颅脑爆炸伤致伤机制及防护研究进展

柳占立; 杜智博; 张家瑞; 严子铭; 栗志杰; 王鹏; 康越; 黄献聪; 马天; 费舟; 庄茁

doi:10.11883/bzycj-2021-0053

颅脑爆炸伤致伤机制及防护研究进展

doi: 10.11883/bzycj-2021-0053

柳占立^1,,
杜智博¹,
张家瑞¹,
严子铭¹,
栗志杰¹,
王鹏¹,
康越²,
黄献聪²,
马天²,
费舟³,
庄茁^1, ,

1.
清华大学航天航空学院，北京 100084
2.
军事科学院军需工程技术研究所，北京 100010
3.
空军军医大学西京医院，陕西西安 710032

详细信息

作者简介:
柳占立（1981－　），男，博士，副教授，liuzhanli@mail.tsinghua.edu.cn

通讯作者:
庄　茁（1952－　），男，博士，教授，博士生导师，zhuangz@tsinghua.edu.cn

中图分类号: O389
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- 被引次数: 0
出版历程
- 收稿日期: 2021-02-03
- 修回日期: 2021-12-20
- 网络出版日期: 2022-03-29
- 刊出日期: 2022-05-09

Progress in the mechanism and protection of blast-induced traumatic brain injury

1.
School of Aerospace Engineering, Tsinghua University, Beijing 100084, China
2.
Institute of Quartermaster Engineering and Technology, Academy of Military Sciences, Beijing 100010, China
3.
Xijing Hospital, Air Force Military Medical University, Xi’an 710032, Shaanxi, China

摘要

摘要: 颅脑爆炸伤是现代战争中士兵面临的主要伤害之一，近年来受到广泛关注。冲击波经由颅脑传播带来的直接伤害被称为初级爆炸伤。目前，初级颅脑爆炸伤致伤机制尚不明确，可能是应力波传播、颅骨弯曲变形、颅脑空化及躯干压缩等多种因素共同作用的结果。该研究是涉及多学科交叉、多物理场耦合及短时和长时效应共存的复杂问题，需要通过建立描述冲击波和颅脑相互作用的高精度、多尺度和多物理场数值模型，发展测量颅骨应变、颅内压力、加速度等力学指标的物理测试系统，结合人体和动物病理、生理、行为学等综合因素分析，最终揭示颅脑爆炸伤致伤机制。本文中介绍了初级颅脑爆炸伤致伤机制，给出了颅脑爆炸伤的行为学、生理学相关的医学评价指标，以及颅骨应变、颅内压力等关键力学评估指标，提出了基于致伤机制和评价指标的防护结构设计方法，包括基于新型防冲击波材料的头盔系统改进、头盔缓冲系统设计、增加头部保护系统的封闭性等，最后展望了在精细化建模、原位实验及防护系统设计等诸多方面的发展趋势。
- 颅脑爆炸伤 /
- 致伤机制 /
- 评价指标 /
- 防护结构设计 /
- 创伤后应激障碍
Abstract: Blast-induced traumatic brain injury (bTBI) is one of the major injuries sustained by soldiers in armed conflict, which has been widely concerned by domestic and overseas researchers in recent years. The brain injury caused by a direct interaction between the blast wave and the head is called primary bTBI. Currently, the injury mechanism of primary bTBI is still unclear. The primary bTBI may be the combined result of multi-factors, such as stress wave propagation, skull flexural deformation, cerebrospinal fluid cavitation, and trunk compression. Since it is a complex problem involving the interdisciplinary of medical and engineering, multi-physical field coupling, and coexistence of short-term and long-term effects, it is necessary to reveal the injury mechanism of bTBI by combining physical experiments, numerical simulations, and medical diagnosis. There are three strategies to investigate bTBI. One is to establish a high-precision and multi-physical-field numerical model to describe the interaction of the blast wave and the head. The second is to develop a surrogate head model to measure the skull strain, intracranial pressure, acceleration, and other mechanical quantities. The third is to analyze human and animal pathology and physiology. Comparing the results of these three strategies can reveal the injury mechanism of bTBI in medicine and mechanics. The research status and development in this field are introduced in this paper based on the authors’ previous research. The evaluation indexes of bTBI are summarized, including the medical indexes related to behavior and physiology and the critical mechanical indexes, such as skull strain, intracranial pressure, and local stress. Furthermore, the protective structure design based on the injury mechanism and the evaluation indexes is described, including the improvement of the helmet system based on new materials, the design of the helmet buffer system, the increase of the sealing of the head protection system, etc. To figure out the bTBI mechanism, more accurate measurement of the in-situ mechanical properties of the brain tissue, and high fidelity numerical and physical models are needed. For bTBI protection research, it needs to improve the biological matching degree and the accuracy of the experimental platform. Finally, three development trends of the bTBI research are pointed out, including the development of multi-scale head models, accurate measurement and verification of the injury indexes and threshold, comprehensive investigation of injury mechanism, evaluation, and protection.
- traumatic brain injury /
- injury mechanism /
- evaluation index /
- protection structure design /
- post-traumatic stress disorder

