西学东渐——“夏侯惇拔矢啖睛”故事对颅脑超长异物盲管伤现场急救的启示

Western learning spreading to the East—Enlightenment of the story “Xia Houdun pulled arrow out and tasted eye” for the field first aid of long foreign body blind tract wound of the brain

从古到今,颅脑超长异物盲管伤时有发生,但如何现场急救,是现场拔除异物再转运患者安全,还是转运患者至医疗场所再拔除异物更安全,遍查中英文外科学著作,均未记述。本文结合工作中的病例和中国著名文学著作《三国演义》中"夏侯惇拔矢啖睛"故事,运用物理学、解剖学、病理学和统计学知识系统分析,认为对于中线部位颅脑超长异物盲管伤往往损伤中线部位的矢状窦和大脑前动脉等重要解剖结构,现场固定、截短颅外部分异物是降低死亡率的有效方法;对于远离中线部位颅脑超长异物盲管伤,为避免转运过程中异物颅外段晃动而使异物颅内部分产生多次往复运动,二次损伤异物颅内部分周围的脑组织或者血管,现场沿原伤道拔出异物后再转运患者是利大于弊的选择。

Blind tract wound with a long foreign body in the brain occurred from time to time. How to do first aid？ Remove foreign body and then transfer the patient, or transport the patient to the medical establishments and then remove foreign body, which is more secure？ There are few related records throughout Chinese and English surgery works. Based on the clinical cases and a story in the Romance of the Three Kingdoms, ＂Xia Houdun pulled arrow out and tasted eye＂, this paper analyzed the field first aid of blind tract wound of the brain using physics, anatomy, pathology and statistical knowledge. We concluded that to truncate the extraeranial portion of the foreign body is an effective method to reduce mortality for the midline brain long foreign body injuries. In such a situation, the important anatomic structures such as sagittal sinus and anterior cerebral artery are prone to be injured by the foreign body. As for the blind tract wound away from the midline brain, pulling the foreign body out on site before transferring is a more advantaged option, which can avoid the secondary injury of brain tissues or vessels around the intracranial part of foreign body caused by the sway of the extracranial part of foreign body in the transport process.