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美军在“自由伊拉克行动”和“持久自由行动”中颅脑战伤救治的经验及对我军颅脑战伤救治的启发
The U.S. Army's experience with management of traumatic brain injury in Operation Enduring Freedom and Operation Iraqi Freedom: lessons to improve our management
- 第三军医大学学报 2018年40卷第2期 页码：91-96
- 作者机构：
400042 重庆，陆军军医大学(第三军医大学)第三附属医院野战外科研究所创伤外科
- 作者简介：
[宗兆文，男，博士，主任医师/教授，博士生导师。任公共安全学会灾难医学分会副主委等学术任职，主持全军军事医学创新工程等十余项课题，主编《现代军医战伤救治培训教程》等7部专著。主要从事战伤模拟训练方面的研究，牵头《总参院校学员战伤自救互救培训》改革试点等项目，多次参加外军的战救技术培训和国际学术交流。先后获国家科技进步二等奖、重庆市科技进步一等奖、总后“科技新星”等荣誉。E-mail：zongzhaowen@163.com ZONG Zhaowen, E-mail: zongzhaowen@163.com
- 基金信息：军事医学创新工程(16CXZ017);装备发展部重点项目“战斗人员战伤自救互救培训装备研究”资助
DOI：10.16016/j.1000-5404.201707136
中图分类号： R642;R651.1;R826.62收稿：2017-07-20，
修回：2017-10-20，
纸质出版：2018-01-30
- 稿件说明：
移动端阅览
宗兆文, 杨磊. 美军在“自由伊拉克行动”和“持久自由行动”中颅脑战伤救治的经验及对我军颅脑战伤救治的启发[J]. 第三军医大学学报, 2018,40(2):91-96.
Zhaowen ZONG, Lei YANG. The U.S. Army's experience with management of traumatic brain injury in Operation Enduring Freedom and Operation Iraqi Freedom: lessons to improve our management[J]. Journal of Third Military Medical University, 2018, 40(2): 91-96.
宗兆文, 杨磊. 美军在“自由伊拉克行动”和“持久自由行动”中颅脑战伤救治的经验及对我军颅脑战伤救治的启发[J]. 第三军医大学学报, 2018,40(2):91-96. DOI： 10.16016/j.1000-5404.201707136.
Zhaowen ZONG, Lei YANG. The U.S. Army's experience with management of traumatic brain injury in Operation Enduring Freedom and Operation Iraqi Freedom: lessons to improve our management[J]. Journal of Third Military Medical University, 2018, 40(2): 91-96. DOI： 10.16016/j.1000-5404.201707136.
摘要
在“自由伊拉克行动(operation iraqi freedom，OIF)”和“持久自由行动(operation enduring freedom，OEF)”两次战争中，爆炸冲击伤是主要的致伤机制，导致颅脑外伤(traumatic brain injury，TBI)的发生率较既往战争明显升高，达到21%~28%。轻、中、重型TBI分别占比约82.4%、8.3%和1.0%。其中，中/重型TBI仍是战亡的首要原因，而轻型TBI后遗症多。美军针对这些流行病学特征制定了对应的防治策略，主要包括：加强作战人员头部防护、采用综合救治措施防止中/重型TBI的继发性损伤、重视轻型TBI的治疗和预后、重视TBI伤员的功能康复、组织规范有序的TBI研究等，从而有效地提高了美军TBI的整体救治水平。以上经验给我军的启发诸如：①现代战争中致伤因素的变化导致TBI的流行病学发生改变，需要根据这一特点制订对应的治疗策略，并需要配套相应的诊断及治疗设备、药品和救治人员; ②增加针对性和实战化的研究; ③结合我军的战略方向，研发适合我军未来作战的TBI战救策略。
Abstract
During the Operation Enduring Freedom and Operation Iraqi Freedom launched by the US army
explosive blast injury was the main mechanism of injuries and caused an incidence of traumatic brain injury (TBI) of 21%~28% among the military personnel
a rate significant higher than those in previous military actions. In these two operations
the percentages of mild
moderate and severe TBI were 82.4%
8.3% and 1%
respectively
Moderate and severe TBI still remained the leading cause of death
while mild TBI was associated with a high incidence of post-concussive symptoms. The US army devised corresponding prevention and treatment strategies based on the epidemiological features of these injuries
including enhancement of head protection
comprehensive measures for controlling secondary injury of moderate and severe TBI
reinforced measures for improving treatment and prognosis of mild TBI
and efforts to encourage systemic TBI research and promote rehabilitation of TBI patients. These measures helped to improve the overall outcomes of TBI. The experiences of the US army provide valuable clues to improve the management of TBI in the Chinese army forces. In modern military operations
the epidemiology of TBI has undergone significant changes due to the changes in the injury mechanisms
for which corresponding management strategies should be devised and related diagnostic and treatment equipment
medicines and personnel should be provided. More specific TBI researches that are closely relevant to the actual conditions in combats need to be promoted. The strategies for TBI management must be improved according to our national strategy to better meet the needs in future military operations.
