山羊高原重度原发性肺冲击伤模型的建立

doi:10.3877/cma.j.issn.1674-6902.2022.05.005

中华肺部疾病杂志(电子版) ›› 2022, Vol. 15 ›› Issue (05) : 637 -642. doi: 10.3877/cma.j.issn.1674-6902.2022.05.005

论著

山羊高原重度原发性肺冲击伤模型的建立

邵世锋¹, 伍正彬¹^,^†(

), 段朝霞², 张良潮², 王耀丽¹^,^†(

), 李琦³, 王建民²

^1. 400042　重庆，陆军军医大学大坪医院战创伤医学中心，创伤、烧伤与复合伤国家重点实验
^2. 400042　重庆，武器杀伤生物效应评估研究室，陆军特色医学中心
^3. 400037　重庆，陆军（第三）军医大学第二附属医院呼吸与危重症医学中心

收稿日期:2022-02-05 出版日期:2022-10-25
通信作者: 伍正彬, 王耀丽
基金资助:
高原新型爆炸武器伤特点及早期救治关键技术(ALJ18J001); 重庆市医学重点专科建设项目(4246Z8A)

Establishment of a model of severe primary lung blast injury in goats at high altitude

Shifeng Shao¹, Zhengbin Wu¹^,^†(), Chaoxia Duan², Liangchao Zhang², Yaoli Wang¹^,^†(), Qi Li³, Jianmin Wang²

^1. Wound trauma medical Center, State Key Laboratory of Trauma, Burn and Combined Injury, Army Medical University, Chongqing 400042, China
^2. Department of Weapon Injury Bioeffect Assessment, Army Medical University, Chongqing 400042, China
^3. Respiratory and Critical Care Medicine Center, Xinqiao Hospital, Army Medical University, Chongqing 400037, China

Received:2022-02-05 Published:2022-10-25
Corresponding author: Zhengbin Wu, Yaoli Wang

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引用本文：

邵世锋, 伍正彬, 段朝霞, 张良潮, 王耀丽, 李琦, 王建民. 山羊高原重度原发性肺冲击伤模型的建立[J]. 中华肺部疾病杂志(电子版), 2022, 15(05): 637-642.

Shifeng Shao, Zhengbin Wu, Chaoxia Duan, Liangchao Zhang, Yaoli Wang, Qi Li, Jianmin Wang. Establishment of a model of severe primary lung blast injury in goats at high altitude[J]. Chinese Journal of Lung Diseases(Electronic Edition), 2022, 15(05): 637-642.

目的

建立山羊在海拔4 600 m高原环境下的重度原发性肺冲击伤模型，分析高原重度原发性肺冲击伤的特点，为院前救治提供实验基础。

方法

选取健康山羊28只，随机分为3 m组22只，3.5 m组6只，采用8 kg TNT当量新型爆炸物，在相同的环境条件下致伤，观察致伤后山羊肺冲击伤伤情，分别于伤前、伤后1 h、24 h监测山羊生命体征、肌钙蛋白Ⅰ，观察肺大体解剖，测肺组织重量、湿/干比重(W/D)等，对重伤山羊进行院前ABC救治。

结果

伤后t≤15 min死亡12只，伤后15 min<t≤30 min死亡4只，其余12只存活。伤后即刻出现呼吸窘迫、精神萎靡、寒战、口眼鼻出血、呛咳、呃逆、站立不稳等。两组山羊肺大体解剖有不同程度肺泡破裂、肺出血、肺水肿、胸腔积血、肺大泡、气道内粉红色泡沫痰，为重度原发性肺冲击伤，AIS评分(4.83±0.87)分，部分肺内可见主支气管及分支气管血凝块、大量食糜。高原重度原发性肺冲击伤肺损伤严重，高原现场环境恶劣、复杂，常规院前气道管理及呼吸功能维持方案难以成功救治。

结论

8 kg TNT当量爆炸物在3 m、3.5 m下，可建立山羊高原重度原发性肺冲击伤模型，模型伤情稳定，用于探索高原环境下原发性肺冲击伤的机制和院前救治的实验研究。

关键词: 高原肺冲击伤, 山羊, 动物模型, 新型爆炸物

Objective

To establish the model of severe primary lung blast injury in goats at an altitude of 4600 meters , and to provide experimental basis for the study of the characteristics and pre-hospital treatment of severe primary lung blast injury at high altitude.

