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目的探讨海上环境对海战伤手术时间与质量的影响,为提高海战救护能力。方法杂种犬60只随机分为陆地手术组(码头环境);海上1组(海上风力2～4级,海面浪高2～3m,舰船摇摆度5～10°环境);海上2组(海上风力5～7级,海面浪高3～5m和舰船摇摆度11～25°环境),每组20只。海上1、2两组在航行中的医院船上进行实验,陆地组在该海域码头实验室中进行实验。动物被制作出颅脑火器伤、开放性胸部伤、开放性腹部伤、下肢伤和烧伤,且行海水浸泡处理。动物接受手术和海水浸泡伤常规处理,每组20只犬,先后行不同部位手术460台次,包括开颅术40台次,剖胸术120台次,剖腹术120台次,下肢骨折内固定术40台次,股动脉吻合术40台次,气管切开术40台次,静脉切开术40台次和清创术20台次。比较三组的手术时间、手术质量及伤后3d内动物死亡率。结果每组手术460台次,时间不等,陆地组共用时300.6min,海上1组369.4min,海上2组426.3min。海上1组手术时间比陆地组长22.9%(P<0.01),海上2组比1组长15.4%(P<0.01)。股动脉吻合术后,陆地组2例血管不通畅,海上1、2两组分别为6和11条血管不通畅。3d内陆地组动物的死亡率为35%(7/20),海上1、2两组分别为45%(9/20)和65%(13/20),海上2组死亡率明显高于其它两组(P<0.01)。结论海上环境对手术时间与质量和动物死亡率有明显影响。明确海上手术特点,提高外科医生在海上的手术技巧和适应海上环境是缩短手术时间、提高质量和降低致伤动物死亡率的关键。
Objective To explore the impact of maritime environment on the time and quality of operation of naval warfare in order to improve the rescue capability of naval warfare. Methods Sixty dogs were randomly divided into three groups: terrestrial surgery group (dock environment), sea group 1 (sea level 2 ~ 4, sea surface wave height 2 ~ 3m, ship sway 5 ~ 10 ° environment) Wind 5 to 7, the sea surface wave height 3 ~ 5m and the ship swing 11 ~ 25 ° environment), each group of 20. Two groups of sea 1 and 2 were conducting experiments on a voyage hospital ship, and the Land Group conducted experiments in the sea terminal laboratory. Animals were made craniocerebral firearm injuries, open thoracic injuries, open abdominal injuries, lower limb injuries and burns, and seawater immersion treatment. The animals were subjected to surgery and seawater immersion wounds routine treatment. Each group of 20 dogs were treated 460 different times, including 40 craniotomy, 120 thoracotomy, 120 laparotomy and internal fixation of lower extremity fracture 40 cases of surgery, 40 cases of femoral artery anastomosis, tracheotomy 40 times, 40 cases of phlebotomy and debridement 20 times. The operation time, the quality of operation and the animal mortality rate within 3 days after injury were compared between the three groups. Results There were 460 surgeries in each group, ranging in duration from 300.6 minutes on land to 369.4 minutes on sea and 426.3 minutes on sea. The operation time of sea group 1 was 22.9% (P <0.01), while that of sea group 2 was 15.4% (P <0.01) longer than that of group 1. After femoral artery anastomosis, 2 vessels in land group were not smooth, and 6 and 11 vessels in sea 1 and 2 were unobstructed respectively. In the 3d inland group, the mortality rate was 35% (7/20) in the inland group, 45% (9/20) and 65% (13/20) in the sea 1 and 2 groups respectively, and the mortality rates in the two groups at sea were significantly higher than those in the other two groups Two groups (P <0.01). Conclusion The marine environment has a significant impact on the operation time and quality and animal mortality. To clarify the characteristics of maritime surgery, to improve the surgeon’s surgical skills at sea and adapt to the marine environment is the key to shortening the operation time, improving the quality and reducing the mortality rate of the injured animal.