涉水触雷爆炸伤的特点及机制

目的 探讨不同水深涉水触雷的损伤特点及机制.方法 健康成年新西兰大白兔96只,体重2.19±0.12kg,随机分为陆地爆炸组(n=16),涉水肢体组(n=16,水深齐实验兔大腿中段),涉水胸部组(n=16,水深齐实验兔剑突),力学测试组(n=30),假致伤组(n=18).点爆源为模拟地雷,远离电引爆,造成兔后肢直立跨步状态下单后肢触雷爆炸伤,以高速摄影机观察爆炸瞬间水介质运动过程.分别于伤前及伤后3、6、12h取股动脉血检测血清心肌损伤磷酸肌酸激酶同工酶(CK-MB)、肌钙蛋白Ⅰ(cTnⅠ)]及神经损伤标志物神经元特异性烯醇化酶(MBP)、髓鞘碱性蛋白(NSE)],并行心脏超声、心电图、CT、数字减影血管造影(DSA)等检查.存活动物于伤后12h解剖,记录其肢体局部和远处脏器损伤情况,并行组织病理学检查明确损伤特点.结果 涉水触雷爆炸造成实验兔脚掌、胫骨下段毁损,常发生远离爆炸残端的闭合性股骨骨折和动脉损伤,未见陆地触雷常见的软组织拖把样撕裂;胸、腹腔脏器以及脑、脊髓损伤程度较陆地爆炸伤重.涉水肢体组以肢体伤为主,涉水胸部组则以胸腹腔脏器、脊髓损伤发生率高,是涉水肢体组的2～3倍.致伤组伤后6h血清心肌损伤标志物及神经损伤标志物较假致伤组显著升高,涉水组伤后12h较陆地组显著升高,以涉水胸部组升高最为明显.陆地组及涉水组伤后6h心功能显著降低,以涉水胸部组伤后12h降低最为明显.结论 涉水爆炸能量传递受水底、水面、肢体或躯干相互作用的影响,是造成其伤情复杂、严重的重要机制,涉水深度是影响爆炸伤严重程度的重要因素.

The characteristics of mine explosion injury of wading in shoal: A study on an animal model

Objective To study the characteristics and mechanism of mine blast injury that wading in shoal of different depths through an animal model.Methods Ninety-six healthy adult New Zealand white rabbits weighing 2.19 ± 0.12kg were randomly divided into land group (n=16),limb wading group (n=16,the water depth reaching up the middle of the thighs of rabbits),and chest wading group (n=16,the water depth reaching up the thoracic xiphoid),stress test group (n=30),fake injury group (n=18).Punctiform burster was used to simulate landmine.Electric ignited the simulated mine away,causing landmine explosion injury to rabbits' one-sided hind limbs in upright state.High-speed photography was used to observe the movement of water accompanying the simulated mine explosion.Arterial blood serum markers of myocardial injury (CK-MB,cTnⅠ) and nerve injury (MBP,NSE) were detected before injury,and 3,6 and 12h after injury,and echocardiography,electrocardiography,CT,DSA and other examinations were implemented at the same time.Survival animals were killed 12h after injury for anatomy to record their injuries to the limbs and distant organs.The histopathological examination was done to define the injury characteristics furthen Results Feet and distal tibia were broken,and closed femoral fractures and arterial damage were often found away from the stump in limb wading group.This type of injury was different from the mop-like tearing tissue in the land group.Chest,abdominal organs and the brain,spinal cord injury in wading group were more severe than those in land group.There were higher incidences of chest,abdominal organs and spinal cord injury in chest wading Group.Conclusion The energy transfer of underwater explosion is affected by water depth and limbs or trunk mutually,which is an important mechanism of the complex and serious injuries in the wading group.The wading depth is an important factor affecting severity of the injury.Based on characteristics and unique mechanism of wading explosion,emergency treatment and the principle of early treatment for injury warrant further explored.