GRIBBLE M D
Br J Ind Med. 1960 Jul;17(3):181-6. doi: 10.1136/oem.17.3.181.
Decompression sickness is an illness which occurs in divers and caisson workers on return to normal atmospheric pressure after working at very high pressures, and in aiRMEN on reaching very low pressures at great altitude. The disease seen after exposure to high pressure is described and compared with that seen on exposure to great altitude. Mild cases show little difference, but serious ones vary sufficiently to justify division of the disease into two distinct syndromes, high-pressure and high-altitude decompression sickness. Both syndromes are caused by the formation of gas bubbles in the blood and body fluids when the tension of dissolved gases becomes sufficiently greater than that of the surrounding atmosphere. These bubbles are composed of a mixture of gases, but their formation is determined mainly by the degree of supersaturation with nitrogen. The diver must first absorb excess nitrogen on exposure to pressure, and it is the subsequent release of this excess on return to the surface which causes decompression sickness; since his stay at pressure is limited, bubbles arise mainly from tissues which can absorb the excess gas readily. In the airman, on the other hand, all tissues are completely saturated with nitrogen before he is exposed to low pressure, and bubbles may arise equally well from any tissue. Nitrogen is much more soluble in fat than in water, so that fatty tissues can form a large reservoir of dissolved nitrogen which may later form a source of bubbles; but the blood supply of fat is poor and nitrogen diffuses slowly through it, hence although the potential capacity of the fatty tissues for excess nitrogen is great, they can only absorb it slowly. Obesity is therefore a major hazard in high-altitude decompression sickness, but relatively unimportant in the high-pressure syndrome. Liability to the airman's sickness increases markedly with age, but the incidence of the diver's syndrome is affected both much less and later in life. Decompression also involves great changes in the working atmosphere, and the effects of these and their possible influence on decompression sickness are discussed.
减压病是一种发生在潜水员和沉箱工人身上的疾病，他们在高压环境下工作后返回正常大气压时会患病，而飞行员在高海拔地区到达极低气压时也会患病。本文描述了暴露于高压后出现的这种疾病，并将其与暴露于高海拔后出现的疾病进行了比较。轻症病例差异不大，但重症病例差异足够大，足以将该疾病分为两种不同的综合征，即高压性和高海拔性减压病。这两种综合征都是由于溶解气体的张力变得比周围大气的张力足够大时，血液和体液中形成气泡所致。这些气泡由多种气体混合而成，但其形成主要取决于氮气的过饱和程度。潜水员在暴露于压力下时必须首先吸收过量的氮气，而随后返回水面时这种过量氮气的释放会导致减压病；由于他在压力下停留的时间有限，气泡主要来自能够轻易吸收过量气体的组织。另一方面，对于飞行员来说，在暴露于低压之前，所有组织都已完全被氮气饱和，任何组织都可能同样容易地产生气泡。氮气在脂肪中的溶解度比在水中大得多，因此脂肪组织可以形成大量溶解氮的储存库，这些溶解氮随后可能成为气泡的来源；但是脂肪的血液供应很差，氮气在其中扩散缓慢，因此尽管脂肪组织吸收过量氮气的潜在能力很大，但它们只能缓慢地吸收。因此，肥胖是高海拔减压病的主要危险因素，但在高压综合征中相对不那么重要。飞行员患减压病的易感性随年龄显著增加，但潜水员综合征的发病率在生命后期受到的影响较小且较晚。减压还涉及工作环境的巨大变化，并讨论了这些变化的影响及其对减压病可能产生的影响。
