海上环境下海战伤救治的实验研究

目的探讨海战伤海上救治的有效方法。方法成年健康杂种犬60只，按多发性火器伤、弹烧复合伤模型方法，制作颅脑火器伤、胸部开放伤、腹部开放伤、四肢伤和烧伤后模型，随机分为陆战伤组、海战伤1组和海战伤2组，每组20只。陆战伤组实验室设在陆地救护所，海战伤1组设在码头救护所，海战伤2组设在医院船上。海战伤2组动物致伤后被海水浸泡30min，陆战伤组不行海水浸泡。陆战伤组采用常规治疗；海战伤2组采用综合治疗：除常规治疗外加温低张液体（38-40℃的5%葡萄糖液）500ml，东莨菪碱20mg／8h，地塞米松40mg／8h和维生素B6 3～5g／8h。实验中监测24h体温、血浆渗透压、血气分析和血电解质变化；观察3d各组伤口感染率与死亡率。结果①海战伤2组伤情明显重于陆战伤组，表现为低温、血浆渗透压升高、高钠、高氯血症、代谢性酸中毒。治疗12h后，海战伤2组各项指标均达到正常水平。②陆战伤组伤后3d的伤口感染率为15％，海战伤1、2组分别为40％和50％。③陆战伤组死亡率30％，海战伤1组为40％，海战伤2组为50％，海战伤2组死亡率与海战伤1组和陆战伤比较明显增高（P〈0．01）。结论海战伤海水浸泡后对机体的血浆渗透压、电解质平衡和体温过低有严重影响；海上环境对海上救治的疗效有明显影响，可能是实验犬致死率高的重要原因。早期加温低张液体对复温、降低血浆透渗压、纠正电解质平衡、提高生存率有重要的意义。

Experimental Study of Treatment on Sea Warfare Wound in Marine Environment

Objective To study an appropriate treatment strategy on sea warfare injury in marine environment. Methods Craniocerebral firearm injury, open chest injury, open abdominal injury, pelviclimb injury andburn injury were induced on 60 dogs. Animals were randomly divided into land warfare wound group （treated in medical aid station on land）, sea warfare wound group Ⅰ （treated in dock）and sea warfare wound group Ⅱ （treated in hospital ship）, each group with 20 dogs. Animals in the latter two groups were additionally immersed in the seawater after wound for 30 mi- nutes. The land warfare wound group were treated with routine methods, and other dogs were treated with comprehensive treatment, including routine treatment plus lukewarm glucose liquid （5%, 38-40 ℃, 500 ml）, scopolamine （21） mg/ 8 h）, dexamethasone （40 mg/8 h） and vitamin B6 （3~5 g/8 h）. Blood samples were obtained at different time intervals to determine serum osmotic pressure and electrolytes. Wound infection rate and mortality were compared in three days. Resuits The two sea warfare groups had hypermatre, hyprechloremia, hypothermia, and acid-base imbalance after seawater immersion. After comprehensive treatment for 12 hours, all indices reached normal level. The infection rate within three days was 15% in land group, and 40% and 50% in sea groups. The mortality in three days was 30% in land group, 40% in sea group Ⅰ and 50% in sea groupⅡ. These rates significantly increased in the sea group Ⅱthan the sea group Ⅰ and the land group （P〈0. 01）. Conclusion Seawater immersion after sea warfare wound is associated with severe electrolyte disturbance,plasma osmotic pressure and hypothermia. Marine environment has obvious influence on treatment effect and may be risk factor for high mortality. Early infusion of lukewarm hypotonic solution can significantly reduce osmotic p＇ressure, and increase survival rate.