不同海况下重度海战伤海上救护的实验研究

Experimental research on medical care at sea of severe sea-battle casualties under different sea status

目的 探讨海上环境对严重海战伤处理的影响,为提高海战救护能力提供参考.方法 杂种犬60只,按数字表法随机分为码头组（码头环境）、海上一组（海上环境风力2～4级,浪高2～3 m,舰船摇摆度5°～10°）、海上二组（海上环境风力5～7级,浪高3～5 m,舰船摇摆度11°～25°）,每组20只.海上一组、二组在航行中的医院船上进行实验,码头组在该海域码头救护所中进行实验.动物被制作成颅脑火器伤、开放性胸部伤、开放性腹部伤、下肢伤和烧伤模型,且先行海水浸泡处理,随后进行手术和海水浸泡伤常规处理.每组先后行不同部位手术20台次,每台次包括开颅术、剖胸术、剖腹术、下肢骨折内固定术、股动脉吻合术、气管切开术、静脉切开术和清创术.对3组的手术时间、手术质量及伤后3 d内动物死亡率进行比较.结果 手术时间,码头组共300.6 min,海上一组共369.4 min,海上二组共426.3 min.海上一组手术时间比码头组长22.9%（P＜0.01）,海上二组比海上一组长15.4%（P＜0.01）.股动脉吻合术后,码头组1条血管不通畅,海上一组、二组分别有3条和5条血管不通畅.3 d内码头组动物的死亡率为35%（7/20）,海上一组、二组分别为45%（9/20）和55%（11/20）,海上二组死亡率明显增高（P＜0.01）.结论 海上环境对手术时间、质量和动物死亡率有明显的影响.明确海上手术特点,提高外科医生海上手术的技巧和适应海上环境是缩短手术时间、提高质量、降低动物死亡率的关键.

Objective To explore effects of marine environment on the treatment of severe sea - battle casualties so as to improve medical care of casualties at sea. Methods Sixty mongrel dogs were randomly divided into 3 groups： the dock group, sea group 1 （scale of wind force 2～4, waves 2～3 m, rolling and pitching of the ship with 5°～10°） and sea group 2 （ scale of wind force 5～7, waves 3～5 m, rolling and pitching of the ship with 11°～25°）, each group consisting of 20 dogs. For sea group 1 and 2, experiments were made while the hospital ship was underway. And for the dock group, researches were made in the laboratory at the dock side of the same sea region. The animals were subjected to craniocerebral firearm injury,open chest injury, open abdominal injury, pelvic limb injury, bum injury, and then were treated with seawater immersion. The dogs were thereafter given surgical operation and routine treatment. A total of 20 operations were performed in each group, including craniotomy, thoracotomy, ventrotomy, lower limb fracture internal fixation, arteriorrhaphy, tracheotomy, venesection and debridement. Surgery time, quality and mortality of the animals 3 days after injury were compared between the 3 groups. Results Two hundred and eighty operations were performed in each group, in different surgery time, with the dock group totaling 300.6 minutes, sea group 1 and 2 totaling 369.9 and 426.3 minutes respectively. The surgery time of sea group 1 was longer by 22.9%than the dock group （P 〈0. 01 =, and the surgery time of sea group 2 was longer by 15.4% than that of sea group 1 （P〈0. 01 =. Following arteriorrhaphy, obstruction of 1 vessel was noted in the dock group, while obstruction of 3 and 5 vessels were seen in sea group 1 and 2. Mortality of the animals in the dock group was 35% （7/20） in 3 days, while that of the animals in sea group 1 and 2 was 45% （9/20） and 55% （11/20）respectively. Mortality of the animals in sea group 2 was apparently the highest （ P〈0. 01=. Conclusions Marine environment had obvious effects on surgery time, quality and mortality of animals. Understanding of the surgery features at sea, improvement of shipboard surgical skills of medical personnel and acclimatization of marine environment are the key to the shortening of surgery time, improvement of surgical quality and reduction of mortality.