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1(a) 爆炸冲击波引起颅脑损伤^[9]

1(a). Traumatic brain injury caused by blast wave^[9]

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图 1(b) 爆炸冲击波载荷特点

Figure 1(b). Characteristics of blast loading

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图 2 颅骨弯曲变形过程^[31]

Figure 2. Flexural deformation process of the skull^[31]

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图 3 颅骨振动有限元模拟^[35]

Figure 3. Finite element simulation of the flexural deformation of the skull^[35]

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图 4 冲击波正面作用时颅脑压力云图与颅骨变形云图^[37]

Figure 4. Nephograms of the brain pressure and skull displacement caused by the frontal impact of the blast wave^[37]

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图 5 大脑椭球体模型的二维示意图^[43]

Figure 5. Two dimensional diagrams of the brain ellipsoid model^[43]

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图 6 直径457 mm的激波管示意图^[44]

Figure 6. The shock tube of 457 mm in diameter^[44]

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图 7 研究bTBI的多尺度数值模型^[51]

Figure 7. Multi-scale numerical model for bTBI study^[51]

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图 8 损伤分类

Figure 8. Damage classification

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图 9 人体头部及肺部冲击波超压耐受曲线^[60]

Figure 9. Shock wave overpressure tolerance curves of the human head and lungs^[60]

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图 10 高仿真头颈部模型主要传感器的布置（清华大学）^[62]

Figure 10. Sensor layout on the high-fidelity head and neck model (Tsinghua University)^[62]

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图 11 高仿真头颈部模型与激波管实验平台^[62]

Figure 11. High-fidelity head and neck model and shock tube experimental platform^[62]

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图 12 实爆实验布置情况^[63]

Figure 12. Layout of the explosion experiment^[63]

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图 13 头部压力监测位置^[63]

Figure 13. Head pressure monitoring positions^[63]

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图 14 爆炸性颅脑损伤（bTBI）模型的细节^[65]

Figure 14. Details of the model of explosive brain injury (bTBI)^[65]

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图 15 爆破实验装置^[66]

Figure 15. Blasting experimental device^[66]

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图 16 大鼠头部暴露的位置^[67]

Figure 16. Location of rat head exposed ^[67]

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图 17 不同头盔的防护效能^[78]

Figure 17. Protection effectiveness of different helmets^[78]

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图 18 头部矢状面和冠状面以及头盔构形^[80]

Figure 18. The vertical plane and coronal plane of the head, as well as the helmet configuration^[80]

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图 19 泡沫材料对矢状面和冠状面模型的影响^[80]

Figure 19. Influences of the foam material on the sagittal model and coronal plane model^[80]

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图 20 不同厚度泡沫垫的应力时程曲线^[81]

Figure 20. The time history of stress in the foam pads of different thicknesses^[81]

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图 21 不同性能泡沫垫中应力的时间历程^[81]

Figure 21. The time histories of stress in the foam pads with different properties^[81]

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图 22 排爆头盔模型^[82]

Figure 22. Explosive ordnance disposal helmet model^[82]

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图 23 全系统头部防护（头盔+眼部防护装置+下颚部防护装置）^[53]

