摘要目的 观察实验兔眼眼球爆裂伤后暴露于海水所引起的角膜超微结构改变,探讨爆裂伤合并海水浸泡眼球的抢救最佳时间.方法 24只健康成年新西兰白兔,用鞭炮爆炸方法造成眼球爆裂伤,各兔右眼浸泡于无菌海水中,左眼暴露空气中作对照,经10 min、0.5h、1h、2h、4h、8h后取出裂伤伤口处角膜,每时间组4只眼球用透射电子显微镜观察其超微形态学变化,以判断角膜各层组织的活性.结果 海水浸泡0.5h,角膜上皮细胞发生脱水、坏死、脱落,角膜内皮细胞脱落;海水浸泡1h,角膜基质细胞出现胞质内空泡、细胞脱水、皱缩,角膜后弹力层脱失;而空气对照组在伤后2～4h、甚至更长时间发生上述超微结构改变.结论 兔眼眼球爆裂伤后暴露于海水中的角膜组织超微结构损伤较单纯暴露于空气中者发生早且组织损伤亦重,海水浸泡1h后角膜的病理改变即为不可逆转.发生海战时,对海水浸泡眼球裂伤,最好在0.5h之内进行角膜裂伤的清创缝合,超过1h,则意义不大.

abstractsObjective To observe the ultrastructural changes of the cornea with open globe laceration and immersed in the seawater.To find out the optimal treatment time for this injury.Methods 24 healthy adult New Zealand white rabbits were induced the open globe laceration by firecrackers explosion.The right eyeballs were immersed into the seawater immediately after the injury as the experimental group and the left ones were exposed to the air after the injury as the control group.The corneas were taken out at 10 min,0.5 h,1 h,2 h,4 h,8 h after the injury,and then the ultrastructure were observed by transmission electron microscopy and the activities of the corneas were evaluated.Results In the 0.5 h seawater immersion group,the corneal epithelial cells dehydrated,necrosed and ablated.The corneal endothelia ablated; In the 1 h seawater immersion group,the corneal stromal cells intra-cytoplasm vacuolated,dehydrated and shrunk and the corneal lamina elastica posterior ablated; However those ultrastructural changes appeared at the 2 ～ 4 h or even longer time in the control group.Conclusion The ultrastructural injuries of eyeballs appeared earlier and severer in the seawater immersion group than those exposed to the air.The pathological changes are irreversible at 1 h after the injuried eyeballs were immersed in the seawater.It is suggested that the bursted and seawater-immersed eyeball should be debrided and sutured at 0.5 h after the injury.