切换至 "中华医学电子期刊资源库"

中华医学超声杂志(电子版) ›› 2019, Vol. 16 ›› Issue (12) : 963 -966. doi: 10.3877/cma.j.issn.1672-6448.2019.12.015

所属专题: 文献

基础研究

超声应用于爆震伤院前救治的实验研究
赵媛媛1, 张霞2, 冯聪2, 吴东东2, 腾越2, 赵宇卓2, 黎檀实2,(), 吕发勤1,()   
  1. 1. 572013 三亚,中国人民解放军总医院海南医院超声科
    2. 100853 北京,中国人民解放军总医院第一医学中心急诊科
  • 收稿日期:2019-08-27 出版日期:2019-12-01
  • 通信作者: 黎檀实, 吕发勤
  • 基金资助:
    全军后勤科研目录重点项目(BWS14J041、BWS16C005); 科技部"十三五"国家重点研发计划(2016YFC0105006)

Application of ultrasound in pre-hospital rescue for blast injury: an experimental study

Yuanyuan Zhao1, Xia Zhang2, Cong Feng2, Dongdong Wu2, Yue Teng2, Yuzhuo Zhao2, Tanshi Li2,(), Faqin Lyu1,()   

  1. 1. Department of Ultrasound, Hainan Hospital of PLA General Hospital, Sanya 572013, China
    2. Department of Emergency Medicine, the First Medical Center of PLA General Hospital, Beijing 100853, China
  • Received:2019-08-27 Published:2019-12-01
  • Corresponding author: Tanshi Li, Faqin Lyu
  • About author:
    Corresponding authors: Lyu Faqin, Email:
    Li Tanshi, Email:
引用本文:

赵媛媛, 张霞, 冯聪, 吴东东, 腾越, 赵宇卓, 黎檀实, 吕发勤. 超声应用于爆震伤院前救治的实验研究[J/OL]. 中华医学超声杂志(电子版), 2019, 16(12): 963-966.

Yuanyuan Zhao, Xia Zhang, Cong Feng, Dongdong Wu, Yue Teng, Yuzhuo Zhao, Tanshi Li, Faqin Lyu. Application of ultrasound in pre-hospital rescue for blast injury: an experimental study[J/OL]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2019, 16(12): 963-966.

目的

采用野战环境下的动物模型进行实验研究,探讨便携超声在爆震伤院前救治中的应用价值。

方法

选用长白山猪90只麻醉后制备爆震伤模型。将致伤成功动物转移至集伤点,分别使用传统体格检查和掌上超声进行检伤分类,并对适合进行静脉穿刺置管的动物模型分别进行徒手穿刺和超声引导下的静脉穿刺,记录体格检查和掌上超声诊断所需时间和准确性以及徒手穿刺和超声引导下穿刺置管所用时间和一次性置管成功率,并对数据进行比较分析。

结果

90只实验猪中,成功致伤44只,致伤成功率48.9%。24只实验动物进行超声伤情评估,平均用时(230±78)s,体格检查伤情评估平均用时(60±23)s(t=10.24,P<0.01)。以手术或CT扫描结果为"金标准",掌上超声与传统体格检查的诊断准确性分别为95.8%(23/24)、54.2%(13/24),2者比较差异有统计学意义(χ2=8.10,P<0.05)。6只动物模型进行超声引导下静脉穿刺置管,平均用时(300±86)s,一次性置管成功率100.0%。徒手穿刺法一次性置管成功2只,平均用时(600±67)s,置管成功率33.3%(2/6)。2种方法穿刺置管所用时间比较,差异有统计学意义(t=10.24,P<0.01)。

结论

超声技术提高了院前爆震伤伤情评估的准确性和损伤控制成功率。超声检查具有便捷、无创、准确以及可重复等优势,其在爆震伤的院前救治中可发挥重要作用。

Objective

Ultrasound (US) has advantages of handiness and multifunction in triage and pre-hospital treatment for blast injury. This study aimed to assess the application of ultrasound in pre-hospital rescue for blast injury in the condition of field battle through animal experiments.

Methods

Animals were anaesthetized and shaved before exposure to explosion, and then randomly assigned to receive extended focused assessment with sonography for trauma (eFAST) or physical examination.

