爆炸冲击波致轻型颅脑损伤的胸部机制
A Thoracic Mechanism of Mild Traumatic Brain Injury Due to Blast Pressure Waves
摘要：
爆炸压力波引起轻度至中度创伤性脑损伤（mTBI）的机制是一个悬而未决的问题。可能包括头部的加速、冲击波通过颅骨的直接通道以及冲击波通过胸部机制传播到大脑。爆炸压力波通过胸部机制到达大脑的假设被认为是在弹道和爆炸压力波的研究。弹道压力波，由穿透弹道射弹或防弹衣的弹道冲击引起，只能通过内部机制到达大脑，并已被证明会引起大脑效应。在动物模型中，当爆炸压力波施加到全身或集中在胸部时，也有类似的效果。虽然迷走神经切断术减少了由于弹道或爆炸压力波引起的呼吸暂停和心动过缓，但它并没有消除大脑中的神经损伤，这表明压力波通过胸部机制直接影响脑细胞。提出了一个实验，该实验将由于冲击波暴露引起的mTBI的胸部机制与颅骨机制分离。研究结果对评估爆炸暴露引起的mTBI风险和制定有效的保护措施具有重要意义。
英文摘要：
The mechanisms by which blast pressure waves cause mild to moderate traumatic brain injury (mTBI) are an open question. Possibilities include acceleration of the head, direct passage of the blast wave via the cranium, and propagation of the blast wave to the brain via a thoracic mechanism. The hypothesis that the blast pressure wave reaches the brain via a thoracic mechanism is considered in light of ballistic and blast pressure wave research. Ballistic pressure waves, caused by penetrating ballistic projectiles or ballistic impacts to body armor, can only reach the brain via an internal mechanism and have been shown to cause cerebral effects. Similar effects have been documented when a blast pressure wave has been applied to the whole body or focused on the thorax in animal models. While vagotomy reduces apnea and bradycardia due to ballistic or blast pressure waves, it does not eliminate neural damage in the brain, suggesting that the pressure wave directly affects the brain cells via a thoracic mechanism. An experiment is proposed which isolates the thoracic mechanism from cranial mechanisms of mTBI due to blast wave exposure. Results have implications for evaluating risk of mTBI due to blast exposure and for developing effective protection.
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