Phillips Y Y, Mundie T G, Yelverton J T, Richmond D R
Department of Respiratory Research, Walter Reed Army Institute of Research, Washington, D.C. 20307-5100.
J Trauma. 1988 Jan;28(1 Suppl):S149-52. doi: 10.1097/00005373-198801001-00030.
Ballistic wounds have been and will remain the principal cause of casualties in combat. Cloth ballistic vests (CBV) play an important role in limiting critical wounds from fragments and small-arms fire. There is an increased risk of primary blast injury on the modern battlefield. In a previous study, volunteers were exposed to short-duration blast waves of low peak pressure (18.6 +/- 0.8 kPa). Pressure measurements made in the distal esophagus as an estimate of intrathoracic pressure (ITP) were significantly higher (p less than 0.05) when the standard U.S. Army ballistic jacket was worn (8.7 +/- 1.2 kPa) than when fatigues alone were worn (7.4 +/- 0.7 kPa). In this study 58 sheep were exposed to nominal blast levels of 115, 230, 295, and 420 kPa peak pressure in groups of 12, 18, 16, and 12, respectively. Half of each group was fitted with a CBV. Lung weight index (LWI), lung weight expressed as a percentage of body weight, was used as a measure of blast injury. Use of the CBV was associated with a significant increase in LWI (p less than 0.05) which averaged 21% for the two middle exposure groups. At the 420 kPa level, two of six non-CBV animals died as opposed to five of six animals wearing the CBV. Intrathoracic pressure was generally higher in the CBV group. Likely mechanisms of injury enhancement include an increase in target surface area and an alteration of the effective loading function on the thorax. This information may be useful in the triage and treatment of casualties exposed to intense blast environments.
弹道伤一直是且仍将是战斗中人员伤亡的主要原因。布质防弹背心（CBV）在限制弹片和小口径武器射击造成的致命伤方面发挥着重要作用。现代战场上原发性爆震伤的风险有所增加。在之前的一项研究中，志愿者暴露于低峰值压力（18.6±0.8千帕）的短持续时间冲击波中。当穿着标准的美国陆军防弹夹克时，在远端食管进行的压力测量作为胸腔内压力（ITP）的估计值（8.7±1.2千帕）显著高于仅穿着工作服时（7.4±0.7千帕）（p＜0.05）。在本研究中，58只绵羊分别以12只、18只、16只和12只为一组，暴露于峰值压力为115、230、295和420千帕的名义爆炸水平。每组中的一半配备了CBV。肺重量指数（LWI），即肺重量占体重的百分比，被用作爆震伤的衡量指标。使用CBV与LWI显著增加相关（p＜0.05），两个中等暴露组的LWI平均为21%。在420千帕水平时，六只未穿CBV的动物中有两只死亡，而六只穿CBV的动物中有五只死亡。CBV组的胸腔内压力总体上更高。损伤增强的可能机制包括目标表面积增加和胸部有效负荷功能改变。这些信息可能对处于强烈爆炸环境中的伤员的分诊和治疗有用。
