从转化医学视角认识肺爆炸冲击伤的精准诊治

Thinking of the precision diagnosis and therapy of pulmonary blast injury from the view of translational medicine

爆炸事故发生后,肺脏作为最易受累的靶器官之一,是临床爆炸冲击伤诊治的重点。既往对肺脏冲击伤诊治措施主要依据伤员症状、体征和影像学、血气分析数据,在改善通气、限制性补液、预防空气栓塞、感染并发症及必要的外科对症治疗。然而,随着社会的发展,爆炸物种类、形式、当量、理化性质以及爆炸场的复杂空间分布更趋多样,肺爆炸冲击伤伤情特点、诊治措施以及预后转归等呈现更多的复杂性和非线性特点。为此,基于预防性、预测性、个体化和参与性的"4P"医学模式,从转化医学视角辨析肺爆炸冲击伤的伤情发生和变迁规律,探究肺爆炸冲击伤理论成果在肺爆炸冲击伤精准治疗中的可行性,尝试从既往以定性为主的常规诊治转化至以量化评估的个体化精准诊治,旨在为探索肺爆炸冲击伤精准救治范式提供有益的借鉴和启示。

In the explosive accidents,lungs are the most easily injured organs owing to the blast wave.The pulmonary blast injury（ PBI） constitutes the key aspect in the diagnosis and therapy of explosive blast injury.Presently,the diagnosis of PBI mainly depends on the symptom,signs,blood gas analysis and imaging of the wounded. The clinical treatment focuses on the ventilation improvement,restrictive fluid infusion,prevention of air embolism,treatment of possible infectious implications as well as necessary surgical procedures. However,with the social development,the categories,patterns,equivalent weight,physicochemical property of explosive substance and more complicated spatial distribution of explosive sites,the state of PBI,measures of its diagnosis and therapy and prognostic outcome demonstrated the characteristics of complexity and nonlinearity.Hence,based on the 4P（ preventive,predictive,personalized and participatory,4P） medicine model,it is of great necessity to discriminate the regularity of happening and transformation of PBI from the view of translational medicine and to investigate the probability of precision treatment of PBI by given its previous theoretical results.It may propel the transformation of patterns of its diagnosis and therapy from routine experienced qualitative treatment to personalized quantative precision treatment. The aim of this study tries to supply a new paradigm for the precision diagnosis and therapy of PBI.