| Objective: In modern war at sea and landing battle, the naval vessel and landing force were often attacked by missiles, bombs, etc. Projectile-burn combined wound would become much more common than before. The wounded person may be immersed in the hyperosmotic, basic and cold seawater containing marine bacteria. Studying on the features of seawater immersion after projectile-burn combined wound would help to improve the early resuscitative effect.Methods:The models of seawater immersion after projectile-burn combined wound were developed in local dogs combined with 10% II ?burn injury and high-velocity projectile wound on their right hind limb before immersion in seawater for 4 hours. (1) The dogs with projectile-burn combined wound were randomly assigned to three groups: immersion group, resuscitation I group and resuscitation n group.(2)In immersion group, the dogs were immersed in seawater for 4 hours, keeping the head and front limbs out of water, then were taken out from seawater and dried with warm wind. Changes of hemodynamic . hemorrheologux acid-base balance . electrolyte balance . osmotic pressure and blood-gas analysis were monitored before and 4. 7. 10. 20. 28h after wound. The morphologic changes in hearu lung> liver and kidney tissue were observed after the experiment was finished. (2) The dogs of seawater immersion after projectile-burn combined wound with resuscitation I(Resuscitation with Parkland Formula) and resuscitation n(Improved Protocol).Resuscitation was performed promptly after the dog's being taken out from water, respectively by means of Parkland formula (lactated Ringer's solution 4 ml/kg/%burn for 24 hours) and the improved protocol (lactated Ringer's solution 2.5 ml/kg/%burn plus colloid solution 6% hetastarch 0.5 ml/kg/'%burn for 24 hours, redressing acidosis powerfully, using antibiotic early). The record time points and parameters were the same as those of immersion group.Results: The mortality in immersion group are 50%.Hypothermia, severe metabolic acidosis, hypernatremia, hyperchloremia and hyperosmolality were found in immersion group.And blood viscosity, erythrocyte rigidity and aggregation became worse after immersion. Bacteriemia was discovered at early stage in immersion group.After resuscitation with Parkland formula, the mortality was significantly decreased, and hypernatremia -. hyperchloremia and hyperosmolality were effectively restored, and the production of urine was generously increased, but metabolic acidosis were not effectively restored. CVP and the amount of urine is larger than normal in early period of experiment. Hemodynamics aggravate again during later period of experiment. Nevertheless, the resuscitation with improved protocol not only decreased the mortality and the shock rate, increase the mean artery pressure (MAP), cardiac index (CI), stroke volum index (SVI) significantly, but also decreased blood viscosity, erythrocyte distortion index (DI), effectively restored metabolic acidosis and hyperosmolality, reduced the infection rate.Conclusions: (1) The experimental models of seawater immersion after projectile-burn combined wound had been successfully developed. (2) The results suggested that seawater immersion after projectile-burn combined wound would aggravate the injury, and have great mortality, so all of the projectile-burn combined wounds with seawater immersion for more than 4 hours should be considered to be heavy injury, and given the first aid. (3) The post-trauma mortality of seawater immersion after projectile-burn combined wound was the highest within the first 10-16 hours after injury, this period within lOhours after injury should be regarded as the golden resuscitation time. (4) Seawater immersion after projectile-burn combined wound would cause severe homodynamic changes, allo-microcirculation, circulation related anoxia, metabolic acidosis, hypernatremia, hyperchloremia and hyperosmolality, and its injuries obviously have subsequent effect. (5) Redressing acidosis powerfully and using antibioltic early would be much more nece...
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