猪的与下车相关的复杂爆炸伤战斗伤员模型。
A combat casualty relevant dismounted complex blast injury model in swine.
机构信息
From the Department of Surgery (A.L.C., E.E.M., D.K., J.R.C., N.V., M.D., T.R.S.J., H.B.M., M.J.C., K.H., C.C.S., A.S.), School of Medicine, University of Colorado Denver, Aurora; Department of Surgery (E.E.M.), Ernest E Moore Shock Trauma Center at Denver Health, Denver; Department of Health Systems (A.S.), Management and Policy, School of Public Health, University of Colorado Denver, Boulder, Colorado; Department of Vascular Surgery (C.J.F.), University of Maryland School of Medicine, Baltimore, Maryland; Vitalant Research Institute (C.C.S.), Denver; and Department of Pediatrics (C.C.S.), School of Medicine, University of Colorado Denver, Aurora, Colorado.
出版信息
J Trauma Acute Care Surg. 2022 Aug 1;93(2S Suppl 1):S110-S118. doi: 10.1097/TA.0000000000003674. Epub 2022 May 12.
BACKGROUND
Improvised explosive devices have resulted in a unique polytrauma injury pattern termed dismounted complex blast injury (DCBI), which is frequent in the modern military theater. Dismounted complex blast injury is characterized by extremity amputations, junctional vascular injury, and blast traumatic brain injury (bTBI). We developed a combat casualty relevant DCBI swine model, which combines hemorrhagic shock (HS) and tissue injury (TI) with a bTBI, to study interventions in this unique and devastating military injury pattern.
METHODS
A 50-kg male Yorkshire swine were randomized to the DCBI or SHAM group (instrumentation only). Those in the DCBI group were subjected to HS, TI, and bTBI. The blast injury was applied using a 55-psi shock tube wave. Tissue injury was created with bilateral open femur fractures. Hemorrhagic shock was induced by bleeding from femoral arteries to target pressure. A resuscitation protocol modified from the Tactical Combat Casualty Care guidelines simulated battlefield resuscitation for 240 minutes.
RESULTS
Eight swine underwent the DCBI model and five were allocated to the SHAM group. In the DCBI model the mean base excess achieved at the end of the HS shock was -8.57 ± 5.13 mmol·L -1 . A significant coagulopathy was detected in the DCBI model as measured by prothrombin time (15.8 seconds DCBI vs. 12.86 seconds SHAM; p = 0.02) and thromboelastography maximum amplitude (68.5 mm DCBI vs. 78.3 mm in SHAM; p = 0.0003). For the DCBI models, intracranial pressure (ICP) increased by a mean of 13 mm Hg, reaching a final ICP of 24 ± 7.7 mm Hg.
CONCLUSION
We created a reproducible large animal model to study the combined effects of severe HS, TI, and bTBI on coagulation and ICP in the setting of DCBI, with significant translational applications for the care of military warfighters. Within the 4-hour observational period, the swine developed a consistent coagulopathy with a concurrent brain injury evidenced by increasing ICP.
背景
简易爆炸装置导致了一种独特的多发创伤损伤模式，称为非车载复杂爆炸伤（DCBI），这种损伤在现代军事战场上很常见。非车载复杂爆炸伤的特点是四肢截肢、节段性血管损伤和爆炸性脑损伤（bTBI）。我们开发了一种与战斗伤员相关的 DCBI 猪模型，该模型将失血性休克（HS）和组织损伤（TI）与 bTBI 相结合，以研究这种独特且具有破坏性的军事损伤模式的干预措施。
方法
将 50 公斤的雄性约克夏猪随机分为 DCBI 或 SHAM 组（仅仪器）。DCBI 组接受 HS、TI 和 bTBI。爆炸伤是通过使用 55-psi 冲击波管波施加的。组织损伤是通过双侧开放性股骨骨折造成的。通过从股动脉出血至目标压力来诱导失血性休克。根据战术战斗伤员救治指南修改的复苏方案模拟了 240 分钟的战场复苏。
结果
8 头猪接受了 DCBI 模型，5 头被分配到 SHAM 组。在 DCBI 模型中，HS 休克结束时达到的平均基础不足为-8.57±5.13mmol·L-1。在 DCBI 模型中检测到明显的凝血功能障碍，表现为凝血酶原时间（15.8 秒 DCBI 与 12.86 秒 SHAM；p=0.02）和血栓弹性描记图最大振幅（68.5mm DCBI 与 78.3mm SHAM；p=0.0003）。对于 DCBI 模型，颅内压（ICP）升高了 13mmHg，最终 ICP 为 24±7.7mmHg。
结论
我们创建了一种可重复的大动物模型，以研究严重 HS、TI 和 bTBI 对 DCBI 中凝血和 ICP 的综合影响，对军事战斗人员的救治具有重要的转化应用价值。在 4 小时的观察期内，猪出现了一致的凝血功能障碍，并伴有 ICP 升高的并发脑损伤。
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