【作者】 马劼；

【导师】 高国栋； 贺世明；

【作者基本信息】 第四军医大学 ， 外科学， 2010， 硕士

【摘要】 随着科学技术的发展及应用,爆震致伤越来越常见。它以致伤的多重性、复杂性及严重性已经成为颅脑火器伤的研究重点,并成为当今创伤医学领域研究的焦点之一。开放性颅脑爆震伤的危害较闭合性损伤更为严重,故研究前者的致伤机制及病情变化具有非常重要的意义,可以为伤员的分类、伤情的分型、疾病的治疗、预后以及后期康复提供理论依据和科学指导。随着人类活动范围的扩大,伤员坠海现象频繁发生,颅脑开放性爆震伤合并海水浸泡伤的情况也逐渐增多,故对其病理学变化的观察及研究,有助于从细胞水平解释病情变化及转归,从而增加医学人员对疾病的认识及预见,从根本上降低致残率及致死率,改善预后。然而目前存在的开放性颅脑爆震伤模型均有其不足方面。在一些实验中,爆震物的能量不足以造成开放性损伤,而另一些实验则可能由于致伤物能量过大,导致了动物过快的死亡,这给实验的复制及观察带来了不便。故为了更好地观察开放性颅脑爆震伤合并海水浸泡伤的早期病理学变化,本研究第一部分着重阐述利用小型球形爆震源制备稳定、符合实际且重复性好的开放性犬颅脑爆震伤模型;第二部分研究中探讨了开放性犬颅脑爆震伤合并海水浸泡伤的早期病理学的变化特点,并且与单纯开放性犬颅脑爆震伤的早期病理学变化进行了对比,从而观察两者的异同点,以期为提高颅脑爆震伤的救治质量提供理论依据,并且为提高开放性颅脑爆震伤的防护作出贡献。目的实验第一部分利用小型球形爆震源建立稳定、符合实际且重复性好的开放性犬颅脑爆震伤动物模型,并且观察犬的伤情变化。在实验第二部分,观察及探讨了开放性犬颅脑爆震伤合并海水浸泡伤的早期脑组织病理学改变,并且与单纯开放性犬颅脑爆震伤的病理学变化进行对比观察。方法实验第一部分,首先将30条健康成年杂种犬随机分为3组(3mm组,3.5mm组,4mm组),每组10只,以颅中线向左(或右)1cm,眶上缘向上1cm交界处为爆震中心,将能量相当于1gTNT当量的小型球形爆震源经过测量后放置于距离犬头部皮肤对应的分组距离处,进而引爆致伤,观察并记录动物的生命体征、存活时间、肢体运动状况及不同组的病理变化经过。尔后,根据模型建立的情况,认为最佳距离为3.5mm,于是进入课题研究的第二部分。将另外30条健康成年杂种犬随机分为2组:单纯爆震伤组和海水爆震伤组,每组15只,并将小型球形爆震源用金属架固定于距头部皮肤3.5mm处进行与实验一中相同的致伤。随后将装有福建沿海区域海水的输液器置入海水爆震伤组动物的颅部伤道中,以500ml/小时的速度对伤口进行滴注。分别观察致伤后3小时,5小时及≥8小时两组动物的局部伤道、颅内血肿的发生及变化情况和脑水肿等。结果在实验第一部分中,由于致伤距离的不同,伤情严重程度不同。3mm组经过爆震后均立即死亡;3.5mm组和4mm组均可观察到短暂时间的生命体征变化。在3.5mm组中,除有四条分别于两天内不同时间死亡外,其余犬存活良好,且头部伤情符合最初实验设计;4mm组均存活,但是致伤效果未达到预期设计。故经过观察及对比发现在3.5mm处安放小型球形爆震源可以成功地制作开放性犬颅脑爆震伤模型。在实验第二部分中,笔者发现在早期阶段单纯爆震伤组脑水肿的严重程度明显高于海水爆震伤组,两组均可见明显的骨折、硬膜外出血、硬膜下出血、脑挫裂伤、颅内点状出血、颅内血肿及爆震所致的其他部位的损伤。结论实验第一部分成功地建立了开放性犬颅脑爆震伤模型,它的优点在于良好的稳定性、较真实地模拟了创伤情况以及具有较高的可重复性,其观察结果对于实验二中单纯爆震伤组的病理变化给予了一定的提示。我们发现海水对于早期爆震伤后脑组织的变性具有延缓和减轻作用,这可能是海水的高渗因素发挥了作用。更多还原

