The pathophysiology of primary blast injury and its implications for treatment. Part I: The thorax.
The pathophysiology of primary blast injury and its implications for treatment. Part I: The thorax.
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原发性爆炸伤的病理生理学及其对治疗的影响。
DOI：
10.1136/jrnms-84-79
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发表时间：
1998
期刊：
影响因子：
--
通讯作者：
N. Cripps
中科院分区：
文献类型：
--
作者：
R. Guy;M. Glover;N. Cripps
没有足够的证据支持对原发肺冲击伤的临床治疗的明确方法。本文综述了爆炸伤后心血管和肺的变化，以强调爆炸伤伤员急救中的重要方面。冲击波的轮廓和损伤的理论机制差异很大，但都会导致机械破坏，并引起相似的病理、生理和生化反应。一些患者可能会出现急性症状，而另一些患者似乎没有受到伤害，并在12-24小时后出现呼吸衰竭。治疗结果可能取决于复苏液体和呼吸支持的正确使用。补充氧气和辅助换气的作用仍然存在争议，尽管高吸入氧浓度和呼吸支持可能是不可避免的。药物操纵反射机制的优势尚未得到证实。高压氧治疗可提高肺冲击伤的存活率。
There is insufficient evidence to support a definitive approach to the clinical management of primary pulmonary blast injury. Post-blast cardiovascular and pulmonary changes are reviewed in this paper in order to highlight important aspects in the immediate management of the blast injured casualty. Blast profiles and theoretical mechanisms of injury vary widely but all result in mechanical disruption and cause similar pathological, physiological and biochemical responses. Some patients may present acutely, while others appear unharmed and develop respiratory failure 12-24 hours later. Treatment outcome may depend on the judicious use of resuscitative fluids and respiratory support. The roles of supplementary oxygen and assisted ventilation remain controversial although administration of high inspired oxygen concentrations and respiratory support may be unavoidable. The advantage of pharmacological manipulation of reflex mechanisms is as yet unproven. Hyperbaric therapy may improve survival in pulmonary blast injury.