涉水触雷爆炸伤的特点及机制

发布时间：2018-03-10 11:00

本文选题：地雷　切入点：爆炸伤　出处：《解放军医学杂志》2017年10期 　论文类型：期刊论文

【摘要】：目的探讨不同水深涉水触雷的损伤特点及机制。方法健康成年新西兰大白兔9 6只,体重2.19±0.12kg,随机分为陆地爆炸组(n=16),涉水肢体组(n=16,水深齐实验兔大腿中段),涉水胸部组(n=16,水深齐实验兔剑突),力学测试组(n=30),假致伤组(n=18)。点爆源为模拟地雷,远离电引爆,造成兔后肢直立跨步状态下单后肢触雷爆炸伤,以高速摄影机观察爆炸瞬间水介质运动过程。分别于伤前及伤后3、6、12h取股动脉血检测血清心肌损伤[磷酸肌酸激酶同工酶(CK-MB)、肌钙蛋白I(c Tn I)]及神经损伤标志物[神经元特异性烯醇化酶(MBP)、髓鞘碱性蛋白(NSE)],并行心脏超声、心电图、CT、数字减影血管造影(DSA)等检查。存活动物于伤后12h解剖,记录其肢体局部和远处脏器损伤情况,并行组织病理学检查明确损伤特点。结果涉水触雷爆炸造成实验兔脚掌、胫骨下段毁损,常发生远离爆炸残端的闭合性股骨骨折和动脉损伤,未见陆地触雷常见的软组织拖把样撕裂;胸、腹腔脏器以及脑、脊髓损伤程度较陆地爆炸伤重。涉水肢体组以肢体伤为主,涉水胸部组则以胸腹腔脏器、脊髓损伤发生率高,是涉水肢体组的2~3倍。致伤组伤后6h血清心肌损伤标志物及神经损伤标志物较假致伤组显著升高,涉水组伤后12h较陆地组显著升高,以涉水胸部组升高最为明显。陆地组及涉水组伤后6h心功能显著降低,以涉水胸部组伤后12h降低最为明显。结论涉水爆炸能量传递受水底、水面、肢体或躯干相互作用的影响,是造成其伤情复杂、严重的重要机制,涉水深度是影响爆炸伤严重程度的重要因素。
[Abstract]:Objective to investigate the damage characteristics and mechanism of wading lightning in different water depths. Methods 96 healthy adult New Zealand white rabbits were used. The body weight was 2.19 卤0.12 kg. The rats were randomly divided into land explosion group (n = 16), wading limb group (n ~ (16)), water depth group (n ~ (16)), chest wading group (n ~ (16)), water depth group (n ~ (16)), mechanical test group (n ~ (30)), pseudoinjury group (n ~ (18)). The point detonation source was a simulated mine, which was far from electric detonation. Causing the rabbit's hind limb to stand upright and stride out an order for the hind limb to be struck by a mine explosion wound, High speed camera was used to observe the motion of water medium in the instant of explosion. The femoral arterial blood samples were taken for detection of myocardial injury [creatine kinase isoenzyme CK-MBN, cardiac troponin I] and nerve injury marker before injury and at 612 hours after injury. Transmergence specific enolase (MBP), myelin basic protein (NSE), and cardiac ultrasound, The surviving animals were dissected 12 hours after injury and recorded the local and distant organ injuries of their limbs. Histopathological examination was performed to determine the injury characteristics. Results the experimental rabbit foot was caused by the explosion of wading thunder. The distal tibia is destroyed, often with closed femoral fractures and arterial injuries far from the explosive stump, without the common soft tissue drag tears that are common to land mines: chest, abdominal organs, and brain, The degree of spinal cord injury was more serious than that of land explosion. The most common injuries were limb injuries in wading limbs group and thoracic and abdominal organs in wading chest group. The incidence of spinal cord injury was higher in wading limbs group than in chest wading group. The serum myocardial injury markers and nerve injury markers were significantly higher in the wading limb group than in the sham injury group at 6 hours after injury, and 12 hours after the injury in the wading group as compared with those in the land group. The cardiac function was significantly decreased 6 hours after injury in the land group and in the wading group, especially at 12 hours after the injury. Conclusion the energy transfer of the wading explosion is affected by the interaction between the water bottom, the water surface, the limb or the trunk. The depth of wading is an important factor affecting the severity of explosive injury.
【作者单位】：第三军医大学大坪医院骨科;第三军医大学大坪医院野战外科研究所六室;
【基金】：全军“十二五”医学科研重点项目(BWS13L019)~~
【分类号】：R82

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