【Abstract】 With the development and utilization of science, explosive injury is to be seen more and more in the daily life. Because of its characteristics such as complexity and severity, explosive injury is the key project to missile craniocerebral injury and traumatic medicine. As a kind of missile craniocerebral injuries, open blast injury is more severe than closed blast injury so that there has been important significance to study the mechanism and changes of the former type. It can provide the basis and directions for sorting injured people into groups、treatment、prognosis and rehabilitation .The sphere of activity has broaden so quickly that the wounded falls into the sea more frequently than before. We can found that there are more and more wounded people with open blast head injury and sea water immersion. As a fact, to observe and study the Pathological changes is helpful for us to illustrate the sequelae at cell level and to better understand the disease. If we can achieve this goal, we can reduce the rate of deformity and low down lethally rate. However, all of the existing models of open blast head injury have their deficiency. Some explosive substance due to lack of energy can not bring about open injury, whereas others can result in death to experimental animals. In order to observe the Pathological changes with open blast head injury and sea water immersion, in the first part of this article, we placed much emphasis on establishing an experimental model of open blast head injury of dog brains . This model should have renewable features and in line with the fact . In the second part , we paid close attention to Pathological changes after blast head injury with seawater immersion of brain and then contrasted these changes to the dogs suffered from open blast head injury . We hoped to find similarities and differences between them in order to improve the quality of the medicine and enhance active protection.ObjectiveIn the first part, we wanted to establish an experimental model of open blast head injury of dog brains and then observe their changes of traumatic condition. This model which made use of small round explosive substance should have renewable features and inline with the fact. In the second part, we observed the pathological changes after blast head injuries with seawater immersion of brain in dogs and then contrasted these changes to the dogs suffered from open blast head injuries.MethodsIn the first part , thirty dogs were divided into three groups randomly(3.0mm , 3.5mm , 4mm)and ten dogs in each group .The explosive substance with energy of 1g TNT was detonate at the interface of brain centre line (1cm left or right)and margo supraorbitalis (1cm above the skin of head). Then recorded vital sign、survival time、limbs movement and Pathological changes. At last, we ascertained 3.5mm for the best distance and we came into the second part of the experiment .Other thirty medical fitness dogs were injuried from spherical explosive(3.5mm above the skin of head ). Then put the apparatus infusionis which was filled with sea water (at speed of 500ml per hour) from the region of Fujian coast into the wound tract. Observed the condition of injury、the incidence rate of cranial cavity hematoma and brain edema. And at the same time compared with the traumatic condition at 3, 5, 8 hour respectively after injury.ResultsAs a result of different traumatic distances ,the incurred injuries were different in the three groups . The group(3mm)were all dead . Respiratory arrest and decreased heart rate were observed after wounding in other two groups .Although four dogs in the group (3.5mm)were dead gradually , others had good condition and met up with criterion . The group (4mm) did not meet the requirement for the experiment design . So 3.5mm was the best place to successfully make the experimental model of open blast head injury of dog brains . In the second part , we found that at the early stage ,the edema in the blast injury group was serious than that with sea water immersion . We could both found skull fracture、epidural hematoma、subdural hematoma、intracerebral hematoma and other wounds .ConclusionIt is a good model that can be used in the experimental study of blast head injury to the dog brain . Sea water immersion can delay and alleviate the denaturation after blast injury .更多还原