Results

Blast injury was successfully induced in 44 (48.9%) of 90 animals. US examination was performed for assessment and damage control on 24 models in site. Physical examination and US examination were completed in (60±23) seconds and (230±78) seconds, respectively (t=10.24, P<0.01). The diagnosis accuracy of US (95.8%) was higher than that of physical examination (54.2%) (χ2=8.10, P<0.05). Besides, ultrasound-guided vein catheterizations were performed on 6 models with 100.0% achieving primary operation, compared with bare-handed ones with a 33.3% success rate; the former ones were completed in (300±86) seconds compared with the later ones in (600±67) seconds (t=10.24, P<0.01).

Conclusion

This is a preliminary study to assess the application of US in pre-hospital treatment. The accuracy of rapid diagnosis is improved remarkably by eFAST and more precise treatment can be achieved under the guidance of ultrasound.

图1 爆震伤动物模型制备中实验动物摆放及实验动物与爆炸点的位置关系示意图
图2 实验炸伤点与战术战伤救治位置和阶段示意图
[1]
Born CT. Blast trauma: the fourth weapon of mass destruction [J]. Scand J Surg, 2005, 94(4): 279-285.
[2]
张连阳.爆炸冲击伤的诊断[J].创伤外科杂志, 2017, 19(2): 157-160.
[3]
姚远,周继红,刘大维,等.爆炸伤伤情创伤评分[J].创伤外科杂志, 2006(6): 533-535.
[4]
康建毅,段朝霞,张洁元,等.不同创伤评分系统在爆炸伤伤情评估中的比较[J].第三军医大学学报, 2019, 41(15): 1403-1406.
[5]
周璇,冯聪, 等.院前超声在急救医学中的应用[J].临床急诊杂志, 2014, 1(15): 16-17.
[6]
冯聪,陈力,周璇, 等. 介入超声在战创伤损伤控制救治中的应用[J].人民军医, 2016, 59(11): 1096.
[7]
Islam NB, Levy PD. Emergency bedside ultrasound to detect pneumothorax [J]. Acad Emerg Med, 2003, 10: 819-820.
[8]
Kirkpatrick AW, Ng AK, Dulchavsky SA, et al. Sonographic diagnosis of a pneumothorax inapparent on plain radiography:confirmation by computed tomography [J]. J Trauma, 2001, 50(4): 750-752.
[9]
李传红.高频超声诊断肋骨骨折的价值[J].中国医学影像学杂志, 2007, 15 (4): 301-302.
[10]
Stengel D, Rademacher G, Ekkernkamp A, et al.Emergency ultrasound-based algorithms for diagnosing blunt abdominal trauma [J]. Cochrane Database Syst Rev, 2015, 14(9): CD004446.
[11]
Catalano O, Lobianco R, Raso MM, et al.Blunt hepatic trauma: evaluation with contrast-enhanced sonography:sonographic findings and clinical application [J]. J Ultrasound Med, 2005, 24(3): 299-310.
[12]
Tang J, Li W, Lv F, et al. Comparison of gray scale contrast-enhanced ultrasonography with contrast-enhanced CT in different grading blunt hepatic and splenic trauma:an animal experiment [J]. Ultrasound Med Biol, 2009, 35(4): 566-575.
[13]
