Department of Physiology and Pharmacology, Karolinska Institutet, Nanna Svartz väg 2, 17177 Stockholm, Sweden.
Eur J Appl Physiol. 2013 Mar;113(3):803-10. doi: 10.1007/s00421-012-2494-6. Epub 2012 Sep 15.
Breath-hold divers report transient, severe neurological symptoms that could be caused by arterial gas embolism after glossopharyngeal insufflation. This technique is often used to overinflate the lungs and stretch the chest prior to breath-holding and can increase the transpulmonary pressure to around 7-8 kPa, so introducing risk of pulmonary barotrauma. Airway pressure, blood pressure and static spirometry (nitrogen dilution) were measured simultaneously in ten subjects attempting to identify individuals at risk. Compared to baseline, total lung capacity (TLC) after glossopharyngeal insufflation increased by 19 % along with increased vital capacity (23 %) and residual volume (6 %) (P < 0.05), while mean relaxed airway pressure (P (aw)) at TLC increased from 3.62 ± 0.93 to 7.26 ± 2.04 kPa as a result of performing glossopharyngeal insufflation (P = 0.0001). Blood pressure fell during glossopharyngeal insufflation and attained relaxed airway pressure correlated positively to baseline mean arterial pressure in the subjects. Two of the subjects had glossopharyngeal insufflation-related accidents before the study and two subjects (with the highest P (aw) during GI; 9 and 10.3 kPa respectively) suffered glossopharyngeal insufflation-related accidents within 6 months after our study, with one suffering a non-fatal drowning accident. The principal finding of this study was that some subjects were able to use GI to reach P (aw) high enough to suggest a risk of pulmonary barotrauma, while other subjects would lose consciousness due to hypotension while still within safe limits of pulmonary pressure. This mechanism could offer an alternative explanation to drowning in breath-hold divers, and indicates that glossopharyngeal insufflation should be avoided or done with extreme caution.
闭气潜水员报告短暂而严重的神经系统症状，这可能是由于在咽鼓管充气后发生动脉气体栓塞引起的。该技术通常用于在闭气前过度充气肺部和拉伸胸部，可将跨肺压增加到约 7-8 kPa，从而增加肺气压伤的风险。在十名尝试识别有风险个体的受试者中，同时测量了气道压力、血压和静态肺量计（氮气稀释法）。与基线相比，咽鼓管充气后总肺容量（TLC）增加了 19%，同时肺活量（23%）和残气量（6%）增加（P<0.05），而在 TLC 时的平均放松气道压力（P(aw)）由于进行咽鼓管充气而从 3.62±0.93kPa 增加到 7.26±2.04kPa（P=0.0001）。在咽鼓管充气期间血压下降，放松气道压力与受试者的基线平均动脉压呈正相关。在研究之前，有两名受试者发生了与咽鼓管充气相关的事故，两名受试者（在 GI 期间 P(aw)最高；分别为 9 和 10.3kPa）在我们的研究后 6 个月内发生了与咽鼓管充气相关的事故，其中一名遭受了非致命性溺水事故。本研究的主要发现是，一些受试者能够使用 GI 达到足以提示肺气压伤风险的 P(aw)，而其他受试者在血压下降的情况下仍然处于肺压安全范围内而失去意识。该机制可能为闭气潜水员溺水提供另一种解释，并表明应避免或极其谨慎地进行咽鼓管充气。
