Department of Biomedical Engineering, Duke University, 136 Hudson Hall, Durham, NC 27708, USA.
Ann Biomed Eng. 2012 Jan;40(1):185-202. doi: 10.1007/s10439-011-0424-0. Epub 2011 Oct 20.
Traumatic brain injury (TBI) from blast produces a number of conundrums. This review focuses on five fundamental questions including: (1) What are the physical correlates for blast TBI in humans? (2) Why is there limited evidence of traditional pulmonary injury from blast in current military field epidemiology? (3) What are the primary blast brain injury mechanisms in humans? (4) If TBI can present with clinical symptoms similar to those of Post-Traumatic Stress Disorder (PTSD), how do we clinically differentiate blast TBI from PTSD and other psychiatric conditions? (5) How do we scale experimental animal models to human response? The preponderance of the evidence from a combination of clinical practice and experimental models suggests that blast TBI from direct blast exposure occurs on the modern battlefield. Progress has been made in establishing injury risk functions in terms of blast overpressure time histories, and there is strong experimental evidence in animal models that mild brain injuries occur at blast intensities that are similar to the pulmonary injury threshold. Enhanced thoracic protection from ballistic protective body armor likely plays a role in the occurrence of blast TBI by preventing lung injuries at blast intensities that could cause TBI. Principal areas of uncertainty include the need for a more comprehensive injury assessment for mild blast injuries in humans, an improved understanding of blast TBI pathophysiology of blast TBI in animal models and humans, the relationship between clinical manifestations of PTSD and mild TBI from blunt or blast trauma including possible synergistic effects, and scaling between animals models and human exposure to blasts in wartime and terrorist attacks. Experimental methodologies, including location of the animal model relative to the shock or blast source, should be carefully designed to provide a realistic blast experiment with conditions comparable to blasts on humans. If traditional blast scaling is appropriate between species, many reported rodent blast TBI experiments using air shock tubes have blast overpressure conditions that are similar to human long-duration nuclear blasts, not high explosive blasts.
创伤性脑损伤（TBI）由爆炸产生了许多难题。这篇综述集中讨论了五个基本问题，包括：（1）人类爆炸 TBI 的物理相关性是什么？（2）为什么目前军事现场流行病学中爆炸引起的传统肺部损伤证据有限？（3）人类原发性爆炸脑损伤机制是什么？（4）如果 TBI 可能出现与创伤后应激障碍（PTSD）相似的临床症状，我们如何在临床上区分爆炸 TBI 与 PTSD 和其他精神疾病？（5）我们如何将实验动物模型扩展到人类反应？临床实践和实验模型的综合证据表明，现代战场上直接爆炸暴露导致爆炸 TBI。已经在冲击波超压时间历史方面建立了损伤风险函数，并在动物模型中有强烈的实验证据表明，轻度脑损伤发生在类似于肺部损伤阈值的爆炸强度下。弹道防护身体装甲增强的胸部保护可能通过防止在可能导致 TBI 的爆炸强度下发生肺部损伤，在爆炸 TBI 的发生中发挥作用。主要的不确定性领域包括需要对人类轻度爆炸损伤进行更全面的损伤评估，需要更好地了解动物模型和人类中爆炸 TBI 的病理生理学， PTSD 的临床表现与钝器或爆炸创伤引起的轻度 TBI 之间的关系，包括可能的协同作用，以及动物模型与战时和恐怖袭击中人类暴露于爆炸之间的缩放关系。实验方法，包括动物模型相对于冲击波或爆炸源的位置，应精心设计，以提供具有与人类爆炸条件相当的现实爆炸实验。如果传统的爆炸缩放在物种之间是合适的，许多使用空气冲击波管的报告啮齿动物爆炸 TBI 实验的爆炸超压条件与人类长持续时间核爆炸相似，而不是高爆炸药爆炸。
