野战条件下多发伤动物模型损伤控制外科救治效果分析及卫勤手术力量优化的思考

Outcomes of damage control surgery in an animal model of multiple injuries under field conditions and thoughts on the optimization of military surgery support force

  • 摘要:
      背景  近年来,全军各单位组织了大量演习,尤其是卫勤救治演习,在救治流程上已日渐成熟。目前在模拟伤员的创伤动物模型等方面研究不够,欠缺实战化经验。
      目的  模拟野战演训基地医疗条件下卫勤手术力量对多发伤动物模型的救治全流程,分析损伤控制手术的时效救治效果,探讨现有机动手术力量的短板不足,并提出优化策略方案。
      方法  选取2只成年实验动物绵羊,麻醉条件下建立目标伤情模型。模型建立后前接、转送至手术方舱进行紧急救治手术,记录手术操作过程、手术时间和生命体征,并在模拟战场环境——突发停电环境下完成救治。手术后转送重伤救治组继续圈养,静脉和动脉采血检测血清电解质并进行血气分析,观察实验动物3 d内存活情况。
      结果  成功建立2例目标伤情动物模型,分别为腹部闭合性撞击伤伴上肢擦伤动物模型、多发伤动物模型。在手术方舱内分别应用常规条件和极端停电条件完成了2例动物模型的紧急救治:模型1手术时间34 min,完成剖腹探查,胃壁破裂穿孔修补术,左上肢清创缝合术;模型2手术时间58 min,完成剖腹探查,经过胃壁破裂穿孔修补术、肝填塞止血、补片辅助临时性腹腔关闭,胸腔探查、胸腔闭式引流管置入术,颅脑坏死组织清除、去骨瓣减压术,左大腿组织清创缝合术。2只实验动物术中和术后生命体征稳定,均于术后30 min顺利清醒,2 h左右恢复自主活动能力,术后6 h给予进食喂养,存活3 d生命体征和自主活动进食情况良好。血清电解质和血气分析指标稳定无异常波动。
      结论  现有机动卫勤手术力量可以完成野战演训基地医疗条件下多发创伤动物模型的紧急手术救治,救治流程配合流畅并固化成熟,但仍应在极端条件卫勤准备等方面进一步贴近实战。

     

    Abstract:
      Background  In recent years, various units of The Chinese People’s Liberation Army have organized a large number of exercises, especially for medical treatment, and the rescue process has gradually become mature. However, there is still a lack of research on the animal models of trauma and experience in actual combat.
      Objective  To simulate the whole rescue process for an animal model of multiple injuries by military surgery support force in field training bases, investigate the effect of damage control surgery and the shortcomings of existing mobile surgical forces, and propose an optimized strategy.
      Methods  Two adult sheep were selected to establish a model of target injury under general anesthesia. After the establishment of the model, the sheep were transferred to the surgical shelter for emergency treatment, and the operation process, time of operation, and vital signs were recorded. The rescue was completed in the simulated battlefield environment with sudden power failure. After surgery, the animals were transferred to a severe injury treatment group for captive breeding; venous and arterial blood samples were collected to measure serum electrolytes and blood gas parameters, and the experimental animals were observed in terms of survival within three days.
      Results  Two animal models of target injury were established successfully, i.e., an animal model of closed abdominal impact injury with upper limb abrasion and an animal model of multiple injuries. Emergency rescue of the two animal models was completed in the surgical shelter under conventional conditions or extreme power failure conditions. For model 1, the time of operation was 34 minutes for exploratory laparotomy, repair of gastric wall rupture and perforation, and debridement and suture of the left upper limb; for model 2, the time of operation was 58 minutes for exploratory laparotomy and temporary abdominal closure by repair of gastric wall rupture and perforation, liver packing hemostasis, and patching, as well as thoracic cavity exploration and placement of closed thoracic drainage tube, craniocerebral necrosectomy and decompressive craniectomy, and debridement and suture of the left thigh. The two experimental animals had stable vital signs during and after surgery and both awoke from anesthesia within 30 minutes after surgery. The ability of autonomic activity was gradually recovered at 2 hours after surgery, and the animals were fed at 6 hours after surgery. Vital signs and autonomic activity were in good condition during the following 3 days. Serum electrolytes and blood gas parameters remained stable without abnormal fluctuation.
      Conclusion  Existing mobile surgical force can complete the emergency surgical treatment of the animal models of multiple injuries under medical conditions in the field training base, and the rescue process is smooth and mature. However, medical preparation under extreme conditions should be further optimized based on actual combat.

     

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