高温高湿环境肢体火器伤病理形态学变化

Pathomorphological study of gunshot wound in limbs of dogs in hot and humid environment

目的通过建立高温高湿环境下犬肢体火器伤动物模型，探讨这一特殊环境下肢体火器伤的病理形态学变化，为 其临床救治提供理论基础。方法将８只杂种犬随机分为高温高湿组（５只）和常温常温组（３只），分别于火器伤后４、８、 １２、２４ ｈ进行大体观察并通过光镜和电镜进行病理形态学观察。结果大体观察可见高温高湿组６－８ ｈ后较常温常湿组 伤道及肌肉变色区明显扩大，肢体肿胀加重，挫伤区色泽暗红，肌肉无收缩且有腐败臭味，有感染征象；而常温常湿组 １２～２４ ｈ伤道始出现臭味。光镜及电镜观察到高温高湿组各区肌肉纤维的病理变化均较常温常湿组显著，且损伤呈进行 性加重，而常温常温组的震荡区及震荡外区２４ｈ伤道组织损伤均有减轻趋势。结论高温高湿环境下肢体火器伤伤道 肌肉组织病理损伤严重，且随时间的延长而逐渐加重，救治时更应强调早期彻底清创。

Objective To investigate the pathomorphological changes of the tissues in gunshot wound in hot and humid environment. Methods Eight mongrel dogs with gunshot wound in the limbs were randomly divided into hot and humid environment group (HHE group, n=5) and normal environment group (NE group, n=3). Gross tissue changes ware observed and optical microscopy (OM) and electron microscopy (EM) were performed 4, 8, 12 and 24 h after the gunshot injury respectively. Results Six to eight hours subsequent to the gunshot injury the wound tracts and discolored area of the tissue in HHE group were more markedly enlarged than those in NE group with more obvious swelling of the wounded limbs, and rotten smell was noted. The signs of infection were observed. while the wounds of NE group did not give off obvious rotten smell until 12 to 24 h after the injury. Under OM and EM, the necrosis and damage of the muscle fibers in HHE group were more severe than that in NE group, which aggravated in HHE group but tended to be relieved in NE group. Conclusion Pathomorphological changes of the tissues in the gunshot wound were serious and tend to deteriorate in hot and humid environment. Complete debridement of the gunshot wound as early as possible was recommended in hot and humid environment.