猪腹部爆炸伤损害控制手术模型的建立及效果观察

Establishment and efficacy observation of a surgical model for controlling abdominal explosive wound in pigs

目的设计并制作大动物爆炸致伤平台,并在此基础上建立可控的与爆炸性武器致伤机制接近的猪腹部爆炸伤损害控制手术模型,观察损害控制手术效果。方法根据本研究需求设计并建立大动物爆炸伤致伤平台,包括致伤场地和致伤保护装置。根据猪腹壁距爆炸源的距离分为A、B和C组,距离分别为1.6 m、1.2 m和0.8 m,采用随机数字表法将30头猪随机分配入A、B和C组。用设计制作的装置固定,高速钢球模拟爆炸性武器的爆炸破片,建立腹部爆炸伤模型。分别检测并记录猪致伤前后生理指标的变化,术中开腹探查猪的受伤情况,并完成相应损害控制手术,术后移入观察帐篷观察6 h。记录各时间点猪的存活情况。统计并观察猪腹部伤情和损害控制手术效果。结果设计并制作了大动物爆炸致伤保护装置。同样爆炸当量下,A组和B组爆炸结束时存活率均为100%,A组有1头猪死于麻醉过量,术中无动物死亡,B组1头猪术中因大出血死亡。C组有2头猪爆炸结束时即刻死亡,2头猪于术中死亡,1头于术后观察30 min内死亡。A组动物伤情总体较轻,有30%猪肝、脾、胃、肠等2个及以下器官出现3处以下伤情,B组猪90%以上有3个以上器官出现4处以上联合伤,C组伤情较重,40%猪有4个以上器官出现8处以上联合伤,3组比较差异有统计学意义(P=0.011)。爆炸致伤后每组猪的各项生理指标均出现异常,与爆炸前相比,差异具有统计学意义(P<0.05)。整体趋势为血压下降、心率减慢,PLT、HGB等指标也明显降低,出现不同程度的休克症状。本研究共27头猪早期复苏成功,并行损害控制手术治疗,除1头因感染死于多器官功能衰竭外,其余均于观察6 h内存活。结论在设定的距离和爆炸当量下,利用设计的大动物爆炸致伤平台能够建立可重复的稳定性好的腹部爆炸伤损害控制手术模型,适用于实验研究或模拟手术训练,利用该模型进行损害控制手术效果好,可推广应用。

Objective To design and prepare a platform for the explosion injury of large animals, and to establish a controllable surgical model for controlling the explosive injury in pigs in order to observe the effect of damage control operation. Methods Firstly, based on the needs of this study, a platform for explosive injury of large animals was designed and produced, including injury site and injury protection device. A total of 30 pigs were randomly divided into groups A, B and C, and then fixed in the self-made device, with the distance from the abdominal wall to the explosion source 1.6, 1.2 and 0.8 m respectively. The explosive fragments of explosive weapons were simulated with high-speed steel balls, and the abdominal explosive injury model was established. The changes of physiological indexes before and after injury were detected and recorded. The injury condition of pigs was explored and the corresponding damage control operations were completed. The damage control was observed after operation and observed for 6 h. The survival rate of pigs at different time points was recorded. Pig abdominal injuries and the efficacy of damage control operation were observed and statistically analyzed. Results A protective device for explosive injury of large animals was designed and manufactured. All the physiological indexes of each pig were abnormal after explosion injury, with statistical difference when compared with those before explosion(P<0.05). The blood pressure was decreased, heart rate was slowed down, and the platelet and hemoglobin levels and other indicators were also obviously reduced, with symptoms of shock at different severities. At the same explosive equivalence, the survival rates of group A and group B were 100%. One pig in group A died of excessive anesthesia, and no animals died during the operation. One pig in group B died of massive bleeding during operation. In group C, 2 pigs died immediately after the explosion, 2 pigs died during the operation, and 1 died within 30 min after operation, with an overall mortality rate of 50%. In group A, the injuries were generally mild, with 30% pigs having 3 or less wounds in 2 or less sites, including the liver, spleen, stomach, and intestines. For the pigs from group B, 90% of them had 4 or more wounds in above 3 sites. The conditions in group C were more severe, and 40% pigs had more than 8 wounds in 4 or over sites. Statistically difference was seen in the severity of injuries among the 3 groups(P=0.011). Finally, there were 27 pigs successfully resuscitated at early period, and undergoing damage control surgery. Except for 1 pig died of multiple organ failure due to infection, the other survived within 6 h of observation. Conclusion Under the given distance and explosive equivalent, a repeatable and stable model for abdominal explosive injury control operation is established by our self-designed large animal explosive injury platform. It is suitable for experimental research or simulated operation training. The model has good effect on damage control operation and can be popularized and applied.