作者:施琼,严宏,钟代星
作者单位:(710038)中国陕西省西安市,第四军医大学唐都医院1眼科;2胸外科
【摘要】目的:观察犬眼室内爆炸冲击波损伤后早期眼组织结构的病理学改变。方法:爆轰塔内B炸药爆炸致眼冲击伤,根据对眼球的不同爆炸强度随机分组:A组549mmHg;B组1089mmHg;C组2128mmHg;D组无致伤对照组。均分别于伤后0.5h和6h处死动物,取眼组织标本于40g/L中性甲醛溶液固定,行常规石蜡包埋,切片,HE染色,光镜观察,拍照。结果:眼部冲击伤后即刻出现球结膜充血、水肿,脉络膜出血,有明显的视网膜血管改变,组织水肿、渗出、出血等改变。结论:爆轰塔内B炸药爆炸致眼冲击波可造成视网膜、脉络膜、视神经的直接损伤。
【关键词】 眼冲击伤; 视网膜; 组织病理改变
Pathological structural changes of dogs eye tissues after ocular blast injury
Qiong Shi, Hong Yan, DaiXing Zhong
1Department of Ophthalmology;2 Department of Thoracic Surgery, Tangdu Hospital, the Fourth Military Medical University, Xian 710038, Shaanxi Province, China
Correspondence to: Hong Yan. Department of Ophthalmology, Tangdu Hospital, the Fourth Military Medical University, Xian 710038, Shaanxi Province, China. [email protected]
AbstractAIM: To observe the pathological structural changes of dogs eye tissues after ocular blast in jury. METHODS: Ocular blast injury models were set up in 22 dogs by the bow wave produced with B detonator in detonation tower. With different detonation degree, the dogs were divided into 4 groups: 549mmHg as group A, 1089mmHg as group B, 2128mmHg as group C and no injury as control. All dogs were sacrificed at 0.5 and 6 hours after injury, their eye tissues were obtained and the pathological structural changes were observed under light microscope. RESULTS: The pathological structural changes of eye tissues induced by blast were summarized as follows: Conjunctival injection and oedema, choroidal hemorrhage appeared after ocular blast injury; Moreover, retinal vessel were changed markedly, such as the changes of tissues oedema, effusion and hemorrhage. CONCLUSION: Ocular blast injury may cause pathological structural changes of eye tissues. The pathological changes of retina, choroid and optic nerve may be associated with the direct effect of the blast and /or ischemia and are possibly important factors in the pathogenesis of vision disturbance. KEYWORDS: ocular blast injury; retina; pathological structure
0引言
眼冲击伤在战时是一种常见的损伤,在平时也较常见。随着现代武器的不断发展更新以及听器和胸部得到相应的防护,眼冲击伤的防治问题就显得更为突出。目前国内外研究大多数是报道眼部爆炸伤的临床特点,对眼冲击伤的深入细致研究报道极少。冲击波眼损伤往往会导致严重的视功能损害,在临床工作中,即使这种损伤未导致眼屈光间质混浊的非穿透性眼球爆炸伤,经过临床治疗,其视功能的恢复也往往不如人意[1]。迄今为止,虽然有一些相关的眼冲击伤的致伤机制的研究探讨,但是冲击波眼损伤的发病机制和病理改变仍不是很清楚。以前研究者们利用生物激波管复制眼冲击伤的实验模型进行研究[2]。我们利用在爆轰塔内B炸药爆炸产生的冲击波对犬在模仿人的站立位情况下的眼组织的早期损伤病理变化的研究,从而为临床眼冲击伤的早期救治提供一定的理论依据。
1材料和方法
1.1材料
健康成年杂种犬22只,第四军医大学动物实验中心提供,雌雄不拘,体质量12.7±0.8kg,根据不同爆炸效应将所有动物随机分为4组:A组6只,炸药剂量30g,犬距离爆源1m,爆炸时犬眼处超压为549mmHg;B组6只,炸药剂量80g,犬距离爆源1m,爆炸时犬眼处超压为1089mmHg;C组5只,炸药剂量80g,犬距离爆源0.8m,爆炸时犬眼处超压为2128mmHg;D组5只,为无致伤对照组。爆轰塔(国家2110工程资助)由我军某高校研究室提供;PCB 137型自由场压力传感器、VXI1115型动态测试仪由204所爆炸测试研究室提供。炸药为40TNT/60RDX标准B炸药, RDX为黑索今,起爆雷管采用8号铜壳电雷管,由204所爆炸测试研究专职人员负责爆炸实施并监测相关数据。
1.2方法
以爆轰塔为爆炸场所,爆轰塔是半径3m半球形全封闭钢制建筑,球壁厚约8mm。场地内实验数据采用VXI1115型动态测试仪采集,采样频率为2Mb/s。场地内置6只PCB 137型自由场压力传感。所用炸药为40TNT/60RDX的标准B炸药,RDX为黑索今,采用8号铜壳电雷管起爆。犬于爆炸前使用速眠新(0.12mL/kg,im)麻醉后,固定犬体位成人的站立位,以模拟人的一般姿势;爆炸装置距地面高度(炸高)、传感器距地面高度均为1m,犬分别于0.5h和6h后经股动脉放血处死,取眼组织标本立即放入40g/L中性甲醛溶液中,固定48h后充分水洗,经12~24h梯度乙醇脱水后,将眼球标本取出,经脱水、透明、浸蜡、包埋、切片做常规HE 染色行光镜检查。
2结果
眼冲击伤后眼球无破裂,无脱出。伤后各致伤组均可见球结膜充血、水肿及明显结膜下气肿,角膜上皮点状或片状剥落、轻度水肿,瞳孔较正常组缩小,房水闪辉阳性,对光反应明显迟钝。伤后0.5h各致伤组均出现上睑肿胀,结膜囊有白色分泌物,球结膜充血水肿更明显,个别角膜上皮小片状剥脱。伤后6h角膜局限性小片状剥脱,晶状体无脱出,透明。正常对照组犬眼角膜、晶状体、视网膜等组织结构清楚。各冲击波损伤组伤后0.5h均存在角膜上皮点状或片状剥脱(图1A,B)、视网膜组织水肿,内界膜部分区域破裂,内核层细胞间水肿,光感受器细胞内节尚完整,外节结构紊乱,膜盘碎裂,碎片散布于内节与色素上皮细胞之间(图1C,D)。伤后6h ,A组犬脉络膜血管明显扩张充血,视网膜感光细胞的锥杆层有碎裂改变,色素上皮细胞破坏,后极部有局灶性视网膜脱离,神经纤维层水肿明显,Müller 纤维支架显露,节细胞数目减少,内核层空泡变性,内界膜灶性破裂(图2A,B)。B、C组犬可见脉络膜上腔出血,视网膜脱离范围较大,视神经乳头神经纤维水肿,表面毛细血管扩张(图2C,D)。
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