【作者】 黄艺峰； 许民辉； 赖西南； 黄莹；

【Author】 HUANG Yi-feng;XU Min-hui;LAI Xi-nan;HUANG Ying;Institute of Surgery Research,Daping Hospital,Third Military Medical University;180th hospital of PLA;

【机构】 第三军医大学附属大坪医院野战外科研究所； 中国人民解放军第180医院；

【摘要】 目的观察手枪弹击中防弹头盔致颅脑损伤的特点。方法将14只健康长白猪随机数字表法分为致伤组(9只)、对照组(5只)。致伤组使用9mm手枪弹、360m/s射速垂直射击防弹头盔板防护下的猪头部;对照组除使用相同弹药量无弹头手枪弹射击外,余同致伤组。观察伤后早期生命体征变化及伤后2h视网膜损伤情况,留取伤前、伤后3h脑脊液,用以检测脑损伤标志物神经元特异性烯醇化酶(neuron specific enolase,NSE)、αII-spectrin蛋白含量。随后处死动物并解剖,观察颅脑大体形态改变,取部分脑皮质固定、HE染色,观察其显微病理改变。结果致伤组伤后早期出现血压下降,心率和呼吸频率加快,视网膜出血(3/9),颅骨骨折(3/9),脑表面损伤(9/9),包括局部脑撞击伤(9/9)及对冲伤(9/9),撞击伤重于对冲伤,显微镜下见撞击部位及对冲部位大脑皮质神经元急性损伤,伤后3h脑脊液NSE、αII-spectrin蛋白含量较伤前显著升高(P<0.05)。结论手枪弹击中防弹头盔板防护下的猪头部早期可致钝性颅脑损伤,且撞击伤重于对冲伤。因此,作战人员防弹头盔后颅脑损伤应引起重视,并得到早期诊断和治疗。更多还原

【Abstract】 Objective To study the characteristics of craniocerebral injury caused by the nonpenetrating handgun bullet impact on the helmet-protected head.Methods Fourteen healthy pigs were randomly divided into the injury group(n=9) and control group(n=5).Pigs of the injury group were shot vertically on the head under the protection of helmet plate with 9mm handgun bullet of velocity of 360m/s.Pigs of the control group were dealt with the same process as the injury group except shot with unarmed handgun bullet of the same ammunition dose.The changes of vital sign in the early of post-injury and retina 2 hours after trauma were observed.Porcine cerebrospinal fluid(CSF) of pre-injury and 3h post-injury was obtained by rachiocentesis to investigate expression levels of protein biomarkers in traumatic brain injury,including neuron specific enolase(NSE) and a II-spectrin.Then animals were sacrificed and dissected.The general morphological changes of the brain were examined,and the parts of the brain cortex were taken,fixed and stained with hematoxylin-eosin for optical microscopic observation.Results In the injury group,blood pressure descenting,heart rate and respiratory rate accelerating in the early stage after injury.Through general morphological observation,we found that retinal hemorrhage occurred in injury pigs(3/9),skull fracture(3/9) and brain surface damage(9/9).Brain surface damage included local impact lesion(9/9) and contrecoup lesion(9/9).Impact lession outweighed generally contrecoup lesion.Optical microscopic observation revealed that the neuron of impacted and contralateral cerebral cortex in injury pigs underwent acute damageand the concentrations of NSE and a II-spectrin were significantly increased in CSF 3 hours after trauma(P<0.05).Conclusion When the nonpenetrating handgun bullet impacted on the porcine head protected by helmet plate,craniocerebral injuryoccurred in the early period and impact lesion outweighed contrecoup lesion.Therefore,traumatic brain injury of soldiers armed with helmets should be stressed and obtained early diagnosis and treatment.更多还原