本文選題：爆炸傷 + 密閉艙室��； 參考：《第二軍醫(yī)大學》2017年碩士論文

【摘要】：研究目的:隨著人類對海上資源爭奪的日漸激烈,爆發(fā)海上戰(zhàn)爭的可能性越來越大。水面艦艇是海上戰(zhàn)爭的主要作戰(zhàn)方式,而艦船艙室多為相對密閉的空間,因此針對性研究密閉空間爆炸傷的傷情特點、損傷機制以及救治重點更具實用價值。本研究從實戰(zhàn)出發(fā),等比例構(gòu)建多艙室艦船模型,選用艦炮為爆源,探討實戰(zhàn)條件艦炮攻擊下艦船密閉艙室內(nèi)艦員損傷的傷情特點及其與爆炸當量、位置、破片、沖擊波等諸因素之間的關(guān)系,為現(xiàn)代海戰(zhàn)傷艦船傷員的救治提供理論依據(jù)。研究方法:采用鋼板以1:1比例模擬多艙室船舶模型重點部位艙室結(jié)構(gòu)構(gòu)建多艙室實驗模型。以76只新西蘭大白兔為實驗動物,選用兩種常規(guī)口徑艦炮為爆源。爆炸后立即清理現(xiàn)場,觀察記錄實驗動物死傷情況并進行X線檢查。死亡動物立即解剖,存活動物單籠飼養(yǎng)24小時后處死解剖:1、尸檢死亡動物分析死因,存活動物觀察臟器是否損傷及損傷特點;2、獲取實驗動物脊髓標本。匯總所得數(shù)據(jù),采用SPSS21.0軟件進行統(tǒng)計學分析,總結(jié)傷亡率及其與艙室結(jié)構(gòu)相關(guān)性。另外,將獲取的脊髓標本經(jīng)福爾馬林固定后進行石蠟包埋切片,并進一步分析其損傷特點:HE染色觀察脊髓組織形態(tài)學改變,TUNEL試劑盒檢測脊髓細胞凋亡與否,免疫組化法檢測凋亡相關(guān)蛋白Caspase-3的表達情況,分析密閉艙室內(nèi)爆炸脊髓損傷的特點。結(jié)果:艙室內(nèi)實驗動物共計76只,整體死亡率59.2%。實彈組死亡率(63.2%)與裸彈組死亡率(55.3%)之間無顯著差異(P0.05)。大口徑組死亡率(73.7%)高于小口徑組死亡率(44.7%)(P0.05);大口徑艦炮爆炸時各艙室死亡率不全相等(P=0.000),其中當艙死亡率最高,之后分別是鄰艙和隔艙;小口徑艦炮爆炸時各艙室死亡率無顯著差異(P0.05)。造成死亡的主要原因是沖擊波和爆炸破片導致的重要臟器的損傷,兩者之間無顯著差異(P0.05)。爆炸后存活動物活動能力評分顯示,當艙及鄰艙機柜前實驗動物活動能力隨時間有不同程度下降;鄰艙機柜后組、隔艙組實驗動物活動能力無明顯變化。存活動物肺沖擊傷評級顯示:當艙及鄰艙機柜前的實驗動物肺損傷最重,均達到中-重度以上損傷;鄰艙機柜后組主要為輕度肺沖擊傷;隔艙組除個別有輕度肺沖擊傷外,其他均無肺沖擊傷表現(xiàn)。實驗動物脊柱骨折發(fā)生率為7.1%,爆炸破片和拋擲摔傷是導致脊柱骨折的主要原因。大體解剖及HE染色可觀察到蛛網(wǎng)膜下腔出血、髓內(nèi)血管破裂出血等脊髓損傷表現(xiàn);細胞層面檢測觀察到,存活組實驗動物脊髓損傷程度較死亡組嚴重:脊髓前角運動神經(jīng)元計數(shù)當即死亡組多于存活組(P0.05);凋亡細胞計數(shù)當即死亡組少于存活組(P0.05)。存活動物中,爆炸當艙及鄰艙機柜前實驗動物脊髓損傷最重:當艙與鄰艙機柜前神經(jīng)元數(shù)量最少,兩者之間無明顯差異(P0.05),其次為鄰艙機柜后和隔艙(P0.05);當艙與鄰艙機柜前凋亡細胞數(shù)量最多,兩者之間無明顯差異(P0.05),之后依次為鄰艙機柜后和隔艙(P0.05)。另外,Caspase-3蛋白陽性表達當即死亡組與當艙存活組、鄰艙機柜前存活組之間無明顯差異(P0.05),但高于鄰艙機柜后存活組及隔艙存活組(P0.05)。結(jié)論:船舶多艙室結(jié)構(gòu)中,大口徑彈藥爆炸的傷亡率明顯大于小口徑彈藥爆炸;實彈與裸彈的致傷類型及死亡率無明顯差異;不同艙室位置死亡率不同,艙室整體結(jié)構(gòu)及內(nèi)部機柜在一定范圍內(nèi)對艙室內(nèi)人員及脊髓組織有明顯的防護作用。艙內(nèi)爆炸時,脊髓爆震傷是爆炸后脊髓損傷的主要類型,其損傷從細胞水平觀察主要表現(xiàn)為細胞凋亡;脊髓損傷程度與肺損傷程度正相關(guān),中、重度以上肺沖擊傷表現(xiàn)提示伴有較重的脊髓損傷。以上傷情特點為密閉艙室爆炸時內(nèi)部人員的防護救治及脊髓爆震傷的早期診斷提供了一個新的嘗試方向。
[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.

【學位授予單位】：第二軍醫(yī)大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R826

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