Mitchell Simon J, Bove Alfred A
Department of Anesthesiology, University of Auckland, Auckland, New Zealand.
Undersea Hyperb Med. 2011 Jul-Aug;38(4):289-96.
Cardiac events are responsible for a significant proportion of recreational diving fatalities. It seems inescapable that our current systems for selecting suitable recreational diver candidates and for longitudinal monitoring of diver health are failing to exclude some divers at high risk of cardiac events. Based on review of practice in parallel sporting disciplines and of the relevant literature, a series of recommendations for screening questions, identification of disqualifying conditions and risk factors, and investigation of candidates with risk factors was drafted. Recommendations for ongoing health monitoring in established divers were also generated. These recommendations were promulgated and debated among experts at a dedicated session of the Divers Alert Network Fatality Workshop. As a result, we propose a modified list of screening questions for cardiovascular disease that can be incorporated into health questionnaires administered prior to diver training. This list is confluent with the American Heart Association (AHA) preparticipation screen for athletes. The exercise stress test unmasks inducible cardiac ischemia and quantifies exercise capacity, and remains the tool of choice for evaluating diver candidates or divers with risk factors for coronary disease. An exercise capacity that allows for sustained exercise at a 6-MET intensity (possibly representing a peak capacity of 11-12 METS) is an appropriate goal for recreational divers.
心脏事件在休闲潜水死亡事故中占很大比例。我们目前用于挑选合适的休闲潜水员候选人以及对潜水员健康进行长期监测的系统似乎不可避免地未能排除一些有心脏事件高风险的潜水员。基于对相关体育项目实践及相关文献的回顾，起草了一系列关于筛查问题、确定不合格状况和风险因素以及对有风险因素的候选人进行调查的建议。还提出了针对已获认证潜水员进行持续健康监测的建议。这些建议在潜水员警报网络死亡事故研讨会的专门会议上由专家们公布并进行了讨论。因此，我们提出了一份经修改的心血管疾病筛查问题清单，可纳入潜水员培训前使用的健康调查问卷中。这份清单与美国心脏协会（AHA）针对运动员的赛前筛查标准一致。运动应激试验可揭示潜在的心肌缺血并量化运动能力，仍然是评估潜水员候选人或有冠心病风险因素的潜水员的首选工具。对于休闲潜水员来说，能够以6代谢当量强度持续运动（可能代表峰值能力为11 - 12代谢当量）的运动能力是一个合适的目标。