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references
HELMICK K M, SPELLS C A, MALIK S Z, et al . Traumatic brain injury in the US military: epidemiology and key clinical and research programs[J ] . Brain Imaging Behav, 2015, 9(3): 358-366. DOI: 10.1007/s11682-015-9399-z.
LOGAN B W, GOLDMAN S, ZOLA M, et al . Concussive brain injury in the military: September 2001 to the present[J ] . Behav Sci Law, 2013, 31(6): 803-813. DOI: 10.1002/bsl.2092.
MARTIN E M, LU WC, HELMICK K, et al . Traumatic brain injuries sustained in the Afghanistan and Iraq wars[J ] . Am J Nurs, 2008, 108(4): 40-47. DOI: 10.1097/01.NAJ.0000315260.92070.3f.
SONE J Y, KONDZIOLKA D, HUANG J H, et al . Helmet efficacy against concussion and traumatic brain injury: a review[J ] . J Neurosurg, 2017, 126(3): 768-781. D OI: 10.3171/2016.2.JNS151972.
MOSS W C, KING M J, BLACKMAN E G. Skull flexure from blast waves: a mechanism for brain injury with implications for helmet design[J]. Phys Rev Lett, 2009, 103(10): 108702. DOI: 10.1103/PhysRevLett.103.108702.
FANG R, MARKANDAYA M, DUBOSE J J, et al . Early in-theater management of combat-related traumatic brain injury: A prospective, observational study to identify opportunities for performance improvement[J ] . J Trauma Acute Care Surg, 2015, 79(4 Suppl 2): S181-S187. DOI: 10.1097/TA.0000000000000769.
TORTELLA F C, LEUNG L Y. Traumatic Brain Injury and Polytrauma in Theaters of Combat: The Case for Neurotrauma Resuscitation[J]. Shock, 2015, 44(Suppl 1): 17-26. DOI: 10.1097/SHK.0000000000000380.
SHEAR D A, TORTELLA F C. A military-centered approach to neuroprotection for traumatic brain injury[J]. Front Neurol, 2013, 4: 73. DOI: 10.3389/fneur.2013.00073.
MEYER K, HELMICK K, DONCEVIC S, et al . Severe and penetrating traumatic brain injury in the context of war[J ] . J Trauma Nurs, 2008, 15(4): 185-189. DOI: 10.1097/01.JTN.0000343324.55087.de.
MEYER R M, LARKIN M B, SZUFLITA N S, et al . Early venous thromboembolism chemoprophylaxis in combat-related penetrating brain injury[J ] . J Neurosurg, 2017, 126(4): 1047-1055. DOI: 10.3171/2016.4.JNS16101.
ROSENFELD J V, BELL R S, ARMONDA R. Current concepts in penetrating and blast injury to the central nervous system[J]. World J Surg, 2015, 39(6): 1352-1362. DOI: 10.1007/s00268-014-2874-7.
WANG E W, HUANG J H. Understanding and treating blast traumatic brain injury in the combat theater[J]. Neurol Res, 2013, 35(3): 285-289. DOI: 10.1179/17431328 12Y.0000000138.
