本文選題：地雷　切入點：爆炸傷　出處：《解放軍醫(yī)學(xué)雜志》2017年10期 　論文類型：期刊論文

【摘要】：目的探討不同水深涉水觸雷的損傷特點及機制。方法健康成年新西蘭大白兔9 6只,體重2.19±0.12kg,隨機分為陸地爆炸組(n=16),涉水肢體組(n=16,水深齊實驗兔大腿中段),涉水胸部組(n=16,水深齊實驗兔劍突),力學(xué)測試組(n=30),假致傷組(n=18)。點爆源為模擬地雷,遠離電引爆,造成兔后肢直立跨步狀態(tài)下單后肢觸雷爆炸傷,以高速攝影機觀察爆炸瞬間水介質(zhì)運動過程。分別于傷前及傷后3、6、12h取股動脈血檢測血清心肌損傷[磷酸肌酸激酶同工酶(CK-MB)、肌鈣蛋白I(c Tn I)]及神經(jīng)損傷標志物[神經(jīng)元特異性烯醇化酶(MBP)、髓鞘堿性蛋白(NSE)],并行心臟超聲、心電圖、CT、數(shù)字減影血管造影(DSA)等檢查。存活動物于傷后12h解剖,記錄其肢體局部和遠處臟器損傷情況,并行組織病理學(xué)檢查明確損傷特點。結(jié)果涉水觸雷爆炸造成實驗兔腳掌、脛骨下段毀損,常發(fā)生遠離爆炸殘端的閉合性股骨骨折和動脈損傷,未見陸地觸雷常見的軟組織拖把樣撕裂;胸、腹腔臟器以及腦、脊髓損傷程度較陸地爆炸傷重。涉水肢體組以肢體傷為主,涉水胸部組則以胸腹腔臟器、脊髓損傷發(fā)生率高,是涉水肢體組的2~3倍。致傷組傷后6h血清心肌損傷標志物及神經(jīng)損傷標志物較假致傷組顯著升高,涉水組傷后12h較陸地組顯著升高,以涉水胸部組升高最為明顯。陸地組及涉水組傷后6h心功能顯著降低,以涉水胸部組傷后12h降低最為明顯。結(jié)論涉水爆炸能量傳遞受水底、水面、肢體或軀干相互作用的影響,是造成其傷情復(fù)雜、嚴重的重要機制,涉水深度是影響爆炸傷嚴重程度的重要因素。
[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 鹵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.
【作者單位】： 第三軍醫(yī)大學(xué)大坪醫(yī)院骨科;第三軍醫(yī)大學(xué)大坪醫(yī)院野戰(zhàn)外科研究所六室;
【基金】：全軍“十二五”醫(yī)學(xué)科研重點項目(BWS13L019)~~
【分類號】：R82

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