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《中华肺部疾病杂志》[ISSN:1006-6977/CN:61-1281/TN]

卷:

期数:

2024年01期

页码:

1-8

栏目:

出版日期:

2024-02-20

文章信息/Info

Title:

Analysis of the characteristics of severe chest blast injuries after rapid ascent to high altitude

作者:

伍正彬¹; 2; 邵世锋²; 张良潮³; 段朝霞²; 王 震²; 王耀丽²; 王建民²; 梁宗安¹

610041 成都,四川大学华西医院呼吸与危重症医学科¹400042 陆军军医大学大坪医院战创伤医学中心,创伤与化学中毒全国重点实验室²

Author(s):

Wu Zhengbin¹; 2;  Shao Shifeng²;  Zhang Liangchao²;  Duan Zhaoxia²;  Wang Zhen²;  Wang Yaoli²;  Wang Jianmin²;  Liang Zongan¹.

¹Department of Respiratory and Critical Care Medicine, West China School of Medicine and West China Hospital, Sichuan University, Chengdu, 610041, China; ²Medical Center of Trauma and War Injury, Daping Hospital, Army Medical University, Trauma and Chemical Poisoning National Key Laboratory, Chongqing, 400042, China.

关键词:

高原重度胸部爆炸伤;  一型爆炸伤;  二型爆炸伤;  早期检伤;  山羊

Keywords:

High-altitude severe chest blast injury;  Primary blast injury;  Secondary blast injury;  Early injury triage;  Goat

分类号:

R563

DOI:

10.3877/cma.j.issn.1674-6902.2024.01.001

摘要:

目的 建立急进高原条件下山羊重度胸部爆炸伤模型,分析不同类型爆炸伤的损伤特点。方法 选取健康山羊70只,从2 800 m常驻地转运至海拔4 600 m地区,路程约130 km,采用8 kg TNT当量,根据爆炸源距离随机分为3 m组30只、3.5 m组12只、8 m组1只、12 m组4只及16 m组23只; 每组山羊同向右侧固定在特制铁架内,分次静爆致伤。致伤前后采集山羊生命体征、动脉血气、影像学资料、肺大体解剖等,采用描述性研究方法比较高原爆炸伤后的特点。结果 常驻2 800 m山羊急进高原4 600 m体温下降[(39.58±0.35)vs.(38.1±0.65)]℃; PaO₂下降[(47.00±5.51 )vs.(36.97±4.69)]mmHg; SaO₂降低[(86.83±4.02)vs.(71.1±12.54)]%。重度胸部爆炸伤后存活时间>15 min 山羊43只(61.42%),其中一型29只(41.42%),二型14只(20.00%); 存活时间>30 min 37只(52.86%),其中一型24只(34.28%),二型13只(18.57%)。一型与二型重度胸部爆炸伤存活例数差异无统计学意义(P>0.05); 一型重度胸部爆炸伤主要表现为气胸、肺冲击伤,部分伴有烧伤、耳、肠道和心脏冲击伤等; 二型重度胸部爆炸伤表现为胸部穿透伤、肺撕裂伤,部分伴有胸腹或心肺联合穿透伤、肝撕裂伤等。一型和二型胸部爆炸伤后平均动脉压增高(P<0.05)。结论 2 800 m山羊急进海拔4 600 m出现缺氧、低体温等高原反应; 两种重度胸部爆炸伤30 min内致死率相同,一型爆炸伤伤情表现隐匿,伤后呼吸增快、低氧血症、酸中毒。二型伤情易发现,早期救治困难。

Abstract:

Objective Under the conditions of rapid highland, by establishing models of severe thoracic blast injuries in sheep, the characteristics of injuries from two different types of blast injuries were analyzed. Methods It was selected that 70 healthy goats from their permanent residence at 2 800 meters and transport them approximately 130 km to an altitude of 4 600 meters, using 8 kg TNT equivalent. Divide the goats into groups based on distance from the explosion source using a random number method: 30 goats at 3 meters, 12 goats at 3.5 meters, 1 goat at 8 meters, 4 goats at 12 meters, and 23 goats at 16 meters. Secure the goats in custom iron frames facing to the right, and then detonate in separate controlled explosions. Collect vital signs, arterial blood gases, imaging data, and gross lung anatomy of the goats before(2 800 m, 4 600 m)and after the explosions, and analyze the characteristics of high-altitude blast injuries using descriptive research methods. Results After reaching an altitude of 4 600 meters, the goats which resided at an altitude of 2 800 meters experienced a decrease in body temperature [(39.58±0.35)vs.(38.1±0.65)]℃, a decline in arterial oxygen pressure[(47.00±5.51 )vs.(36.97±4.69)]mmHg, and a reduction in SaO₂ [(86.83±4.02)vs.(71.1±12.54)]%. Severe thoracic blast injuries resulted in a survival rate of over 15 minutes of 43 individuals(61.42%)in primary, there were 29 individuals(41.42%), and in secondary, there were 14 individuals(20.00%). And over 30 minutes of 37 individuals(52.18%), in primary, there were 24 individuals(34.28%), and in secondary, there were 13 individuals(18.57%). Primary and secondary severe thoracic blast injuries showed no statistically significant difference in survival rate(P>0.05). severe primary thoracic blast injuries mainly presented as pneumothorax and lung contusion, sometimes accompanied by burns, ear, intestinal, and cardiac contusions. Secondary severe thoracic blast injuries were characterized by chest penetration injuries and lung lacerations, sometimes accompanied by thoracoabdominal or cardiorespiratory penetrating injuries, liver lacerations, and others. Following both types of thoracic blast injuries, the average arterial pressure significantly increased(P<0.05). Conclusion At an altitude of 2 800 meters, local goats exhibit symptoms of high-altitude sickness such as hypoxia and hypothermia after reaching an altitude of 4 600 meters. There are two types of severe chest blast injuries with the same fatality rate within 30 minutes. primary blast injury manifest discreetly and are followed by increased breathing, hypoxemia, and acidosis. Secondary injuries are easily detected but pose relative difficulties in early treatment.

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备注/Memo

备注/Memo:

基金项目: 国家自然科学基金资助项目(81970259);
重庆市技术创新与应用发展专项重点项目(318-084063)
通信作者:梁宗安, Email:?liangza@scu.edu.cn

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更新日期/Last Update: 2024-02-20