模拟实战条件舰炮攻击下舰船密闭舱室内舰员的伤情分析及脊髓损伤研究

发布时间：2018-05-06 00:42

本文选题：爆炸伤 + 密闭舱室　；参考：《第二军医大学》2017年硕士论文

【摘要】：研究目的:随着人类对海上资源争夺的日渐激烈,爆发海上战争的可能性越来越大。水面舰艇是海上战争的主要作战方式,而舰船舱室多为相对密闭的空间,因此针对性研究密闭空间爆炸伤的伤情特点、损伤机制以及救治重点更具实用价值。本研究从实战出发,等比例构建多舱室舰船模型,选用舰炮为爆源,探讨实战条件舰炮攻击下舰船密闭舱室内舰员损伤的伤情特点及其与爆炸当量、位置、破片、冲击波等诸因素之间的关系,为现代海战伤舰船伤员的救治提供理论依据。研究方法:采用钢板以1:1比例模拟多舱室船舶模型重点部位舱室结构构建多舱室实验模型。以76只新西兰大白兔为实验动物,选用两种常规口径舰炮为爆源。爆炸后立即清理现场,观察记录实验动物死伤情况并进行X线检查。死亡动物立即解剖,存活动物单笼饲养24小时后处死解剖:1、尸检死亡动物分析死因,存活动物观察脏器是否损伤及损伤特点;2、获取实验动物脊髓标本。汇总所得数据,采用SPSS21.0软件进行统计学分析,总结伤亡率及其与舱室结构相关性。另外,将获取的脊髓标本经福尔马林固定后进行石蜡包埋切片,并进一步分析其损伤特点:HE染色观察脊髓组织形态学改变,TUNEL试剂盒检测脊髓细胞凋亡与否,免疫组化法检测凋亡相关蛋白Caspase-3的表达情况,分析密闭舱室内爆炸脊髓损伤的特点。结果:舱室内实验动物共计76只,整体死亡率59.2%。实弹组死亡率(63.2%)与裸弹组死亡率(55.3%)之间无显著差异(P0.05)。大口径组死亡率(73.7%)高于小口径组死亡率(44.7%)(P0.05);大口径舰炮爆炸时各舱室死亡率不全相等(P=0.000),其中当舱死亡率最高,之后分别是邻舱和隔舱;小口径舰炮爆炸时各舱室死亡率无显著差异(P0.05)。造成死亡的主要原因是冲击波和爆炸破片导致的重要脏器的损伤,两者之间无显著差异(P0.05)。爆炸后存活动物活动能力评分显示,当舱及邻舱机柜前实验动物活动能力随时间有不同程度下降;邻舱机柜后组、隔舱组实验动物活动能力无明显变化。存活动物肺冲击伤评级显示:当舱及邻舱机柜前的实验动物肺损伤最重,均达到中-重度以上损伤;邻舱机柜后组主要为轻度肺冲击伤;隔舱组除个别有轻度肺冲击伤外,其他均无肺冲击伤表现。实验动物脊柱骨折发生率为7.1%,爆炸破片和抛掷摔伤是导致脊柱骨折的主要原因。大体解剖及HE染色可观察到蛛网膜下腔出血、髓内血管破裂出血等脊髓损伤表现;细胞层面检测观察到,存活组实验动物脊髓损伤程度较死亡组严重:脊髓前角运动神经元计数当即死亡组多于存活组(P0.05);凋亡细胞计数当即死亡组少于存活组(P0.05)。存活动物中,爆炸当舱及邻舱机柜前实验动物脊髓损伤最重:当舱与邻舱机柜前神经元数量最少,两者之间无明显差异(P0.05),其次为邻舱机柜后和隔舱(P0.05);当舱与邻舱机柜前凋亡细胞数量最多,两者之间无明显差异(P0.05),之后依次为邻舱机柜后和隔舱(P0.05)。另外,Caspase-3蛋白阳性表达当即死亡组与当舱存活组、邻舱机柜前存活组之间无明显差异(P0.05),但高于邻舱机柜后存活组及隔舱存活组(P0.05)。结论:船舶多舱室结构中,大口径弹药爆炸的伤亡率明显大于小口径弹药爆炸;实弹与裸弹的致伤类型及死亡率无明显差异;不同舱室位置死亡率不同,舱室整体结构及内部机柜在一定范围内对舱室内人员及脊髓组织有明显的防护作用。舱内爆炸时,脊髓爆震伤是爆炸后脊髓损伤的主要类型,其损伤从细胞水平观察主要表现为细胞凋亡;脊髓损伤程度与肺损伤程度正相关,中、重度以上肺冲击伤表现提示伴有较重的脊髓损伤。以上伤情特点为密闭舱室爆炸时内部人员的防护救治及脊髓爆震伤的早期诊断提供了一个新的尝试方向。
[Abstract]:Research purposes: with the increasingly fierce competition for marine resources, the possibility of the outbreak of naval warfare is becoming more and more likely. Surface warships are the main mode of operation at sea war, and the cabin room of the ship is mostly relatively closed space. Therefore, it is more practical to study the injury characteristics of the explosion injury in closed space, the mechanism of damage and the focus of treatment. In this study, we set up a multi cabin ship model with equal proportion from the actual combat, select the naval gun as the explosion source, and discuss the injury characteristics of the damage of the interior warship in the closed cabin of the ship under the attack of the actual combat conditions and the relation between the factors and the factors such as the explosive equivalent, the position, the fragment and the shock wave, which provide the theory for the rescue of the wounded in the modern naval battle. According to the research method, the experimental model of multi compartment chamber structure was constructed by using steel plate to simulate the cabin structure of the key parts of the multi cabin ship model with 1:1 ratio. 76 New Zealand white rabbits were used as experimental animals, and two conventional caliber naval guns were selected as the explosion source. The scene was cleared immediately after the explosion, and the death and injury of experimental animals were observed and the dead animals were examined. Immediately dissected, the survival animals were reared for 24 hours to die: 1, the dead animals were analyzed the cause of death, the survival animals observed the damage and damage of the viscera; 2, obtain the specimens of the spinal cord of the experimental animals. The collected data were collected, and the statistical analysis was carried out by SPSS21.0 software to summarize the casualty rate and the correlation with the cabin structure. In addition, it will be obtained. The spinal cord specimens were embedded in paraffin embedded section after formalin fixation, and the damage characteristics were further analyzed: HE staining was used to observe the morphological changes of spinal cord tissue, TUNEL kit was used to detect the apoptosis of spinal cord cells, and the expression of apoptosis related protein Caspase-3 was detected by immunohistochemistry. Results: there were 76 experimental animals in the cabin, and there was no significant difference between the mortality of the whole mortality 59.2%. (63.2%) and the mortality of