美军在“自由伊拉克行动”和“持久自由行动”中颅脑战伤救治的经验及对我军颅脑战伤救治的启发

The U.S. Army's experience with management of traumatic brain injury in Operation Enduring Freedom and Operation Iraqi Freedom: lessons to improve our management

在"自由伊拉克行动(operation iraqi freedom,OIF)"和"持久自由行动(operation enduring freedom,OEF)"两次战争中,爆炸冲击伤是主要的致伤机制,导致颅脑外伤(traumatic brain injury,TBI)的发生率较既往战争明显升高,达到21%~28%。轻、中、重型TBI分别占比约82.4%、8.3%和1.0%。其中,中/重型TBI仍是战亡的首要原因,而轻型TBI后遗症多。美军针对这些流行病学特征制定了对应的防治策略,主要包括:加强作战人员头部防护、采用综合救治措施防止中/重型TBI的继发性损伤、重视轻型TBI的治疗和预后、重视TBI伤员的功能康复、组织规范有序的TBI研究等,从而有效地提高了美军TBI的整体救治水平。以上经验给我军的启发诸如:(1)现代战争中致伤因素的变化导致TBI的流行病学发生改变,需要根据这一特点制订对应的治疗策略,并需要配套相应的诊断及治疗设备、药品和救治人员;(2)增加针对性和实战化的研究;(3)结合我军的战略方向,研发适合我军未来作战的TBI战救策略。

During the Operation Enduring Freedom and Operation Iraqi Freedom launched by the US army, explosive blast injury was the main mechanism of injuries and caused an incidence of traumatic brain injury （TBI） of 21%~28% among the military personnel, a rate significant higher than those in previous military actions. In these two operations, the percentages of mild, moderate and severe TBI were 824%, 8.3% and 1%, respectively, Moderate and severe TBI still remained the leading cause of death, while mild TBI was associated with a high incidence of post-concussive symptoms. The US army devised corresponding prevention and treatment strategies based on the epidemiological features of these injuries, including enhancement of head protection, comprehensive measures for controlling secondary injury of moderate and severe TBI, reinforced measures for improving treatment and prognosis of mild TBI, and efforts to encourage systemic TBI research and promote rehabilitation of TBI patients. These measures helped to improve the overall outcomes of TBI. The experiences of the US army provide valuable clues to improve the management of TBI in the Chinese army forces. In modern military operations, the epidemiology of TBI has undergone significant changes due to the changes in the injury mechanisms, for which corresponding management strategies should be devised and related diagnostic and treatment equipment, medicines and personnel should be provided. More specific TBI researches that are closely relevant to the actual conditions in combats need to be promoted. The strategies for TBI management must be improved according to our national strategy to better meet the needs in future military operations.