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目的:探讨水下冲击伤的病理形态学改变。方法:成年杂种犬61只,山羊8只,用200,500和1000gTNT水下爆炸致水下冲击伤,PCB水下爆炸压力传感器测定冲击波物理参数,观察伤后6h动物的存活情况和冲击伤病理形态学改变。结果:水下冲击波物理参数的特征表现为高的峰值压力,正向持续时间较短,冲量较大。61只犬中,死亡23只,死亡率为37.7%(23/61),8只山羊中,死亡2只。形态学观察发现肺损伤发生率最高,其次为胃肠道损伤,少数动物可发生肝脾等实质脏器损伤,而膀胱和胆囊等含液脏器则很少发生损伤。肺损伤主要表现为不同程度的肺出血,重者常伴有肺水肿,甚至发生血性肺大泡和肺撕裂。胃肠道损伤主要表现为不同程度的浆膜下出血,部分动物可见浆膜下血肿和浆肌层撕裂,甚至发生胃肠道穿孔。肝脾等实质脏器可见包膜下出血、血肿,严重者发生肝脾破裂。形态学改变与冲击波物理参数明显有关,冲量越大,发生率越高,伤情也越重。结论:水下冲击伤具有伤情重和死亡率高的特点,早期救治中应加强急性呼吸窘迫、胃肠道穿孔和实质脏器引起的内出血的处理。
Objective: To investigate the pathological changes of underwater injury. Methods: 61 adult hybrid dogs and 8 goats were killed by underwater blasting with 200, 500 and 1000g TNT underwater. Physical parameters of shock wave were measured by PCB underwater explosion pressure sensor. The survival of animals at 6 h and the morphological injury change. Results: The physical parameters of underwater shock wave are characterized by high peak pressure, shorter forward duration and larger impulse. Among 61 dogs, 23 died, with a mortality rate of 37.7% (23/61) and 8 of 8 goats, with 2 deaths. Morphological observation found that the highest incidence of lung injury, followed by gastrointestinal injury, a small number of animals may occur liver and spleen and other organ damage, while the bladder and gallbladder and other fluid-containing organs are rarely damaged. Lung injury mainly manifested as varying degrees of pulmonary hemorrhage, severe cases often accompanied by pulmonary edema, and even bloody pulmonary bullae and lung tear. Gastrointestinal injury mainly manifested as varying degrees of sub-serous hemorrhage, some animals showed sub-submental hematoma and myometrial tear, and even gastrointestinal perforation. Liver and spleen and other organs can be seen under the capsule hemorrhage, hematoma, severe cases of rupture of liver and spleen. Morphological changes and shock wave physics parameters are obviously related to the impulse, the higher the incidence, the more serious injuries. CONCLUSION: Underwater impact injuries have the characteristics of heavy injury and high mortality rate. Early treatment should be strengthened to deal with acute respiratory distress, gastrointestinal perforation and internal bleeding caused by real organs.