医院船上开展海战伤救治的实验研究  

Experimental study of treatment of sea-war wound in hospital ship

作　　者：李乙尼[1] 汪先兵[1] 周菲[1] 谢培增[1] 

机构地区：[1]解放军第四二一医院,广州510318

出　　处：《海军医学杂志》2010年第3期197-200,共4页Journal of Navy Medicine

基　　金：全军医学科学技术"十一五"课题(06MB174)

摘　　要：目的探讨在医院船上开展海战伤救治的有效方法。方法成年健康杂种犬60只,制作成颅脑火器伤、胸部开放伤、腹部开放伤、四肢伤和烧伤复合伤模型后,随机分为陆战伤组、海战伤一组和海战伤二组,每组20只。陆战伤组实验室设在陆地救护所,海战伤一组设在码头救护所,海战伤二组设在医院船上。海战伤一、二组动物致伤后海水浸泡30 m in,陆战伤组不行海水浸泡。陆战伤组采用常规治疗;海战伤一、二组采用综合治疗：除常规治疗外,加温低张液体（38~40℃的5%葡萄糖液）500 m l,东莨菪碱20 mg/8 h,盐酸纳洛酮4.8 mg/d,地塞米松40 mg/8 h和维生素B63~5 g/8 h。实验中监测24 h体温、血浆渗透压、血气分析和血电解质变化;观察3 d各组伤口感染率与死亡率,且进行比较。结果 （1）海战伤一、二组伤情明显重于陆战伤组,表现为低温、血浆渗透压升高、高钠、高氯血症、代谢性酸中毒。治疗12 h后,海战伤一、二组各项指标均达到正常水平。（2）陆战伤组伤后3 d的伤口感染率为15%,海战伤一、二组分别为40%和50%。（3）陆战伤组死亡率30%,海战伤一组为40%,海战伤二组为50%,海战伤二组死亡率与海战伤一组和陆战伤组比较明显增高（P〈0.01）。结论海战伤海水浸泡后对机体的血浆渗透压、电解质平衡和体温过低有严重影响;海上环境对海上救治的疗效有明显影响,可能是实验犬致死率高的重要原因。早期使用温低张液体对复温、降低血浆透渗压、纠正电解质平衡、提高生存率有重要的意义。ObjectiveTo investigate an effectual treatment method on sea-war wound in hospital ship.Methods After 60 dogs were subjected to craniocerebral firearm injury,open chest injury,open abdominal injury,pelviclimb injury and burn injury,the animal models were randomly divided into land warfare wound group（in land medical aid station）,sea warfare wound groupⅠ（in dock medical aid station）and sea warfare wound groupⅡ（in hospital ship）,each group with 20 dogs.Animals in the sea warfare two groups were immersed into the seawater for 30 minutes after wounded.Land warfare group was not immersed.The dogs were received routine treatment in land warfare wound group,and the other dogs were received synthetical treatment,that is,beside in routine treatment,5% lukewarm glucose liquid（38-40 ℃） 500 ml,scopolamine 20 mg/8 h,naloxone 4.8 mg/d,dexamethasone 40 mg/8 h and vitamin B6 3-5 g/8 h need be used.Blood samples were obtained at different time intervals to determine body temperature,serum osmotic pressure,blood gas analysis and electrolytes changes for 24 h and wound infection rate and mortality of three groups were compared for three days.Results （1） The two groups of sea warfare wound had symptoms such as hypermatre,hyprechloremia,hypothermia and acid-base imbalance after seawater immersion for 30 minutes.In the two groups of sea warfare wound,all indices were found to recover normal level after the dogs had been received synthetical treatment for 12 hours.（2）The wound infection rate was 15% in land warfare wound group,40% and 50% in sea warfare wound groups Ⅰand Ⅱ,respectively,in three days.（3）The mortality was 30% in land warfare wound group,40% and 50% in sea warfare wound groups ⅠandⅡ,respectively,in three days.The mortality and wound infection rate were significantly higher in the sea warfare wound group Ⅱ than in Ⅰ and in the land warfare wound group（P0.01）.Conclusion The effects of seawater immersion on electroly disturbance,plasm osmotic pressure and hypematre were very

关 键 词：海战伤 医院船 犬 

分 类 号：R821.1[医药卫生—临床医学]