张惠琴,梁峭嵘,唐杰, 等.肝外伤超声分级与CT、手术结果对照的初步研究[J].中华超声影像学杂志, 2007, 16 (10): 875-877.
[14]
吕发勤,黎檀实. 微型超声在胸腹战伤"黄金1小时"救治中的应用前景[J].临床急诊杂志, 2017, 18(10): 729-731.
[15]
Kristensen MS, Teoh WH, Graumann O, et al. Ultrasonography for clinical decision-making and intervention in airway management:from the mouth to the lungs and pleurae [J]. Insights Imaging, 2014, 5(2): 253-279.
[16]
Tang H, Pan T, Qin X, et al. A portable thoracic closed drainage instrument for hemopneumothorax [J]. J Trauma Acute Care Surg, 2012, 72(3): 671-675.
[17]
Vegas A, Denault A, Royse C. A bedside clinical and ultrasound-based approach to hemodynamic instability-Part II: bedside ultrasound in hemodynamic shock: continuing professional development [J]. Can J Anaesth, 2014, 61(11): 1008-1027.
[18]
冯聪,陈力,周璇,等.创伤超声重点评估技术在战现场战伤救治中的应用[J].人民军医, 2016, 59(11): 1093-1094.
[19]
吕发勤,黎檀实.超声在战现场战伤救治中的应用价值[J].人民军医, 2016, 59(10): 983-984.
[1] 章建全, 程杰, 陈红琼, 闫磊. 采用ACR-TIRADS评估甲状腺消融区的调查研究[J/OL]. 中华医学超声杂志(电子版), 2024, 21(10): 966-971.
[2] 罗辉, 方晔. 品管圈在提高甲状腺结节细针穿刺检出率中的应用[J/OL]. 中华医学超声杂志(电子版), 2024, 21(10): 972-977.
[3] 杨忠, 时敬业, 邓学东, 姜纬, 殷林亮, 潘琦, 梁泓, 马建芳, 王珍奇, 张俊, 董姗姗. 产前超声在胎儿22q11.2 微缺失综合征中的应用价值[J/OL]. 中华医学超声杂志(电子版), 2024, 21(09): 852-858.
[4] 孙佳丽, 金琳, 沈崔琴, 陈晴晴, 林艳萍, 李朝军, 徐栋. 机器人辅助超声引导下经皮穿刺的体外实验研究[J/OL]. 中华医学超声杂志(电子版), 2024, 21(09): 884-889.
[5] 史学兵, 谢迎东, 谢霓, 徐超丽, 杨斌, 孙帼. 声辐射力弹性成像对不可切除肝细胞癌门静脉癌栓患者放射治疗效果的评价[J/OL]. 中华医学超声杂志(电子版), 2024, 21(08): 778-784.
[6] 李洋, 蔡金玉, 党晓智, 常婉英, 巨艳, 高毅, 宋宏萍. 基于深度学习的乳腺超声应变弹性图像生成模型的应用研究[J/OL]. 中华医学超声杂志(电子版), 2024, 21(06): 563-570.
[7] 洪玮, 叶细容, 刘枝红, 杨银凤, 吕志红. 超声影像组学联合临床病理特征预测乳腺癌新辅助化疗完全病理缓解的价值[J/OL]. 中华医学超声杂志(电子版), 2024, 21(06): 571-579.
[8] 项文静, 徐燕, 茹彤, 郑明明, 顾燕, 戴晨燕, 朱湘玉, 严陈晨. 神经学超声检查在产前诊断胼胝体异常中的应用价值[J/OL]. 中华医学超声杂志(电子版), 2024, 21(05): 470-476.
[9] 胡可, 鲁蓉. 基于多参数超声特征的中老年女性压力性尿失禁诊断模型研究[J/OL]. 中华医学超声杂志(电子版), 2024, 21(05): 477-483.
[10] 张妍, 原韶玲, 史泽洪, 郭馨阳, 牛菁华. 小肾肿瘤超声漏诊原因分析新思路[J/OL]. 中华医学超声杂志(电子版), 2024, 21(05): 500-504.
[11] 席芬, 张培培, 孝梦甦, 刘真真, 张一休, 张璟, 朱庆莉, 孟华. 乳腺错构瘤的临床与超声影像学特征分析[J/OL]. 中华医学超声杂志(电子版), 2024, 21(05): 505-510.
[12] 侯中光, 詹韵韵, 毕玉, 王佳佳, 吴瑕璧, 彭梅. 三维反转成像技术在BI-RADS 4类乳腺肿块应用中的初步研究[J/OL]. 中华医学超声杂志(电子版), 2024, 21(04): 370-376.
[13] 钱警语, 郑明明. 《2024意大利妇产科学会非侵入性和侵入性产前诊断指南》解读[J/OL]. 中华妇幼临床医学杂志(电子版), 2024, 20(05): 486-492.
[14] 张琛, 秦鸣, 董娟, 陈玉龙. 超声检查对儿童肠扭转缺血性改变的诊断价值[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(06): 565-568.
[15] 陈秀晓, 隋文倩, 王珉鑫, 吴圆圆. 腹股沟斜疝并腹腔游离体超声表现一例[J/OL]. 中华临床医师杂志(电子版), 2024, 18(05): 516-517.
阅读次数
全文


摘要


AI


AI小编
你好!我是《中华医学电子期刊资源库》AI小编,有什么可以帮您的吗?