高温高湿环境肢体火器伤肌组织能量代谢变化

目的探讨高温高湿环境下火器致伤后动物组织损伤特点，判断组织损伤的程度及转归，旨在为这一特殊环境下 火器伤后软组织清创的时机、方法及抗生素的应用提供实验依据。方法将８只犬随机分为高温高湿（ＨＨＥ）组和常温 常湿（ＮＥ）组。分别于火器伤前、伤后０、４、８、１２、２４ ｈ测定挫伤区、震荡区和震荡外区组织的ＡＴＰ、ＡＤＰ、ＡＭＰ及能荷含 量。结果（１）ＡＴＰ值：伤后 ８ ｈ，ＨＨＥ组挫伤区明显较 ＮＥ组低（Ｐ＜０．０５）， １２ ｈ后进行性下降，较 ＮＥ组有更显著差异 （Ｐ＜０．０１）；（２）ＡＤＰ值：ＨＨＥ组挫伤区伤后 ８ ｈ及震荡区伤后 １２ ｈ较 ＮＥ组低（Ｐ＜０．０５）；（３）ＡＭＰ值：伤后 １２ ｈ，ＨＨＥ组 挫伤区明显高于 ＮＥ组（Ｐ＜０．０１）；（４）能荷：伤后 ８ ｈ，ＨＨＥ组挫伤区明显低于 ＮＥ组（Ｐ＜０．０５），伤后 １２ ｈ较 ＮＥ组降低 更为显著（Ｐ＜０．０１）。结论高温高湿环境肢体火器伤后肌组织能量储备匮乏且随时间延长显著下降，处理应强调及早、 彻底的清创和使用有效的抗生素。

Changes of energy metabolism in the skeletal muscles of canine limbs after gunshot wound in hot and humid environment

Objective This experiment aims to formulate the characteristics of the gunshot wound in the tissues of animals, evaluate the degree of damage and decide the outcome, to provide experimental basis for the methods and schedule of debridement and the application of antibiotics. Methods Eight dogs with gunshot wound in both hind limbs were subjected to hot and humid (HHE group, n=5) and normal (NE group, n=6) environmental conditions. Before the injury and at the time points of o, 4, 8, 12, 24 h after the injury, tissue specimens were taken from the contusion, shock and extrashock areas around the wounds of dogs in both groups to determine ATP, ADP and AMP content, and the energy charge was calculated. Results In the contusion area, ATP content of HHE group 8 h after the wound was lower than that of NE group (P<0.05), which progressively decreased; at 12 h, the difference between the 2 groups further expanded (P<0.01). Lower ADP contents in the contusion area at 8 h and in the extrashock area at 12 h were detected in HHE group than in NE group (P<0.05). In contrast AMP content in the contusion area of HHE group was higher than that of NE group at 12 h (P<0.01). At 8 h, levels of energy charge in HHE group was lower than that in NE group (P<0.05), and was even more so at 12 h (P<0.01). Conclusion The shortage of energy storage characterizes the muscles around the gunshot wound in hot and humid environment, which tends to deteriorate with the passage of time. Early and complete debridement of the wound together with the application of effective antibiotics is therefore of great importance in this condition.