Influence of vagal injury on acute traumatic reaction after blast injury
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ORIGINAL ARTICLE
Influence of vagal injury on acute traumatic reaction after blast injury Y. Wang • L. Pan • W. Fan • Z. Zhou L. Zhu • Y. Wang • R. Hu
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Received: 7 December 2012 / Accepted: 12 March 2013 / Published online: 3 April 2013 Ó Springer-Verlag Berlin Heidelberg 2013
Abstract Introduction A prospectively randomised, controlled animal study was conducted to analyse the influence of vagal injury on acute cardio-respiratory responses to blast injury. Materials and methods We used a previously described model of blast-fragment combined injuries to divide dogs randomly into three groups: normal control, blast injury with fragment shot at the masseter and blast injury with fragment shot at the neck. The vagal histomorphologic changes were investigated by haematoxylin–eosin staining and immunocytochemical analysis of neuron-specific enolase and glial fibrillary acidic protein. The indices of respiration, heart rate, blood pressure and body temperature were recorded continuously before and after blast exposure. Results The vagal injury was more severe in the neckinjured than in the face-injured group. However, bradycardia, hypotension and absence of compensatory peripheral vasoconstriction, which are typically seen in animals subjected to blast injury without vagal nerve injuries, were partly inhibited when the vagal nerve was injured. Conclusion A vagally mediated reflex, such as a cardiorespiratory system defensive reflex that caused shock, was observed immediately after blast pressure wave injury. These observations may have important implications for the emergency management of blast injury cases. Y. Wang W. Fan Z. Zhou L. Zhu Y. Wang R. Hu (&) Institute of Stomatology, Stomatology School & Hospital, Wenzhou Medical College, Wenzhou 325027, China e-mail: [email protected] L. Pan School of Laboratory Medicine and Life Science, Wenzhou Medical College, Wenzhou 325035, China
Keywords Vagal injury Vagal reflex Blast injury Breathing rate Heart rate Blood pressure and body temperature Traumatic shock NSE GFAP
Introduction Improved armour and battlefield medicines have increased the survival and prevented the frequency of craniomaxillofacial and neck injuries of soldiers in the wars in Iraq and Afghanistan [1]. Modern combats are characterised by blast injuries and result in higher incidences of injury to the craniomaxillofacial and neck regions [2]. Vagal nerve trauma could often result from skull base surgeries, leading to many serious complications, such as dysphasia [3], acute traumatic haemorrhagic shock [4], gastric injury [4, 5], bradycardia [6] and arrhythmia [5]. Blast-induced neurotraumas, especially vagal injury, are usually vital in head and neck explosive wounds [7]. The incidence of traumatic shock, a lifethreatening complication, is high in primary blasts [8]. Previous studies have indicated that a vagally mediated reflex has a significant role in traumatic shock [7, 9]. The vagus nerve can inhibit detrimental immune responses that contribute to organ damage in haemorrhagic
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