不同救治环境下海战伤救治的效果观察

Influences of different rescue environment on therapy effects of sea warfare injury

目的探讨海战伤海上救治的有效方法。方法成年健康杂种犬60只，制作成颅脑火器伤、胸部开放伤、腹部开放伤、四肢伤和烧伤模型后，随机分为海战伤Ⅰ组、海战伤Ⅱ组和陆战伤组，每组20只。海战伤Ⅰ组实验室设在码头救护所，海战伤Ⅱ组设在舰船或医院船上，陆战伤组设在陆地救护所。2组海战伤动物海水浸泡30min，陆战伤组不作海水浸泡。陆战伤组采用常规治疗；2组海战伤采用综合治疗：除常规治疗外加低张液体（5％葡萄糖液500ml）、东莨菪碱20mg／8h、地塞米松40mg／8h和维生素瞰3～5g／8h。实验中监测24h体温、血浆渗透压、血气分析和血电解质变化；观察3d各组伤口感染率与死亡率，且进行比较。结果2组海战伤伤情明显重于陆战伤组，表现为低温、血浆渗透压升高、高钠、高氯血症、代谢性酸中毒。治疗12h后，2组海战伤各项指标均达到正常水平。陆战伤组伤后3d伤口感染率为15％，海战伤Ⅰ、Ⅱ组分别为40％和50％；陆战伤组死亡率30％，海战伤Ⅰ组为40％，海战伤Ⅱ组为50％；海战伤Ⅱ组与Ⅰ组和陆战伤组比较差异有统计学意义（P〈0．01）。结论海战伤海水浸泡后对机体的血浆渗透压、电解质平衡和体温有严重影响；海上环境对海上救治的疗效有明显影响，可能是实验犬致死率高的重要原因。早期低张液体对降低血浆透渗压、纠正电解质平衡、提高生存率有重要意义。

Objective To investigate effective methodes on sea warfare injury in different rescue environment. Methods After 60 dogs were subjected to eraniocerebral firearm injury, open chest injury, open abdominal injury, limbs injury and burn injury, they were randomly divided into sea warfare wound group Ⅰ and sea warfare wound group Ⅱ , land warfare wound group, with 20 dogs in each group. The laboratory rooms were founded at dock medical aid station in sea warfare wound group Ⅱ , in hospital ship and warship in sea warfare wound group Ⅱ and at land medical aid station in land warfare wound group. The animals in two groups with sea warfare were immersed for 30 min in seawater after wound and received combined therapy, including in routine treatment and drug treatment, for example, 5% glucose liquid 500 ml, scopolamine 20 mg/8 h, dexamethasone 40 rag/8 h and vitamin B6 3 -5 g,/8 h. The dogs in land warfare group were not immersed and only received routine treatment. Temperature, plasma osmotic pressure and the changes of blood electrolytes had being detected for 24 h and wound infection rate and mortality in the three groups were compared in three days. Results The two groups with sea warfare wound had more severe traumatic condition than land warfare wound group. They appearanced hypothermia, high plasma osmotic pressure, hypernatrium, hyperchloraemia and metabolic acidosis. At 12 h after the dogs in the two groups with sea warfare wound were treated, all indexes in the dogs were recovered normal level. The wound infection rate was 15% in land warfare wound group, 40% in sea warfare wound group Ⅰ and 50% in sea warfare wound group Ⅱ in three days after wound. The mortality was 30% in/and warfare wound group, 40% in sea warfare wound group Ⅰ and 50% in sea warfare wound group Ⅱ in three days after wound. The mortality and wound infection rate of animals were apparently higher in the sea warfare wound group Ⅱ than those in sea warfare wound group Ⅰ and in land warfare wound group （P 〈 0. 01 ）. Conclusions After sea warfare wound, seawater immersion can severely influence on plasma osmotic pressure, electrolyte balance and hypothermia. It could be a chief reason of high mortality of experimental dogs that the sea environment could obviously influence on therapeutic effect of sea warfare wound. Early infusion of hypotonic solution could significantly reduce plasma osmotic pressure, retrieve electrolyte balance and increase survival rate.