肺冲击伤转化研究——历史、现状与挑战

Transformation research of pulmonary blast injury——history,current situation and challenges

冲击伤是火药、炸药等易燃、易爆品发明的副产物。肺脏作为爆炸冲击致伤中最易受累的空腔脏器,是临床冲击伤诊治的重点。与普通急性肺损伤相比,肺冲击伤在致伤原因、病理生理反应、诊治和防护、转归和预后等方面,有其特定表现形式与制约瓶颈。既往依据伤员症状、体征、影像学、血气分析,在肺冲击伤诊治中积累了许多经验。然而,鉴于当前安全形势和生产、生活潜在爆炸风险,爆炸物种类、理化性质、爆炸当量以及爆炸现场的复杂空间分布为肺冲击伤的诊治与防护提出了新的要求,特别是在我国创伤救治水平显著提升背景下,肺冲击伤伤员在诊治上对基于疗效和后期康复的个体化诊治需求尤为迫切,对肺冲击伤高效防护新措施渐趋关注。因此,笔者在系统回顾肺冲击伤流行病学规律基础上,从精准诊断、精准治疗和高效防护三方面概述肺冲击伤转化研究现状,并基于瓶颈问题提出愿景和展望,以期从转化医学视角分析肺冲击伤的历史、现状,探究肺冲击伤理论成果向精准治疗和高效防护转化的可行性,尝试从既往定性诊治转化为以量化评估为基础的个体化诊治,旨在为肺爆炸冲击伤精准救治和防护范式提供借鉴和启示。

Blast injuries are negative products of inflammable and explosive materials such as gunpowder and explosives.As the most vulnerable hollow organ in the explosion,the lung is the focus of clinical diagnosis and treatment for blast injuries.Compared with common acute lung injury,pulmonary blast injury(PBI)has its specific manifestation and constraint bottleneck in the causes of injury,pathophysiological responses,diagnosis and treatment,prevention,outcome and prognosis,etc.In the past,based on the symptoms,signs,imaging,blood gas analysis of the wounded,many experiences have been accumulated in the diagnosis and treatment of PBI.However,in view of the current security situation and the potential risks of production and life,the types of explosives,physical and chemical properties,explosive equivalents and the complex spatial distribution of the explosion site have continuously put forward new requirements for the diagnosis and treatment of PBI.With the significant improvement of trauma treatment in China,it is particularly urgent in the individualized diagnosis and treatment based on curative effect and post-rehabilitation,and effective protective measures for PBI patients.Therefore,based on the systematic review of the epidemiological data of PBI,this paper summarizes its research status from the precision diagnosis,precision treatment and high efficiency protection,and proposes the vision and prospect based on the bottleneck problem,in order to analyze from the perspective of translational medicine.The history and current situation of PBI,and the feasibility of transforming the theoretical results of PBI to precision treatment and efficient protection were given.It may propel the transformation of patterns of its diagnosis and therapy from routine experienced qualitative to personalized quantitive treatment.The aim of this paper tries to supply a new paradigm for the precision diagnosis,therapy and protection of PBI.