Figure 23. Full system head protection (helmet + visor + mandibular shield)^[53]

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图 24 不同头部防护组合的效果对比^[53]

Figure 24. Comparison of the effects of different head protection combinations^[53]

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图 25 装备多层防护面罩头盔的仿真模型^[83]

Figure 25. Simulation model of helmet equipped with a multi-layer face shield^[83]

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图 26 面部结构防护效果对比^[83]

Figure 26. Comparison of the facial protective effects^[83]

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表 1 格拉斯哥昏迷评分

Table 1. Glasgow coma scale (GCS)

评分	眼睛状况	口头表达	动态行为
无法监测	例如：严重的眼外伤	例如：插管	例如：瘫痪
1	不睁眼	不能言语	刺痛下肢体不动
2	刺痛睁眼	只能发音	刺痛下有肢体伸直
3	呼唤睁眼	回答含糊不清	刺痛下有肢体屈曲
4	自动睁眼	回答有错误	刺痛下有躲避反应
5	−	回答正确	能定位刺痛位置
6	−	−	按吩咐动作

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表 2 致伤阈值相关性^[54]

Table 2. Correlation of the injury threshold^[54]

致伤阈值计算受伤区域与行为学损伤区域匹配相关度
标准	压力/Pa	Mises应力/Pa	等效应变	体积能量率/（J·s⁻¹）	剪切能量率/（J·s⁻¹）	轴突拉伸	轴突拉伸能量率/（J·s⁻¹）
灰质	56	39	56	56	72	−	−
白质	44	33	44	22	44	33	56

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表 3 bTBI常见医学指标^[71]

Table 3. Common medical indexes of bTBI^[71]

事件	机制	血清生物标志物
事件	机制	轻度创伤性脑损伤	中度创伤性脑损伤	严重创伤性脑损伤
神经元和神经胶质细胞死亡	激活触发坏死和/ 或凋亡的因子	神经元：NSE，Ctau，SBP，所有血影蛋白	神经元：NSE, PNF-H, NF-H, NMDAR, Hsp70, UCH-L1, C-tau, 所有血影蛋白, SBP，促泌素	神经元：NSE, PNF-H, NF-H，NMDAR, Hsp70, UCH-L1, C-tau, 所有血影蛋白, SBP, 促泌素
神经元和神经胶质细胞死亡	激活触发坏死和/ 或凋亡的因子	神经胶质：S100β， GFAP，MBP，C-tau	神经胶质： S100β, GFAP,MBP, NMDAR, Hsp70, IL-1β, L-6, L-8, TN-α，C-tau, AQP4	神经胶质: S100β, GFAP, MBP, NMDAR, Hsp70, IL-1β, IL-6, IL-8, TN-α, C-tau, AQP4
血管痉挛	血管收缩和松弛的失调	−	Hsp70, TNF-α, VEGF, Claudin-5, vWF	Hsp70, TNF-α, VEGF, Claudin-5, vWF
水肿	毒性和炎症因子引起的血管生成和细胞毒性事件	−	Hsp70, IL-1β, IL-6, IL-8, VEGF, Claudin-5, vWF, AQP4, MMP9	Hsp70, IL-1β, IL-6, IL-8, VEGF, Claudin-5, vWF, AQP4, MMP9
轴突损伤	机械损伤；神经元变性	S100β, NSE, C-tau, MBP, SBP, 所有血影蛋白	S100β, MBP, NSE, PNF-H, NMDAR, Hsp70, C-tau, 所有血影蛋白, SBP	S100β, MBP, NSE, PNF-H, NMDAR, Hsp70, C-tau, 所有血影蛋白, SBP
炎症	细胞因子释放与细胞应激	IL-1β, IL-6, IL-8, TNF-α, IFN -γ	Hsp70, IL-1β, IL-6, IL-8, TNF-α, IFN -γ	Hsp70, IL-1β, IL-6, IL-8, TNF-α, IFN -γ
代谢变化	缺氧；能量需求改变、离子稳态与神经传递；增加了修复过程	−	血浆铜蓝蛋白，HIF-1α	血浆铜蓝蛋白，HIF-1α

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