颅脑和胸部撞击伤发生机制研究  

Mechanism of craniocerebral and thoracic impact injuries

作　　者：王正国[1] 刘宝松[1] 李晓炎[1] 杨志焕[1] 朱佩芳[1] 

机构地区：[1]第三军医大学野战外科研究所四室,重庆400042

出　　处：《中国危重病急救医学》2001年第7期400-403,共4页Chinese Critical Care Medicine

基　　金：国家自然科学基金资助项目 (No.3 963 0 3 3 0 )

摘　　要：目的 :介绍自制的各种生物撞击机 ,总结以往颅脑和胸部撞击伤发生机制方面的研究成果 ,以便为颅脑和胸部撞击伤的防治提供理论依据。方法 :应用自行研制的生物撞击机 ,给犬、兔、大鼠等动物造成不同类型的撞击伤 ,并进行颅脑和胸部撞击伤发生机制的研究。结果 :(1)制成几种生物撞击机和颅脑、胸部撞击伤模型。(2 )证实原发颅脑撞击伤的主要原因是外力作用于颅脑后形成的剪切应力所致。 (3)继发性颅脑伤是因血管损伤、炎症损伤和兴奋性氨基酸增多致神经元钙离子内流等因素所致。钙通道阻断剂尼莫地平和血管扩张药物伊洛前列素 (Iloprost)均有抗损伤作用。 (4 )胸部损伤与胸腔内应力传播有关 ,黏性损伤标准可作为最有效的伤情指数。结论 :原发颅脑和胸部撞击伤是由于体内应力传播和应力集中所致。继发性损伤与血管损伤、过度炎症反应和兴奋性氨基酸增多致使神经元钙内流增强有关 。Objective:To investigate the mechanism of on craniocerebral and thoracic impact injuries inflicted with a selfmade impact apparatus.Methods:Using selfmade impact apparatus to produce impact injuries on dogs,rabbits and rats.The mechanism of the impact injuries was then investigated.Results:(1) Animal models of craniocerebral and thoracic impact injuries were successfully produced.(2) The main cause of primary craniocerebral impact injury resulted from the shear stress formed by an external force acting on the craniocerebrum.(3) The main causes of secondary craniocerebral injury was due to the increase of Ca 2+ inflow to the neurons resulted from vascular damage,inflammatory injury and the increase of excitatory amino acid (EAA) delivery.Nibodipine,an agent for preventing Ca 2+ inflow and Iloprost,a vasodilative agent were proved to be effective for the treatment of brain injury.(4) There was a close relationship between thoracic impact injury and intrathoracic stress transmission.Viscous injury criterion proved to be the best parameter for judging the severity of injury.Conclusions:Primary craniocerebral and thoracic injuries resulted from transmission and concentration of stress of the impact force,and secondary injuries are related to vascular damage,inflammatory injury and increase of EAA,leading to Ca 2+ inflow to neurons.Appropriate therapeatic measures prove to be effective for the treatment of these impact injuries.

关 键 词：颅脑撞击伤 胸部撞击伤 撞击伤发生机制 剪切应力 黏性损伤标准 

分 类 号：R641[医药卫生—外科学]