-efficie nt me asures at PMCWi nclude vigorous e nergy manageme nt systems,capture and reuse of waste heat, efficient lightingstrategies, daylight controls, variable air volumehandling, building commissioning, and the carefulselection of energy-saving medical equipment.4 庭院为D&T侧翼大楼引入自然光线6 带有绿化的阳台庭院为候诊患者及家属创造舒适的休息空间5 室外花园为候诊区引入自然光线和良好视野7 病房项目概况项目名称：西帕洛玛医疗中心建设地点：美国加利福尼亚州埃斯孔迪多市业 主：帕洛玛波默拉多健康机构设计单位：CO建筑师事务所合作设计：Stantec Anshen + Allen用地面积：75.27hm 2建筑面积：68 377m 2建筑层数：11层手术室数量：11间病床数量：360床项目负责人：Tom Chessum, Steve Yundt, DennisMcFadden建筑专业：Eyal Perchic, Frances Moore, AlexKorter, Jenna Knudsen结构专业：KPFF Consulting Engineers 设备专业：M E Engineers 景观专业：Spurlock Poirier施工单位：DPR Construction 设计时间：2003年建成时间：2012年图纸版权：CO建筑师事务所1 清洁区2 放射科3 术前/术后4 手术室5 病理科6 提前登记住院7 资料室8 小教堂9 住院康复10 药房11 室外庭院1 急诊2 影像3 康复治疗4 员工休息5 心肺诊断/抽血室6 大厅7 售卖8 金融咨询9 商业中心10 会议中心11 室外庭院1 绿色屋顶2 咖啡3 机械/设备4 餐厅露台1 护理单元（24床）2 护理单元（30床）3 休息区4 花园阳台10 二层平面9 一层平面12 标准层平面12343。