the naked group (55.3%). The mortality of the large caliber group (73.7%) was higher than that of the small caliber group (44.7%) (P0.05), and the mortality of the cabin was not all equal (P=0.000) when the large diameter vessel explosion was exploded (P=0.000), among which the death of the cabin was dead. The rate was the highest, followed by the adjacent cabin and the compartment, and there was no significant difference in the mortality of the cabin during the explosion of small caliber naval guns (P0.05). The main cause of death was the damage of the important organs caused by the shock wave and the explosion fragment, and there was no significant difference between the two (P0.05). The viability score of the surviving animal after the explosion showed that the cabin and the adjacent cabin cabinet were before the explosion. The ability to test animal activity decreased in varying degrees with time; there was no significant change in the activity ability of experimental animals in the adjacent cabin group. The rating of lung impact injury in the surviving animals showed that the lung injury of the experimental animals before the cabin and the adjacent compartment was the most serious, and all reached the moderate to severe injury; the next cabin group was mainly a mild lung shock injury; the compartment group was mainly a septum group. The incidence of spinal fractures in the experimental animals was 7.1%. The incidence of spinal fractures in experimental animals was 7.1%. The main causes of spinal fractures were exploding fragments and throwing and falling injuries. The gross anatomy and HE staining could be used to observe the subarachnoid hemorrhage, the rupture of intramedullary blood vessels and other spinal cord injuries; cell level detection and observation The degree of spinal cord injury in the survival group was more severe than that in the death group: the count of motor neurons in the anterior horn of the spinal cord was more than that in the survival group (P0.05), and the number of apoptotic cells was less than that of the survival group (P0.05). In the surviving animals, the most serious injury of the spinal cord before the explosion compartment and the adjacent compartment was tested: the neurons in the cabin and the adjacent compartment. There was no significant difference between the two (P0.05), followed by the adjacent cabin cabinet and the compartment (P0.05), the number of apoptotic cells in front of the cabin and the adjacent cabin was the most, and there was no significant difference between the two (P0.05), followed by the adjacent compartment and compartment (P0.05). In addition, the positive expression of Caspase-3 protein in the dead group and the survival group of the cabin and the adjacent cabin There was no significant difference between the surviving groups in front of the cabinet (P0.05), but higher than the survival group and the survival group (P0.05) after the adjacent cabin. Conclusion: in the multi compartment structure of the ship, the casualty rate of the explosion of large caliber ammunition is obviously greater than that of small caliber ammunition; there is no obvious difference in the type and death rate of the injury caused by the actual bomb and the naked bomb; the mortality of the different cabin position is different, the cabin is different. The overall structure of the chamber and the internal cabinet have obvious protective effect on the cabin personnel and spinal cord tissue in a certain range. When the explosion in the cabin, the spinal cord detonation injury is the main type of spinal cord injury after the explosion. The damage of the spinal cord is mainly manifested by the apoptosis from the cell level. The degree of spinal cord injury is positively related to the degree of lung injury, medium and severe. The manifestations of the lung impact injuries are suggestive of a heavier spinal cord injury. The above features provide a new direction for the protection of the internal personnel and the early diagnosis of the detonation injury of the spinal cord in the closed cabin explosion.

【学位授予单位】：第二军医大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R826

【参考文献】