高压氧对犬海水浸泡骨骼肌贯通弹道伤愈合的影响

Effect of hyperbaric oxygen on the healing of penetrating skeletal muscle wound coupled with seawater immersion in dogs

目的观察高压氧（HBO）对犬海水浸泡骨骼肌贯通弹道伤愈合的影响，为HBO辅助治疗海水浸泡肢体火器伤提供临床依据。方法成年杂交犬18只，按数字表法随机分为对照组（n=9）和HBO组（n=9）；用九二式军用手枪距离500mm垂直射击犬右后肢肌肉丰满处造成肢体火器伤，然后人工海水浸泡1h后行清创术，制备海水浸泡骨骼肌贯通弹道伤模型，常规换药和抗炎处理；HBO组行HBO治疗，1次／a，计14次；纯氧治疗方案：治疗压力0．22MPa，用时75min。观察2组犬饮食和防卫行为恢复时间，对比伤后3、6、9d创面愈合率和伤后10～14d累计愈合创面数；伤后14d处死动物，裸眼观察伤道疤痕，病理检查取材于疤痕部位，行光镜、电镜观察。结果HBO组饮食和防卫行为恢复时间[（45．3±9．5）h及（48．9±11．8）h]短于对照组[（61．2±10．0）h及（66．7±10．6）h]，2组比较差异有统计学意义（P〈0．01），HBO组创面愈合率和愈合创面累计数均高于对照组，2组比较差异有统计学意义（P〈0．05）。光镜下HBO组伤道主要为瘢痕组织愈合，对照组为瘢痕组织和肉芽组织混合愈合，HBO组伤道组织修复进程快于对照组。结论HBO治疗能促进海水浸泡骨骼肌弹道伤的愈合。

Objective To observe the effect of hyperbaric oxygen（HBO） on the healing of penetrating skeletal muscle wound induced by fire arms coupled with seawater immersion, and to provide evidence for adjuvant HBO treatment of limb wounds induced by fire arms coupled with seawater immersion. Methods Eighteen adult hybrid dogs were randomly divided into the control group （n = 9） and the HBO group （n = 9）. The gunshot wound and seawater immersion model was established by firing type 92 military pistol at the right hind limb of the dogs from a perpendicular height of 500 mm, then, were immersed in artificial seawater for 1 h and were given debridement, routine dressing change and antibiotic treatment. The HBO group received pure HBO therapy, one session a day for 75 minutes, for a succession of 14 days at a pressure of 0. 22 MPa. The recovery time of diet and defensive behavior of the animals, the healing rates of wound surface on the 3rd, 6th and 9th days, and the wound surface healing time from the 10th to 14th days following injury were monitored both in the control group and the HBO group. The dogs were sacrificed 14 days after injury. The scar pathology of the wounded muscular tissue was observed with naked eye, and samples from the wounded sites were collected for light and electron microscopy. Results The recovery time of diet and defensive behavior for the animals in the HBO group were obviously shorter than that of the control group（ P 〈 0. 01 ）. The wound surface healing rate for the HBO group was significantly higher than that of the control group （P 〈 0. 05）. The wound surface healing time for the HBO group was obviously shorter than that of the control group（P 〈 0. 05）. Under the light microcopy, the scar tissue could be observed in the primary wound track area in the animals of the HBO group. For the animals in the control group, the scar tissue and a mixture of granulation tissue could be observed. The healing process of the damaged tissue in the animals of the HBO group was obviously faster than that of the animals in the control group. Conclusions HBO had the effect of enhancing the healing of the gunshot injury coupled with seawater immersion.