比较猪模型中神经减压病治疗再压缩表。

Comparison of treatment recompression tables for neurologic decompression illness in swine model.

机构信息

Naval Medical Research Center, Bethesda, Maryland, United States of America.

Henry M. Jackson Foundation, Bethesda, Maryland, United States of America.

出版信息

PLoS One. 2022 Oct 5;17(10):e0266236. doi: 10.1371/journal.pone.0266236. eCollection 2022.

DOI:10.1371/journal.pone.0266236

PMID:36197931

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9534405/

Abstract

BACKGROUND

Significant reductions in ambient pressure subject an individual to risk of decompression illness (DCI); with incidence up to 35 per 10,000 dives. In severe cases, the central nervous system is often compromised (>80%), making DCI among the most morbid of diving related injuries. While hyperbaric specialists suggest initiating recompression therapy with either a Treatment Table 6 (TT6) or 6A (TT6A), the optimal initial recompression treatment for severe DCI is unknown.

METHODS

Swine were exposed to an insult dive breathing air at 7.06 ATA (715.35 kPa) for 24 min followed by rapid decompression at a rate of 1.82 ATA/min (184.41 kPa/min). Swine that developed neurologic DCI within 1 hour of surfacing were block randomized to one of four United States Navy Treatment Tables (USN TT): TT6, TT6A-air (21% oxygen, 79% nitrogen), TT6A-nitrox (50% oxygen, 50% nitrogen), and TT6A-heliox (50% oxygen, 50% helium). The primary outcome was the mean number of spinal cord lesions, which was analyzed following cord harvest 24 hours after successful recompression treatment. Secondary outcomes included spinal cord lesion incidence and gross neurologic outcomes based on a pre- and post- modified Tarlov assessment. We compared outcomes among these four groups and between the two treatment profiles (i.e. TT6 and TT6A).

RESULTS

One-hundred and forty-one swine underwent the insult dive, with 61 swine meeting inclusion criteria (43%). We found no differences in baseline characteristics among the groups. We found no significant differences in functional neurologic outcomes (p = 0.77 and 0.33), spinal cord lesion incidence (p = 0.09 and 0.07), or spinal cord lesion area (p = 0.51 and 0.17) among the four treatment groups or between the two treatment profiles, respectively. While the trends were not statistically significant, animals treated with TT6 had the lowest rates of functional deficits and the fewest spinal cord lesions. Moreover, across all animals, functional neurologic deficit had strong correlation with lesion area pathology (Logistic Regression, p < 0.01, Somers' D = 0.74).

CONCLUSIONS

TT6 performed as well as the other treatment tables and is the least resource intensive. TT6 is the most appropriate initial treatment for neurologic DCI in swine, among the tables that we compared.

摘要

背景

环境压力的显著降低会使个体面临减压病（DCI）的风险；发病率高达每 10000 次潜水 35 次。在严重的情况下，中枢神经系统经常受到损害（>80%），使 DCI 成为潜水相关伤害中最严重的疾病之一。虽然高压专家建议使用治疗表 6（TT6）或 6A（TT6A）开始重新压缩治疗，但严重 DCI 的最佳初始重新压缩治疗尚不清楚。

方法

猪暴露于 7.06ATA（715.35kPa）的冲击潜水，呼吸空气 24 分钟，然后以 1.82ATA/min（184.41kPa/min）的速度快速减压。在浮出水面后 1 小时内出现神经减压病的猪被随机分为以下四组美国海军治疗表（USN TT）之一：TT6、TT6A-空气（21%氧气，79%氮气）、TT6A-氮氧混合气（50%氧气，50%氮气）和 TT6A-氦氧混合气（50%氧气，50%氦气）。主要结局是脊髓病变的平均数量，在成功重新压缩治疗后 24 小时采集脊髓后进行分析。次要结局包括根据改良 Tarlov 评估进行的脊髓病变发生率和大体神经学结局。我们比较了这四组之间以及两种治疗方案（即 TT6 和 TT6A）之间的结果。

结果

141 头猪进行了冲击潜水，其中 61 头符合纳入标准（43%）。我们发现各组之间的基线特征没有差异。我们发现，在功能神经学结果（p=0.77 和 0.33）、脊髓病变发生率（p=0.09 和 0.07）或脊髓病变面积（p=0.51 和 0.17）方面，四种治疗组之间或两种治疗方案之间均无显著差异。尽管趋势没有统计学意义，但接受 TT6 治疗的动物功能缺陷发生率最低，脊髓病变最少。此外，在所有动物中，功能神经学缺陷与病变区病理学有很强的相关性（逻辑回归，p<0.01，Somers'D=0.74）。