Laboratory of Environmental and Occupational (Integrative) Physiology, Haute Ecole Bruxelles-Brabant, Auderghem, Brussels, Belgium.
Division of Research, Divers Alert Network Europe, Gharghur, Malta.
Minerva Anestesiol. 2019 Oct;85(10):1129-1137. doi: 10.23736/S0375-9393.19.13618-8. Epub 2019 Jun 20.
Our understanding of decompression physiopathology has slowly improved during this last decade and some uncertainties have disappeared. A better understanding of anatomy and functional aspects of patent foramen ovale (PFO) have slowly resulted in a more liberal approach toward the medical fitness to dive for those bearing a PFO. Circulating vascular gas emboli (VGE) are considered the key actors in development of decompression sickness and can be considered as markers of decompression stress indicating induction of pathophysiological processes not necessarily leading to occurrence of disease symptoms. During the last decade, it has appeared possible to influence post-dive VGE by a so-called "preconditioning" as a pre-dive denitrogenation, exercise or some pharmacological agents. In the text we have deeply examined all the scientific evidence about this complicated but challenging theme. Finally, the role of the "normobaric oxygen paradox" has been clarified and it is not surprising that it could be involved in neuroprotection and cardioprotection. However, the best level of inspired oxygen and the exact time frame to achieve optimal effect is still not known. The aim of this paper was to reflect upon the most actual uncertainties and distil out of them a coherent, balanced advice towards the researchers involved in gas-bubbles-related pathologies.
在过去的十年中，我们对减压病理生理学的理解逐渐提高，一些不确定性已经消失。对卵圆孔未闭 (PFO) 的解剖和功能方面有了更好的理解，导致对那些患有 PFO 的人潜水医学适应性的态度变得更加宽松。循环血管气体栓塞 (VGE) 被认为是减压病发展的关键因素，并且可以被认为是减压应激的标志物，表明诱导了病理生理过程，不一定导致疾病症状的发生。在过去的十年中，似乎可以通过所谓的“预处理”来影响潜水后的 VGE，例如潜水前的脱氮、运动或一些药物。在本文中，我们深入研究了关于这个复杂但具有挑战性的主题的所有科学证据。最后，阐明了“常压氧悖论”的作用，它可能参与神经保护和心脏保护并不奇怪。然而，吸入氧气的最佳水平和达到最佳效果的确切时间框架仍不清楚。本文的目的是反思最当前的不确定性，并从中提炼出一套连贯、平衡的建议，供从事与气泡相关病理的研究人员参考。
