湿热环境火器伤有限清创术疗效观察的初步实验研究  

Observation of effects of limited debridement for gunshot wounds on swine extremities

作　　者：张敬良[1] 裴国献[1] 张洪涛[1] 郑晓勇[1] 孙鸿涛[1] 罗炳德[2] 耿穗娜[3] 

机构地区：[1]广州第一军医大学附属南方医院全军创伤骨科中心,广州市510515 [2]第一军医大学热带医学研究所高温医学研究室,广州市510515 [3]第一军医大学南方医院检验科,广州市510515

出　　处：《中华创伤骨科杂志》2003年第4期288-290,300,共4页Chinese Journal of Orthopaedic Trauma

基　　金：全军"九五"医药卫生杰出中青年基金(98J004);全军医学科研"十五"计划重点课题(02Z001)

摘　　要：目的观察比较高温高湿环境猪肢体火器伤有限清创、开放引流术与彻底清创、开放引流术的疗效。方法24只猪枪击至伤双后肢,各8只分别置于高温高湿环境4、6、8h三个时段进行初期外科处理,每一处理时限分为彻底清创、开放引流组(4只,8肢)和有限清创、开放引流组(4只,8肢)两组。观察比较每一时限下两种不同处理的伤道愈合情况、伤道壁组织细菌数及血中细菌内毒素水平。结果伤后4h处理,两组各实验点细菌数无显著差异,内毒素含量48h和72h时间点,彻底清创组低于有限清创组,两者有显著性差异(P<0.05)。伤后6h处理,细菌数及内毒素含量在术后均无明显差异。伤后8h处理,细菌计数彻底清创组在处理后72h和1周两个时间点明显高于有限清创组,两者有显著性差异(P<0.05),血中内毒素水平72h,1周两时间点,彻底清创组明显高于有限清创组(P<0.01)。三个处理时限的伤口愈合时间,彻底清创组均要长于有限清创组(P<0.05)。结论本实验提示我们,高温高湿环境肢体火器伤的初期外科处理,采取有限清创、开放引流的方法效果较好。如按传统的方法进行彻底清创、开放引流处理,其处理时限应趋向于在伤后4h内进行。Objective To compare the curative effects between open drainage following meticulous debridement and open drainage following limited debridement in hot and humid environment. Methods 24 swine with gunshot wounds on back extremities were put in hot and humid environment for 4h, 6h and 8h respectively. At each management time, 8 swine were divided randomly into open drainage following meticulous debridement group (group 1, 4 cases, 8 limbs) and open drainage following limited debridement group (group 2, 4 cases, 8 limbs) for observation of the wounds healing, bacterial counts in wound tracts and endotoxin level in blood at every management time. Results In the management after 4h, there wasnt a significantly difference in qualities of bacterium while endotoxin level in group was lower than that at 48h and 72h point(P< 0.05). In the management after 6h, there wasnt significant difference between the two groups both in qualities of bacterium and endotoxin level. In the management after 8h, there was significant difference between the two groups both in qualities of bacterium(P< 0.05) and endotoxin level at 72h and 1w point(P< 0.01). The healing time of the wound tracts in group 1 was longer than that in group 2 in three management times. Conclusions The observation shows that the open drainage following limited debridement is better than open drainage following meticulous debridement. As a primary surgical management for gunshot wounds in hot and humid environment, the open drainage following meticulous debridement can be used if the wound is not severe, but the management should be done within 4h.

关 键 词：湿热环境 火器伤 有限清创术 疗效观察 军事医学 热带医学 

分 类 号：R826.5[医药卫生—临床医学]