海上环境下海水浸泡颅脑火器伤治疗的实验研究

目的探讨海上环境对海水浸泡颅脑火器伤治疗的影响,为提高海战救护能力提供参考。方法雄性杂种犬60只,按数字表法随机分为陆地组码头环境,气温（30±5）℃,相对湿度（86.3±5）%],海上组在医院船上,海上风力2～5级,海面浪高2～5m,舰船摇摆度8～16°,气温（32±5）℃,相对湿度（92.3±6）%],每组30只。动物被制作成海水浸泡颅脑火器伤模型。30min后用常规方法加β-七叶皂甙钠、盐酸纳洛酮治疗。对两组动物行经颅多普勒超声检测、动脉血气分析、颅内压监测,并对各项指标变化及疗效进行比较。结果治疗后3h两组犬各项检测指标均优于治疗前（P〈0.05）。治疗后陆地组脑血管痉挛好转率、颅内压恢复情况、动物存活率都优于海上组（P〈0.01）。结论海上风浪、风力和湿热环境对海水浸泡颅脑火器伤的救治疗效有明显的影响。针对海上环境的影响因素采取相应的措施,提高医护人员海上的手术技巧和对海上环境的适应能力是提高海上颅脑火器伤救治疗效和降低死亡率的关键。

Experimental study of treating craniocerebral firearm injuries with seawater immersion on the sea

Objective To enhance the level of treating the craniocerebral firearm injury（CFI） with seawater immersion on the sea.Methods Sixty male Cross-bred dogs were randomly divided into land group on the dock,where air temperature was（30±5）%,and relative humidity was（86.3±5）%,and sea environment group on board ship,where wind force was 2～5,wave high was 2～5 m,rock degrees was 8～16°,air temperature was（32±5）%,and relative humidity and（92.3±6）%,of 30 dogs each.The model of CFI with seawater immersion was established in all the dogs.The dogs with sea water immersion CFI were treated by routine methods plus s-aescine and naloxone 30 minutes after the injury.The transcranial Doppler ultrasound,blood gas analysis and monitoring intracranial pressure（ICP） were performed in all the dogs.The curative effects were compared between both the groups.Results The cerebrovascular spasm incidence,and the indexes of blood viscosity and blood air analysis were improved 3 hours after the treatment compared to those before the treatment in the land and sea environment groups（P〈0.01）.The above-mentioned indexes were significantly better in the land group than those in the sea environment group 3 hours after the treatment（P〈0.01）.The ICP was significantly lower in the land group than that in the sea environment group 8 after the treatment（P〈0.01）.The ICP was significantly lower 8 hours after the treatment than that before the treatment（P〈0.01） in both the groups.The dead rate was significantly lower in the land group than that in the sea environment group 7 days after the treatment（P〈0.01）.Conclusions The therapeutic effect on CFI with seawater immersion may significantly be lowered by the sea environment including the wind,wave,and megathermal and megahumid weather.To counter the adverse environment on the sea,the enhancement the trains of medical technique and medical staffs＇physical stamina is necessary to improvement of the curative effect on CFI with seawater immersion.