海上环境对海战伤手术的影响

目的探讨海上环境对海战伤手术时间与质量的影响，为提高海战救护能力。方法杂种犬60只随机分为陆地手术组（码头环境）；海上1组（海上风力2～4级，海面浪高2～3m，舰船摇摆度5～10。环境）；海上2组（海上风力5～7级，海面浪高3～5m和舰船摇摆度11～25°环境），每组20只。海上1、2两组在航行中的医院船上进行实验，陆地组在该海域码头实验室中进行实验。动物被制作出颅脑火器伤、开放性胸部伤、开放性腹部伤、下肢伤和烧伤，且行海水浸泡处理。动物接受手术和海水浸泡伤常规处理，每组20只犬，先后行不同部位手术460台次，包括开颅术40台次，剖胸术120台次，剖腹术120台次，下肢骨折内固定术40台次，股动脉吻合术40台次，气管切开术40台次，静脉切开术40台次和清创术20台次。比较三组的手术时间、手术质量及伤后3d内动物死亡率。结果每组手术460台次，时间不等，陆地组共用时300．6min，海上1组369．4min，海上2组426．3min。海上1组手术时间比陆地组长22．9％（P〈0．01），海上2组比1组长15．4%（P〈0．01）。股动脉吻合术后，陆地组2例血管不通畅，海上1、2两组分别为6和11条血管不通畅。3d内陆地组动物的死亡率为35％（7／20），海上1、2两组分别为45％（9／20）和65％（13／20），海上2组死亡率明显高于其它两组（P〈0．01）。结论海上环境对手术时间与质量和动物死亡率有明显影响。明确海上手术特点，提高外科医生在海上的手术技巧和适应海上环境是缩短手术时间、提高质量和降低致伤动物死亡率的关键。

Effect of Marine Environment on Surgical Operation on Sea

Objective To explore the affection of marine environment on surgery time and quality for sea-war wounds and to supply reference to improve the rescue capacity. Methods Sixty cross-bred dogs were randomly and evenly divided into land group （treated in dock on South China Sea）, sea group Ⅰ （treated in the marine environment with wind force 2-4, wave height 2-3m, rock degree 5~10°） and sea group Ⅱ （treated in the marine environment with wind force 5~7, wave height 3~5 m, rock degree 11 ~25°）. For the sea groups the experiment was carried out in hospital ship sailing on South China Sea. The dogs were subjected to craniocerebral firearm injury, open chest injury, open abdominal injury, pelvic limb injury and burn injury, and then the wounds underwent seawater immersion. The dogs were given surgical operation and routine treatment. The overall operation were 460 table times in each group, including craniotomy （40 table times）, ventrotomy （120）, thoracotomy （120）, limb （40）, arteriorrhaphy （40）, tracheotomy （40）, venesection （40） and debridement （20）. The treatment quality and mortality of the dogs were compared among the three groups. Results The operation time of the land group was 300. 6 rain, sea group 1 369. 9 rain and sea group Ⅱ 426. 3 rain. The operation time was 22. 9% longer for sea group I than land group （P〈0. 01）, and 15.4% longer for sea group Ⅱthan sea group Ⅰ （P〈0. 01）. After arteriorrhaphy, 2, 6 and 11 vessels were obstructed in land group, sea group Ⅰ and Ⅱ respectively. The mortality of animals within three days was 35% （7/20）, 45% （9/20） and 65% （13/20） in land group sea group Ⅰ and Ⅱrespectively. The mortality was significantly higher in sea group Ⅱ （P〈0. 01 ）. Conclusion The marine environment has obvious affection on time and quality of surgical operation. In order to reduce the operation time, improve the operation quality and reduce the mortality of sea-war wounds, training on surgery operation skills and adaptation to marine circumstances are very important.