Methods

Twenty-eight healthy goats were randomly divided into two groups , 3 m group (n=22) and 3.5 m group (n=6). The lungs of goats were injured under the same environmental conditions with 8 kg TNT equivalent new explosives. The vital signs, troponin I, gross anatomy of lung, lung tissue weight and wet / dry specific gravity were observed before injury and 1 h, 24 h after injury. The seriously injured goats were treated with pre-hospital ABC.

Results

12 goats died within 15 minutes (including 15 minutes)after injury, survived more than 15 minutes after injury, but 4 goats died within 30 minutes (including 30 minutes), and the other 12 goats survived. According to the observation of the characteristics of severe primary lung blast injury, persistent respiratory distress, deep malaise, shivering, mouth, eye and nose bleeding, cough, hiccup and unstable standing appeared immediately after injury. The gross anatomy of the lungs of the two groups showed different degrees of pulmonary hemorrhage, pulmonary edema, pleural hemorrhage, pulmonary vesicles and pink foamed sputum in the airway, which were severe blast injury. The AIS score was 4.83 ±0.87. blood clots and a large amount of chyme could be seen in the main bronchus and branch trachea in part of the lungs. The lung injury of severe primary lung blast injury at high altitude is serious, and the on-site environment at high altitude is bad and complex, so it is difficult to treat the routine pre-hospital airway management and respiratory function maintenance program.

Conclusion

The model of severe primary lung blast injury in goats at high altitude can be established by 8 kg TNT equivalent explosive at a distance of 3m and 3.5m. This model is stable and can be used to study the mechanism and pre-hospital treatment of primary lung blast injury at high altitude.

Key words: Blast injury of lung at high altitude, Goat, Animal model, New explosive

图1 山羊布放情况；注：A：海拔4 600 m山羊统一右侧胸部朝向爆炸源，同心圆插空布放；B：山羊固定于特制钢架内

图2 3 m组(n＝20)、3.5 m组(n＝4)山羊伤后出现口鼻处粉红色泡沫及鲜红色血性分泌物。注：A：口部见血性分泌物流出；B：鼻部可见血性分泌物流出；C：气管切开后见气切导管内大量粉红色泡沫分泌物流出

图3 3 m组(n＝20)、3.5 m组(n＝4)山羊伤后气道内情况。注：A：气管内可见大量血凝块；B：气管内可见大量食糜；C：可见喉头水肿、充血

表1 脏器损伤严重程度评分

组　别	例数	脏器损伤分级(n)				AIS评分(分)
组　别	例数	Ⅰ	Ⅲ	Ⅳ	Ⅴ	AIS评分(分)
3 m组	20	0	3	16	1	4.95±0.22
3.5 m组	4	1	1	2	0	4.25±2.22

表1 脏器损伤严重程度评分

组　别	例数	脏器损伤分级(n)				AIS评分(分)
组　别	例数	Ⅰ	Ⅲ	Ⅳ	Ⅴ	AIS评分(分)
3 m组	20	0	3	16	1	4.95±0.22
3.5 m组	4	1	1	2	0	4.25±2.22

图4 高原山羊原发性肺冲击伤肌钙蛋白Ⅰ及心脏解剖图；注：A：高原原发性肺冲击伤伤前(n＝12)与伤后24 h(n＝4)肌钙蛋白对比；B：左心室心内膜下见广泛出血点

图5 山羊高原原发性肺冲击伤肺解剖图。A：肋骨多发闭合性骨折；B：胸腔内积血；C：双肺出血、实变；D：双肺实变伴散在肺大泡

图6 3 m组山羊爆炸致肺冲击伤后0.5 h内死亡的胸部影像学。注：A：CT见山羊双下肺不均一肺挫伤、实变；B：CT见山羊双肺气胸；C：X线见山羊双肺气胸；D：X线见山羊膈肌上移

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