高温高湿环境猪肢体火器伤初期外科处理的初步观察及细菌学分析

Primary surgical management and bacteriological analysis of gunshot wounds on swine extremities in hot and humid environment

目的初步观察高温高湿环境下肢体火器伤不同初期外科处理方法的效果。方法建立猪双后肢火器伤动物模型并立即置于高温高湿环境,分别于伤后3h和4h进行外科处理。每一处理时限均分为一期闭合组(组1:8只,16肢)和开放引流组(组2:6只,12肢)两组。分别观察每一时限下,两种不同外科处理前及处理后8h、24h、48h、72h、1周时血中白细胞数、伤道壁组织细菌数及伤口愈合情况。结果在伤后3h处理时限下,两种外科处理前后的各时间点白细胞数均无显著差异;外科处理后组1的细菌数低于组2且渗出较少,除两组中有个别肢体有少量干性脓苔外其余均无明显感染征象;组1的伤口愈合时间明显低于组2(P<0.05)且瘢痕形成小。在伤后4h处理时限下,外科处理后1周前的白细胞数和细菌数两组均无差别,致1周时组1要明显高于组2(P<0.05);组1有4肢伤口发生感染,而组2只1肢有少量脓苔样分泌物外其余均无明显感染发生;伤口愈合时间两组已无差别。结论结果显示高温高湿环境下的猪肢体火器伤在伤后3h内采用一期闭合处理效果较好,但应考虑到实验与实战环境有着较大的距离;而且在延长较短的处理时限后就会使感染有增加的趋势。因此,高温高湿环境肢体火器伤,即使受伤时间极短,若要采用较为积极的清创缝合时,应充分考虑伤口的污染及组织损伤程度。

Obiective To observe the outcomes of different primary surgical managements at certain time points for gunshot wounds on swines extremity. Methods 26 swine with gunshot wounds on back extremities were put in hot and humid environment for 3h and 4h respectively. At each time, 16 swine were rundomized into group of primary closure after meticulous debridement(1st group,8 cases,16 limbs) and group of open drainage following limited debridment(2nd group,6cases, 12 limbs)for operation and observation. At the preoperative point(0h) and postoperative ones of 8h, 24h, 48h, 72h and 1w,the WBC counts were measured, the bacterial cultures and counts were performed,and the wound healing was observed.Results In the management after 3h , there wasnt a significantly difference in quantity of WBC between 1st and 2nd group while bacteria of the 1st group were less than those in 2nd group postoperatively, but they were normal in 1 week. The healing time of the wound in 1stgroup was shorter than that in 2nd group(P< 0.05). In the management after 4h, there was a remarkable difference both in WBC count and bacteria on 1w time point, and that in 1st group was higher(P< 0.05). The infection occared in 4 of the 16 limbs of 1st group, but there was no one in 2nd. There wasnt remarkable difference in healing time between 1st and 2nd group.Conclusion The trial shows that, for the primary surgical management of gunshot wounds in hot and humid environment, the primary closure after meticulous debridement only suits a special situation and the open drainage following limited debridement is safer and more reliable.