| Objective Fighting on the sea is a very important means of our army to oppose the independence of Taiwan, and to safeguard the sovereignty of our country's territorial waters. The medical principle and treatment measures to the wounded soldiers in the sea fighting are a great topic of medical service of our army. Our research is a branch of the great special purpose of our army's medical science, which is"Serial research on the medical technique for the wounded soldier in the sea fighting". Our purpose is to observe the influence on wound healing after seawater immersion, to explore its mechanism, and to introduce the treatment measures.In modern sea conflict, the wounded soldiers may fall into sea. The wound may be injured by seawater heavily because seawater has special characteristics. It is significant to explore the influence factors of the seawater immersion to the wound healing, and to formulate the medical principle and treatment measures.Content There are three parts in our research.①Study of the influence on wound healing after seawater immersion;②Study on the mechanism of the influence on the delayed wound healing after seawater immersion;③Introduce the medical principle and treatment measures to the wound after seawater immersion.Methods By establishing the experimental model of skin wound and firearm wound with seawater immersion, we observed the process of wound healing, and by using the technique of pathology, biochemics, immunohistochemistry and molecular biology, we explored the mechanism of the influence of the seawater immersion on wound healing from almost all levels. We also studied the influence on the growth and function of fibroblasts after seawater immersion by cell culture. The therapeutic effects of rhEGF and rhbFGF on seawater immersion wound healing were observed too.Results1, The healing time of seawater immersion group sharply increased. Rabbits with wounds on back be immersed in the seawater for 20min, the wound healing time was 16.9±1.1d, and simple wound group was 12.4±0.9d; Rats with wounds on back be immersed in artificial seawater for 30min, the wound healing time was 14.3±0.8d, and simple wound group was 12.0±1.0d; Rats with firearm wounds on back be immersed in artificial sea water for 30min, the wound healing time was 17.7±1.3d, and simple firearm group was 15.8±0.6d.2, The temperature of the seawater immersion group decreased rapidly in the seawater. Rats be immersed in the seawater with 22℃for 30min, the temperature droped 10℃in average. 3, After seawater immersion, if the wound has be treated without disinfection, the amount of bacteria increased obviously after 12h of wounded. The mainly bacteria include E coli, Baumanii, Enterobacter cloacae and Vibrio vulnificus. E coli and Vibrio vulnificus also can be found in the blood of the wounded. The amout of endotoxin and white blood count also increased.4, The characteristics of pathological change after seawater immersion with the wound show that:①The inflammatory response in the early phase of wound healing was enhanced obviously, especially the numbers of infiltrated neutrophils, a lot of striated muscles were degenerated and necrosis;②The growth and mature of granulation tissue was slow in the early and middle phase of wound healing;③The formation of collagen and the hyperplasia of fibrous tissue delayed.5, The protein of bFGF, c-myc, PAR-1 and NF-κB expressed low in the early phase of wound healing in seawater immersion group. The studying of immunohistochemisty also has the same verification that PAR-1 and NF-κB expressed low. And in the seawater immersion group, the numbers of myofibroblast cells were no as many as the simple wound group in 3~7 days.6, Seawater immersion induced the increase of the apoptosis and necrosis of 3T3 cells in vitro cell culture, and which was relate to the immersion time. The transcript amount of FGFR increase greatly in the seawater immersion group, but the transcript amount of bFGF was very low when compared with simple control group.7, Topically applied the rhbFGF and rhEGF to the seawater immersion wound, the former healing time of the wound on the rabbits back was 13.5±1.1d, the latter was 15.6±1.1d;Conclusion1, The healing time of wound shall be obvious postponed after seawater immersion.2, The impaired factors of seawater to the wound healing were:①the normal environment of wound healing was changed because of the special characteristics of seawater;②there are a great number of bacteria in the sea, and it is easy for the wounded to be infected;③the temperature of seawater is low, which could cause the wounded low temperature.3, The impaired mechanism of seawater immersion to the delayed wound healing were:①the inflammatory response in the early phase of wound healing was enhanced obviously;②combined infection of land and marine bacteria often can be seen in the wound;③the proliferation of fibroblast and vascular endothelial cell can be inhibited;④the growth and mature of granulation tissue is slow in the early and middle phase of wound healing;⑤the formation of myofibroblast is few;⑥the amount of bFGF, c-myc, PAR-1and NF-κB expression was low in the early phase of wound healing may be the molecular mechanism of seawater immersion group;⑦seawater immersion can cause low temperatue, systemic infection, abnormal metabolism and low power of resistance.4, Introduce the medical principle and treatment measures for improving the healing of the seawater immersed wound. Medical principle and Treatment measures1, Salvage the wounded soldiers as soon as possible, which can avoid the durative drop of temperature. And take proper measures to resume the temperature of the wounded in time.2, The flesh wound shall be solved by washing or sterilizing.3, The wound should be practice the debridement, and ought to adopt"3C"methods (consistency, contraction, circulation) to removal the devitalized tissue.4, Antibiotic should be taken or injected to the wounded soldiers after seawater immersion.5, The rhbFGF can be used to improve the healing time of the seawater immersion wound.
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