犬颈部模拟爆炸条件下颈总动脉的病理改变

Experiment study of blast injury on the cariod artery in dog neck

目的 探讨在一种新的颌面颈部致伤模型的作用下 ,颈部大血管 (颈总动脉 )受爆炸伤后的病理变化 .方法 采用雷管置于面部咬肌上方 10 cm处引爆模拟爆炸冲击波 ,同时 ,颈部用五三式滑膛弹道枪致颈部切线伤或贯通伤模拟爆炸时破片致伤作用 .结果 致伤后距伤道中点 1,3和 5 cm的颈总动脉均有不同程度的损伤 .光镜下均可见血管内皮粗糙、血栓形成、中膜弹力纤维断裂以及中外膜大量炎细胞浸润 .电镜下内皮细胞、平滑肌细胞的表现以变性坏死为主 .结论 颈总动脉间接火器性损伤后血栓形成以 2 4 h为高峰( P<0 .0 5 ) .在上述模型作用下 ,除距伤道 1cm处的动脉内皮损伤较重外 ,其他距离的内皮细胞和中膜损伤程度均未发现明显差异 .说明爆炸 +破片复合伤 (简称破 -冲复合伤 )的作用较单纯的破片损伤程度为重 .另外 ,致伤后的内膜及中膜的断裂有使外膜疝出的趋势 ,为研究临床上间接性火器损伤所致的假性动脉瘤的形成机制提供了理论依据 .

AIM To research the pathological changes of common carotid artery caused by blast. METHODS The impact wave was simulated by detonator blast in the distance of 10cm over masseter, and the edge or penetration injury of cervical skin and muscle was made by rifle to imitate segments in blast. RESULTS The common carotid artery was injured in the distance of 1, 3, 5 cm from the middle of the wound track. The artery pathological changes could be found under microscope, including rough endothelia, thrombosis, elastic layer broken and inflammatory infiltration in the middle and external layer of vessels. Under electric microscope, deterioration and necrosis were the main changes. CONCLUSION Thrombosis reaches extremity at 24 h after indirect firearm injury. The injury of endothelium in the distance of 1 cm from the wound track is severer than the other distances in which there's no apparent difference in injury extent in the endothelium and middle layer, suggesting that the complicated effect of blast and segments is severer than single effect of segments. In addition, the breaking of internal and middle layer tends to form hernia of the external layer. This can be the theoretic evidence for the research of pseudoaneurysm formation in clinic after indirect firearm wound.