Adir Yochai, Shupak Avi, Gil Amnon, Peled Nir, Keynan Yoav, Domachevsky Liran, Weiler-Ravell Daniel
IDF Medical Corps, Israel Naval Medical Institute, Haifa.
Chest. 2004 Aug;126(2):394-9. doi: 10.1378/chest.126.2.394.
Acute pulmonary edema has been noted in swimmers and divers, and has been termed swimming-induced pulmonary edema (SIPE). The mechanisms and consequences of SIPE are unknown, and there are currently no series of carefully evaluated patients with this condition. Herein we report the clinical presentation, incidence of recurrence, findings on physical examination, chest radiography, and oxygen saturation in 70 trainees with a diagnosis of SIPE. We also report the results of forced spirometry in a subgroup of 37 swimmers.
SIPE was diagnosed when severe shortness of breath and cough were reported during or after swimming, and were associated with evidence of pulmonary edema. During the years from 1998 to 2001, 70 cases of SIPE were documented in young healthy male subjects participating in a fitness-training program. Physical examination and pulse oximetry were performed immediately. Chest radiographs were obtained in all cases 12 to 18 h following onset of symptoms. In 37 swimmers, spirometry was performed at the time of chest radiography and again after 7 days.
All subjects complained of severe shortness of breath. Sixty-seven of the 70 subjects (95.7%) had a prominent cough; in 63 subjects (90%), there was significant sputum production. Hemoptysis was observed in 39 subjects (55.7%). Mean arterial oxygen saturation after swimming was 88.4 +/- 6.6% breathing air, compared with 98 +/- 1.7% breathing air at rest before the start of the swimming trial (mean +/- SD) [p < 0.001]. Chest radiographs obtained 12 to 18 h after swimming were normal in all cases. Sixteen trainees (22.9%) had a recurrence of SIPE. Spirometry demonstrated restrictive lung function, which persisted for a week.
In our trainee population, SIPE is a not uncommon, often recurrent phenomenon that significantly influences performance. It is not clear what predisposes to its occurrence or recurrence and what, if any, are its long-term effects.
游泳者和潜水员中曾发现急性肺水肿，被称为游泳诱发的肺水肿（SIPE）。SIPE的发病机制和后果尚不清楚，目前也没有对患有这种疾病的患者进行过一系列仔细评估的报道。在此，我们报告70例诊断为SIPE的受训者的临床表现、复发率、体格检查结果、胸部X线检查结果及血氧饱和度。我们还报告了37名游泳者亚组的用力肺活量检测结果。
当在游泳期间或之后报告有严重呼吸急促和咳嗽，并伴有肺水肿证据时，诊断为SIPE。在1998年至2001年期间，记录了70例参与健身训练项目的年轻健康男性受试者的SIPE病例。立即进行体格检查和脉搏血氧饱和度测定。所有病例在症状出现后12至18小时进行胸部X线检查。37名游泳者在胸部X线检查时及7天后再次进行肺活量测定。
所有受试者均主诉有严重呼吸急促。70名受试者中有67名（95.7%）有明显咳嗽；63名受试者（90%）有大量痰液产生。39名受试者（55.7%）观察到咯血。游泳后呼吸空气时的平均动脉血氧饱和度为88.4±6.6%，而在游泳试验开始前休息时呼吸空气时为98±1.7%（平均值±标准差）[p<0.001]。游泳后12至18小时进行的胸部X线检查在所有病例中均正常。16名受训者（22.9%）出现SIPE复发。肺活量测定显示肺功能受限，这种情况持续了一周。
在我们的受训者群体中，SIPE是一种并不罕见且常复发的现象，会显著影响运动表现。目前尚不清楚其发生或复发的诱因是什么，以及它是否有长期影响（如果有，是什么影响）。
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