对海水浸泡复合伤伤情的简易评估方法

背景建立海水浸泡复合伤伤情快速评定方法的实验动物模型,以利于其愈后恢复.目的探讨建立海水浸泡复合伤简易伤情评定方案的方法.设计分组对照实验.单位解放军第一一三医院骨二科,第三军医大学大坪医院野战外科研究所.材料健康成年杂交犬32只,体质量12～15kg,雌雄不限.方法本实验部分于2001-10/2002-06由第三军医大学大坪医院野战外科研究所第五、六研究室在我国特定海域完成.犬随机分为烧冲复合伤组与弹烧复合伤组,每组又分浸泡组10只与对照组6只.烧冲复合伤组制造烧伤和轻度冲击伤模型,对照组致伤后直接置于25℃室内,浸泡组立即用固定架将犬浸泡模拟海水中.弹烧复合伤组制造烧伤和轻中度弹片伤模型,致伤后对照组和浸泡组处理方法同前.观察各组在伤后28 h内各项生理指标的变化,找出与死亡发生有关的指标,分析其相关性,建立伤情评分表,内容包括体温、心率、平均动脉压、氯离子浓度、动脉氧分压及致伤因素各项,分为0～5分,总分分值越高死亡率越高.主要观察指标①各组犬死亡数分析.②伤情评分.③评分表评定伤情的验证.结果32只犬均进入结果分析.①犬死亡数分析及各项指标与死亡发生的关系犬共死亡12只,10～20 h是死亡发生高峰期,无论浸泡是否发生;体温、心率、平均动脉压、动脉氧分压、氯离子浓度等5指标与死亡发生有显著影响(P＜0.05).②各组犬伤情评分、预测死亡率与实际死亡率比较烧冲对照组各项分别为(5.89±3.25)分,0,17%;弹烧对照组分别为(6.78±2.02)分,25%,33%;烧冲浸泡组分别为(9.50±4.20)分,50%,30%;弹烧浸泡组评分别为(11.13±3.57)分,50%,60%.结论①建立的评分表易于获得常用生理指标以快速评定伤情,且有无合并海水浸泡均可进行评定,适用面较广.②评定的准确性经验证可以接受.③但此表是基于动物实验数据建立,与真正的伤员伤情评分表仍有差距.

Simple evaluation on combined wound with seawater immersion

BACKGROUND: To establish experimental animal model for rapid evaluation of combined wound with seawater immersion so as to benefit wound healing and recovery.OBJECTIVE: To explore the plan of simple evaluation of combined wound with seawater immersion.DESIGN: Group division and controlled experiment was designed.SETTING: Second Department of Orthopaedics, the 113 Hospital of Chinese PLA; Research Institute of Surgery, Daping Hospital, Third Military Medical University of Chinese PLAMATERIALS: Totally 32 health hybridized adult dogs were employed,mass weighted varied from 12 to 15 kg, of either sex.METHODS: The experiment was performed partially in the specific sea area of the Fifth and Sixth Room , Research Institute of Surgery of Daping Hospital of the Third Military Medical University of Chinese PLA from October 2001 to June 2002. The dogs were randomized into burn-blast combined wound group and projectile-burn combined wound group and each group was subdivided into immersion group (10 dogs) and the control (6 dogs). Burn-blast combined wound group: The model of burn and mild blast injury was prepared. In the control, the dogs were put in a room at 25 ℃ directly after injury; But in immersion group, the dogs were immersed immediately in simulated seawater with holder. Projectile-burn combined wound group: The model of burn and mild projectile injury was prepared. The managements were same as the previous after injury in the control and immersion group. The change of physiologic indexes was observed in 28 hours after injury. The indexes related to death were picked up for correlative analysis and establishing wound scoring scale, inducing body temperature, heart rate, mean arterial pressure (MAP), chloride concentration, PaO2 and causative factor, 0-5 score were designed, the higher the score was, the higher mortality would be.MAIN OUTCOME MEASURES: ① Analysis of dead cases in each group. ② Wound scoring. ③ Verification of wound in scoring scale.RESULTS: 32 dogs all entered result analysis. ① Analysis of dead cases and relationship: Totally, 12 dogs were died. The peak of death was in 10-12hours, no matter the immersion happened or not. 5 indexes were associated significantly with death, named body temperature, heart rate, MAP, PaO2 and chloride concentration (P ＜ 0.05). ② Comparison of wound scoring, predictive mortality and actual mortality in each group: The results in burn-blast control were (5.89±3.25) score, 0 and 17% successively. Those in projectileburn control were (6.78±2.02), 25% and 33% successively. Those in burn blast immersion group were (9.50±4.20) scores, 50% and 30% and those in projectile-burn immersion group were (11.13±3.57) scores, 50% and 60%.CONCLUSION: ① The established scoring scale is apt to obtain common physiological indexes so as to evaluate the wound rapidly, which is applica ble for either seawater immersed cases or non-immersed cases, indicating extensively applications. ② The correction of evaluation is acceptable with verification. ③ The scale is based on animal experimental data, for which,it is still different from the one of real wound evaluation.