高度发育的卵圆孔未闭是休闲潜水员非诱发减压病的一个危险因素。

High-grade patent foramen ovale is a risk factor of unprovoked decompression sickness in recreational divers.

机构信息

Department of Cardiology, Charles University in Prague, 2nd Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Center for Advanced Preclinical Imaging, Charles University in Prague, First Faculty of Medicine, Prague, Czech Republic.

Center for Advanced Preclinical Imaging, Charles University in Prague, First Faculty of Medicine, Prague, Czech Republic; Department of Neurology, Charles University in Prague, 2nd Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Comprehensive Stroke Center, Military University Hospital, Prague, Czech Republic.

出版信息

J Cardiol. 2019 Dec;74(6):519-523. doi: 10.1016/j.jjcc.2019.04.014. Epub 2019 Jun 26.

DOI:10.1016/j.jjcc.2019.04.014

PMID:31255461

Abstract

BACKGROUND

Patent foramen ovale (PFO), male sex, age, and body mass index (BMI) were all identified as potential risk factors of decompression sickness (DCS). It has been debated whether PFO might cause unprovoked DCS (i.e. without violation of decompression procedure) due to paradoxical embolization of venous gas emboli. To date, there are no data on the incidence or risk factors of unprovoked DCS. This study sought to evaluate the risk factors of unprovoked DCS in recreational divers.

METHODS

A total of 489 consecutive divers were screened for PFO between January 2006 and January 2014 by means of transcranial Doppler. All patients were prospectively included in the study registry. Survival analysis techniques were used to assess for risk factors for unprovoked DCS. Age, sex, BMI, PFO presence, and grade were analyzed. The total sum of dives was used as a measure of time.

RESULTS

The group performed a total of 169,411 dives (mean 346±636). Thirty-six (7%) of the divers suffered from an unprovoked DCS. The frequency of PFO was 97.2% in divers with a history of unprovoked DCS and 35.5% in controls (p<0.001). There was no difference in sex, age, BMI, or total number of dives between the respective groups. In the adjusted Cox proportional hazards model, PFO grade 3 was a major risk factor for unprovoked DCS; there was a slight protective effect of increasing age.

CONCLUSIONS

We demonstrated that a high-grade PFO was a major risk factor for unprovoked DCS in recreational scuba divers.

摘要

背景

卵圆孔未闭（PFO）、男性、年龄和体重指数（BMI）均被认为是减压病（DCS）的潜在危险因素。有人争论说，由于静脉气体栓子的反常栓塞，PFO 可能导致自发性 DCS（即没有违反减压程序）。迄今为止，尚无关于自发性 DCS 的发病率或危险因素的数据。本研究旨在评估休闲潜水员自发性 DCS 的危险因素。

方法

2006 年 1 月至 2014 年 1 月期间，通过经颅多普勒对 489 名连续潜水员进行了 PFO 筛查。所有患者均前瞻性纳入研究登记册。采用生存分析技术评估自发性 DCS 的危险因素。分析年龄、性别、BMI、PFO 存在和等级。潜水总次数作为时间的度量。

结果

该组共进行了 169411 次潜水（平均 346±636）。36 名（7%）潜水员发生自发性 DCS。有自发性 DCS 病史的潜水员的 PFO 发生率为 97.2%，对照组为 35.5%（p<0.001）。两组之间的性别、年龄、BMI 或总潜水次数无差异。在调整后的 Cox 比例风险模型中，PFO 3 级是自发性 DCS 的主要危险因素；年龄的增加有轻微的保护作用。