高速高能战创伤间接伤的特点及其致伤机理

Characteristics of the Indirect Injuries Caused by High Speed and High Energy Trauma and War Wounds and Its Wounding Mechanism

以５．５６ｍｍ和７．６２ｍｍ弹头、１．０３ｇ钢球致伤４３７只狗、猪双下肢、腹部、头部和模拟介质明胶块，用７．１ｋｇ重锤从３米高处自由落下（速度２７ｍ／ｓ）致伤狗下腹部。以高速摄影拍摄致伤瞬间脏器位移和血管变形，同步测定不同管径内压力变化与瞬间血流量变化和病理、生化的功能与形态改变。旨在为临床诊治提供理论依据。结果发现：高速高能是远达效应发生的重要条件，从不同管径内压力衰减梯度和瞬间血流量激增与脏器点片状出血特点看，致伤瞬间引起管路内血流剧烈扰动是导致远达效应发生的主要因素。撞击伤间接损伤机理主要是脏器的位移和变形而造成的挤压和撕拉性损伤。它引起的管路内血流扰动与火器伤相比只是程度上有所差别，它们的规律基本是相同的。对临床诊治有重要参考价值。

Four hunded and thirty seven dogs and swines were wounded by 5.56mm and 7.62mm bullets at their both hind legs,abdomen and head,also water and gelatin block were shot,and another group of dogs were hypogastrically impacted by cylinder iron hammer weighing 7.5kg that was free dropped from a height of 3 m (Velocity is 27m/s).The instantaneous organ movement and deformation of the vessels were photographed,also the pressure inside the tubeline of various diameters,the instantaneous changes of flow,as well as the biochenical function and morphological changes synchronously observed.The purpose of the study is to provide reference for climical diagnosis and treatments.The results showed high speed and high energy are the important precondition for the occurrence of remote effects. From the pressure attenuation grade inside tubes of different diameters,the drastic increasement of instantaneous blood flow and characterstic spot or patch like bleeding,it was suggested that the drastic blood flow disturbance inside tubes occurred at the instant of wounding was the main cause of the occurrence of remote effects.The mechanism of the indirect damages caused by impact injury were mainly associated with the crushing and lacerating process resulted from the movement and deformation of organs.The blood flow disturbance caused by firearm wounding or impacting has the similar law,but the intensities were different,which is of important value for clinical practise.