Blast injury from explosive munitions
Blast injury from explosive munitions
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DOI：
10.1097/00005373-199907000-00021
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发表时间：
1999-07-01
影响因子：
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通讯作者：
Jevtic, M
中科院分区：
文献类型：
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作者：
Cernak, I;Savic, J;Jevtic, M
目的：为了评估爆炸的影响，在常见的warinnings.Methods：1303例爆炸性弹药受伤，并证明四肢伤口没有其他穿透伤的患者在1991年和1994年之间在贝尔格莱德的军事医学院。其中，665例（51%）患者的症状和体征符合原发性冲击伤的临床诊断，而其余658例患者则不符合。在创伤后早期随机抽取65名爆炸组患者，结果显示血液血栓素A（2）（TxA（2））、前列环素（PGI（2））、和硫肽白三烯与非原始细胞组62例患者的随机样本进行比较。这种差异不能通过两组之间不同的损伤严重程度来解释，因为两组中通过损伤严重程度评分和红十字会伤口分类测量的伤口严重程度相似。在爆炸患者中，200例患者（30%）有反映中枢神经系统疾病的长期（1年）症状和体征。这些症状和体征仅在4%的非原始细胞患者中零星发现。这些研究结果表明，原发性爆炸伤在战争创伤中比以前认为的更常见，在受爆炸影响的人中，令人惊讶的是，很高比例的人保留了长期的神经功能障碍。类花生酸的升高可用于确认和监测blast injury.Conclusion在爆炸性武器伤患者的立即处理，因此，应特别注意冲击伤的存在和/或发展。我们的研究结果表明，爆炸是更常见的战争伤害比以前认为的。冲击伤后类花生酸的变化提示冲击伤是一种重要的生理应激。对中枢神经系统的各种影响表明，爆炸伤可能是造成现在被认为是创伤后应激障碍的某些方面的原因。
Objective: To evaluate the effect of blast in common war injuries.Methods: One thousand three hundred and three patients injured by explosive munitions and demonstrating extremity wounds without other penetrating injuries were admitted to the Military Medical Academy in Belgrade between 1991 and 1994. of these, 665 patients (51%) had symptoms and physical signs that were compatible with the clinical diagnosis of primary blast injury, whereas the remaining 658 patients did not.Results: Random sampling of 65 patients in the blast group during the early posttraumatic period showed statistically significant elevations in blood thromboxane A(2) (TxA(2)), prostacyclin (PGI(2)), and sulfidopeptide leukotrienes compared with the random sample of 62 patients in the nonblast group. This difference could not be accounted for by differing injury severity between the groups, because the severity of wounds as measured by both the Injury Severity Score and the Red Cross Wound Classification was similar in both groups. Amongst blast patients, 200 patients (30%) had long-term (1 year) symptoms and signs reflecting central nervous system disorders. These symptoms and signs were only sporadically found in 4% of the nonblast patients. These findings indicate that primary blast injury is more common in war injuries than previously thought and that of those affected by blast, a surprisingly high proportion retain long-term neurologic disability. The elevation in eicosanoids could be used to confirm and monitor blast injury.Conclusion In relation to the immediate management of patients injured by explosive weapons, it follows that particular attention should be paid to the presence and/or development of blast injury. Our findings indicate that blast is more common in war injuries than previously thought. Eicosanoid changes after blast injury suggest that blast injury causes a major physiologic stress. A variety of effects on the central nervous system suggest that blast injury could be responsible for some aspects of what is now considered to be the posttraumatic stress disorder.