超声应用于爆震伤院前救治的实验研究

目的采用野战环境下的动物模型进行实验研究,探讨便携超声在爆震伤院前救治中的应用价值。 方法选用长白山猪90只麻醉后制备爆震伤模型。将致伤成功动物转移至集伤点,分别使用传统体格检查和掌上超声进行检伤分类,并对适合进行静脉穿刺置管的动物模型分别进行徒手穿刺和超声引导下的静脉穿刺,记录体格检查和掌上超声诊断所需时间和准确性以及徒手穿刺和超声引导下穿刺置管所用时间和一次性置管成功率,并对数据进行比较分析。 结果90只实验猪中,成功致伤44只,致伤成功率48.9%。24只实验动物进行超声伤情评估,平均用时（230±78）s,体格检查伤情评估平均用时（60±23）s（t=10.24,P<0.01）。以手术或CT扫描结果为"金标准",掌上超声与传统体格检查的诊断准确性分别为95.8%（23/24）、54.2%（13/24）,2者比较差异有统计学意义（χ²=8.10,P<0.05）。6只动物模型进行超声引导下静脉穿刺置管,平均用时（300±86）s,一次性置管成功率100.0%。徒手穿刺法一次性置管成功2只,平均用时（600±67）s,置管成功率33.3%（2/6）。2种方法穿刺置管所用时间比较,差异有统计学意义（t=10.24,P<0.01）。 结论超声技术提高了院前爆震伤伤情评估的准确性和损伤控制成功率。超声检查具有便捷、无创、准确以及可重复等优势,其在爆震伤的院前救治中可发挥重要作用。

Application of ultrasound in pre-hospital rescue for blast injury: an experimental study

ObjectiveUltrasound (US) has advantages of handiness and multifunction in triage and pre-hospital treatment for blast injury. This study aimed to assess the application of ultrasound in pre-hospital rescue for blast injury in the condition of field battle through animal experiments. MethodsAnimals were anaesthetized and shaved before exposure to explosion, and then randomly assigned to receive extended focused assessment with sonography for trauma (eFAST) or physical examination. ResultsBlast injury was successfully induced in 44 (48.9%) of 90 animals. US examination was performed for assessment and damage control on 24 models in site. Physical examination and US examination were completed in (60±23) seconds and (230±78) seconds, respectively (t=10.24, P<0.01). The diagnosis accuracy of US (95.8%) was higher than that of physical examination (54.2%) (χ²=8.10, P<0.05). Besides, ultrasound-guided vein catheterizations were performed on 6 models with 100.0% achieving primary operation, compared with bare-handed ones with a 33.3% success rate; the former ones were completed in (300±86) seconds compared with the later ones in (600±67) seconds (t=10.24, P<0.01). ConclusionThis is a preliminary study to assess the application of US in pre-hospital treatment. The accuracy of rapid diagnosis is improved remarkably by eFAST and more precise treatment can be achieved under the guidance of ultrasound.