TURCO L, CORNELL D L, PHILLIPS B. Penetrating Bihemispheric Traumatic Brain Injury: A Collective Review of Gunshot Wounds to the Head[J]. World Neurosurg, 2017, 104: 653-659. DOI: 10.1016/j.wneu.2017.05.068.
LEVIN H S, DIAZ-ARRASTIA R R. Diagnosis, prognosis, and clinical management of mild traumatic brain injury[J]. Lancet Neurol, 2015, 14(5): 506-517. DOI: 10.1016/S1474-4422(15)00002-2.
CHAPMAN J C, DIAZ-ARRASTIA R. Military traumatic brain injury: a review[J]. Alzheimers Dement, 2014, 10(3 Suppl): S97-104. DOI: 10.1016/j.jalz.2014.04.012.
ADAM O, MAC DONALD C L, RIVET D, et al . Clinical and imaging assessment of acute combat mild traumatic brain injury in Afghanistan[J ] . Neurology, 2015, 85(3): 219-227. DOI:10.1212/WNL.0000000000001758.
BUONORA J E, YARNELL A M, LAZARUS R C, et al . Multivariate analysis of traumatic brain injury: development of an assessment score[J ] . Front Neurol, 2015, 6: 68. DOI: 10.3389/fneur.2015.00068.
O'NEIL M E, CARLSON K F, STORZBACH D, et al . Factors Associated with Mild Traumatic Brain Injury in Veterans and Military Personnel: A Systematic Review[J ] . Journal of the International Neuropsychological Society, 2014, 20(3): 249-261. DOI: 10.1017/s135561771300146x.
PUGH M J, SWAN A A, CARLSON K F, et al . Traumatic Brain Injury Severity, Comorbidity, Social Support, Family Functioning, and Community Reintegration Among Veterans of the Afghanistan and Iraq Wars[J ] . Archives of Physical Medicine and Rehabilitation, 2017. DOI: 10.1016/j.apmr.2017.05.021.
TRUDEL T M, NIDIFFER F D, BARTH J T. Community-integrated brain injury rehabilitation: Treatment models and challenges for civilian, military, and veteran populations[J]. J Rehabil Res Dev, 2007, 44(7): 1007-1016. DOI:10.1682/jrrd.2006.12.0167.
DHARM-DATTA S, GOUGH M R, PORTER P J, et al . Successful outcomes following neurorehabilitation in military traumatic brain injury patients in the United Kingdom[J ] . J Trauma Acute Care Surg, 2015, 79(4 Suppl 2):S197-203. doi: 10.1097/TA.0000000000000721.
COOPER DOUGLAS B, BUNNER ANNE E, KENNEDY JAN E, et al . Treatment of persistent post-concussive symptoms after mild traumatic brain injury: a systematic review of cognitive rehabilitation and behavioral health interventions in military service members and veterans[J ] . Brain Imaging and Behavior, 2015, 9(3): 403-420. DOI:10.1007/s11682-015-9440-2.
RAYMONT V, SALAZAR A M, KRUEGER F, et al . "Studying injured minds" -the Vietnam head injury study and 40 years of brain injury research[J ] . Front Neurol, 2011, 2: 15. DOI:10.3389/fneur.2011.00015.
SALAZAR A M, ZITNAY G A, WARDEN D L, et al . Defense and Veterans Head Injury Program: background and overview[J ] . J Head Tra uma Rehabil, 2000, 15(5): 1081-1091. DOI: 10.1097/00001199-200010000-00002.
BLACKBOURNE L H, BAER D G, EASTRIDGE B J, et al . Military medical revolution: military trauma system[J ] . J Trauma Acute Care Surg, 2012, 73(6 Suppl 5): S388-S394. DOI: 10.1097/TA.0b013e31827548df.
郭毅军, 蔡绍皙, 赵志强, 等.次声波与次声武器[J].生物学通报, 2007, 42(7): 3-5. DOI: 10.3969/j.issn.0006-3193.2007.07.005.
GUO Y J, CAI S X, ZHAO Z Q, et al . Infrasonic wave and infrasonic wave weapons[J ] . Bull Biol, 2007, 42(7): 3-5. DOI: 10.3969/j.issn.0006-3193.2007.07.005.
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