不同能量弹丸致颅脑伤后生理病理研究

Experimental study of craniocerebral bullet wounds

目的：为了探求致伤能量与伤情的关系，就我军制式弹丸致颅脑火器伤的生理、病理进行研究。方法：手、步枪弹丸在常见的射距内致狗颅脑贯通伤。观测伤后生理指标和病理改变。结果：步枪弹组和手枪弹组均在伤后数分至１小时内出现明显的心率减慢，血压下降，颈动脉血流量减少，呼吸停止且不易恢复，表现为脑干功能衰竭。减速弹组伤后数分钟内出现一过性血压增高，心率变慢，颈动脉血流量增高，呼吸减慢或暂停，以后生理指标逐渐恢复近正常水平。脑伤道以外的病理改变，步枪弹组表现神经细胞缺血，坏死不明显，脑干出血；手枪弹组表现脑血管扩张，充血，血管周围环形出血，神经细胞轻度缺血、坏死；减速弹组表现神经细胞缺血，坏死和明显脑水肿，无脑干出血。三组间脑伤道破坏区直径无差异，出血区宽度有显著差异。结论：致伤能量愈大，生理指标变化愈明显，脑伤道出血区愈宽，减速弹组动物模型可为今后颅脑枪弹伤研究提供一新的方法。

Objective: To explore the correlations between the impact energy and wound condition. Animal models were studied in pathologically and physiologically by shoting the dog's head with the formular bullets of PLA. Mothod: Dogs were shot by rifle bullets or pistol bullets to make craniocerebral penetrating wounds but the diminishing velocity bullets to make perforating wound models. The physiological parameters and the pathological changes were recorded. Results: the rifle group (RG) and the pistol group (PG) obviously showed slow heart beat, reduced blood pressure, low carotid blood flow and respiratory arrest which can not be recovered. The brain stem failure also occurred. The diminishing velocity bullet group (DVBG) first showed a peak of hypertension, bradycardia, increased carotid blood low, and bradypnea or apnea, then all these parameters gradually came to normal. It showed no ischemia and necrosis and hemorrhage in brain stem in the pathologically in RG. There were cerebral vascular dilation, hyperemia and perivascular hemorrhage in the PG. The main features were ischemia necrosis of the neunons and perivascular edema in the DVBG without brain stem hemorrhage. The diameters of inner destructive area were measured, no difference among 3 groups. The width of outer hemorrhage area in the RG and the PG were significantly wider than that in the DVBG. Conclusions: The greater the impact energy was, the greater the physiologic parameters changes were and the wider the width of outer hemorrhage area was. The animal models of the DVBG was a new method, to study the craniocerebral bullet wounds in the future.