白磷弹药造成伤害的医疗后果和治疗方法

J. Lakota
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引用次数: 0

摘要

自第一次世界大战以来,白磷(WP)一直被用于手榴弹、迫击炮弹、炮弹和航空炸弹中。最近,白磷被用于伊拉克、叙利亚、阿富汗、也门、纳戈尔诺-卡拉巴赫的作战行动中,并在加沙的巴以冲突中使用。可湿性粉剂造成的烧伤通常会导致死亡或残疾。这项工作的目的是分析和总结有关使用可湿性粉剂弹药造成的医疗后果和治疗方法的科学文献数据。材料和方法。为了进行分析,我们使用了现有的描述敌对行动中可湿性粉剂烧伤后果的科学出版物。分析方法是描述性的。我们完成了以下任务:研究了可湿性粉剂作为一种破坏性制剂的特性;总结了有关可湿性粉剂灼伤的医学后果和治疗此类灼伤的方法的资料。结果讨论。可湿性粉剂具有高反应性和剧毒性,在 35°C 的空气中即可点燃。可湿性粉剂病变的严重程度是燃烧的热效应和化学效应共同作用的结果。因可湿性粉剂烧伤致死的人数不到体表总面积的 10%。可湿性粉剂烧伤的愈合速度比热烧伤慢。可湿性粉剂会深入皮下脂肪组织。因此,烧伤是全厚坏死性的。吸收的可湿性粉剂可作为细胞毒物,对中枢神经系统、肝脏、肾脏、心肌和其他器官造成损害。伤口中残留的可湿性粉剂微粒可能会再次燃烧。结论在入院前阶段,首先要做的是用凉水冲洗伤口,并用镊子取出掉入皮肤的可湿性粉剂碎片。紫外线灯的光线有助于观察可湿性粉剂的小颗粒。清洁脱落的皮肤和清除皮肤上可见的可湿性粉剂颗粒是限制伤口严重程度和全身可湿性粉剂吸收的关键方法。建议在皮损发生后一小时内切除烧伤部位,并重复手术操作,直至磷颗粒全部清除;在最初的 48 小时内控制血清中钙和磷的含量,并进行适当的纠正。今后,最好进行皮肤移植和异体间充质干细胞治疗。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Medical Consequences and Treatment of Injuries Caused by White Phosphorus Munitions
White phosphorus (WP) has been used in hand grenades, mortar and artillery shells, and aerial bombs since World War I. Recently it has been used in combat operations in Iraq, Syria, Afghanistan, Yemen, Nagorno-Karabakh and is used during the Palestinian-Israeli conflict in Gaza. Burns caused by WP usually result in death or disability. The purpose of the work is to analyze and summarize the data of the scientific literature on the medical consequences and treatment of lesions caused using ammunition with WP. Materials and methods. For the analysis, we used available scientific publications describing the consequences of WP burns received during hostilities. The method of analysis is descriptive. The following tasks were solved: the properties of WP as a damaging agent were studied; materials on the medical consequences of WP lesions and methods of treatment of such lesions were summarized. Discussion of the results. WP is highly reactive, highly toxic and ignites in air as early as 35°C. The severity of WP lesions is the result of both the thermal and chemical effects of combustion. Fatalities among humans from WP burns have occurred involving less than 10% of the total body surface area. Burns caused by WP heal more slowly than thermal burns. WP penetrates deeply through the fatty subcutaneous tissue. Therefore, the burns are full-thick, necrotic. The absorbed WP acts as a cellular poison and causes damage to the central nervous system, liver, kidneys, myocardium, and other organs. Any WP particles trapped in the wound may re-ignite. Conclusion. At the pre-hospital stage, the first thing to do is to wash off the wounds with cool water and remove the pieces of WP that have fallen into the skin with forceps. The light from the UV lamp can help to visualize the small particles of WP. Cleaning exfoliated skin and removing visible WP particles from the skin are critical methods for limiting wound severity and systemic WP absorption. It is advisable to excise the burned area within an hour after the lesion and repeat surgical procedures until all phosphorus particles have been removed; to control during the first 48 hours for the content of calcium and phosphorus in the blood serum with appropriate correction. In the future, skin grafting and treatment with allogeneic mesenchymal stem cells are advisable.
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