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职业性减压病:一例报告。

Occupational decompression sickness: A case report.

作者信息

Diederich Taylor, Briggs Allyson M, Malik Adrienne, Beaver Bryan

机构信息

Department of Emergency Medicine University of Kansas Medical Center, University of Kansas Health System Kansas City Kansas USA.

出版信息

J Am Coll Emerg Physicians Open. 2024 Mar 18;5(2):e13144. doi: 10.1002/emp2.13144. eCollection 2024 Apr.

DOI:10.1002/emp2.13144
PMID:38504776
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10948946/
Abstract

Decompression sickness describes the clinical pathology that ensues when rapid decompression from a highly pressurized environment causes the formation of venous and extravascular inert gas bubbles. Symptoms vary widely, commonly including arthralgias, myalgias, paresthesias, and numbness. Severe and potentially life-threatening pathology, such as neurologic impairment, cardiopulmonary instability, and gastrointestinal hemorrhage, can occur as well. Most think of diving endeavors as a common exposure predisposing to this condition, commonly referred to as "the bends." Other occupational exposures documented in the medical literature include military training, caisson work, such as in mining and bridge construction, and hyperbaric treatment attendance. This article presents the case of a 32-year-old male presenting with a mottled rash, arthralgias, myalgias, headache, vision changes, and weakness, which is found to have decompression sickness secondary to occupational exposure in a factory-based pressurized chamber. The patient underwent two hyperbaric chamber sessions with complete resolution of his symptoms. During hospitalization, he was found to have a patent foramen ovale. The patient was counseled to avoid further occupational exposure.

摘要

减压病描述的是当从高压环境快速减压导致静脉和血管外惰性气泡形成时所产生的临床病理情况。症状差异很大,常见的包括关节痛、肌痛、感觉异常和麻木。严重且可能危及生命的病理情况,如神经功能损害、心肺功能不稳定和胃肠道出血,也可能发生。大多数人认为潜水活动是导致这种情况的常见诱因,通常称为“减压病”。医学文献中记录的其他职业暴露包括军事训练、沉箱作业,如采矿和桥梁建设中的沉箱作业,以及高压治疗参与。本文介绍了一名32岁男性的病例,该患者出现了斑驳皮疹、关节痛、肌痛、头痛、视力变化和虚弱症状,经诊断为因在工厂的加压舱中职业暴露继发的减压病。该患者接受了两次高压舱治疗,症状完全缓解。住院期间,发现他有卵圆孔未闭。建议该患者避免进一步的职业暴露。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f5d1/10948946/92a408c28a21/EMP2-5-e13144-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f5d1/10948946/3883d1778414/EMP2-5-e13144-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f5d1/10948946/92a408c28a21/EMP2-5-e13144-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f5d1/10948946/3883d1778414/EMP2-5-e13144-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f5d1/10948946/92a408c28a21/EMP2-5-e13144-g001.jpg

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引用本文的文献

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Recurrent cutaneous decompression sickness in a hyperbaric chamber attendant with a large persistent foramen ovale.一名伴有大型持续性卵圆孔未闭的高压氧舱工作人员反复发生皮肤减压病。
Diving Hyperb Med. 2024 Dec 20;54(4):354-359. doi: 10.28920/dhm54.4.354-359.

本文引用的文献

1
Decompression Illness in Divers With or Without Patent Foramen Ovale : A Cohort Study.潜水员中有或无卵圆孔未闭时减压病:一项队列研究。
Ann Intern Med. 2023 Jul;176(7):934-939. doi: 10.7326/M23-0260. Epub 2023 Jul 11.
2
Decompression Sickness and Arterial Gas Embolism.减压病与动脉气体栓塞
N Engl J Med. 2022 Mar 31;386(13):1254-1264. doi: 10.1056/NEJMra2116554.
3
Discovery of caisson disease: a dive into the history of decompression sickness.沉箱病的发现:深入探究减压病的历史。
Proc (Bayl Univ Med Cent). 2021 Sep 1;35(1):129-132. doi: 10.1080/08998280.2021.1967021. eCollection 2022.
4
Livedo Racemosa - The Pathophysiology of Decompression-Associated Cutis Marmorata and Right/Left Shunt.网状青斑 - 减压相关大理石样皮肤及右/左分流的病理生理学
Front Physiol. 2020 Sep 3;11:994. doi: 10.3389/fphys.2020.00994. eCollection 2020.
5
DCS or DCI? The difference and why it matters.弥漫性脑肿胀还是弥漫性脑缺血?差异及重要性所在。
Diving Hyperb Med. 2019 Sep 30;49(3):152-153. doi: 10.28920/dhm49.3.152-153.
6
High-grade patent foramen ovale is a risk factor of unprovoked decompression sickness in recreational divers.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。
J Cardiol. 2019 Dec;74(6):519-523. doi: 10.1016/j.jjcc.2019.04.014. Epub 2019 Jun 26.
7
Diving patterns and decompression sickness among South Korean fishery divers.韩国渔业潜水员的潜水模式和减压病。
J Occup Health. 2019 Jan;61(1):143-153. doi: 10.1002/1348-9585.12035.
8
Health effects of hyperbaric exposure on chamber attendants: a literature review.
Int Marit Health. 2018;69(1):58-62. doi: 10.5603/IMH.2018.0009.
9
The key role of differential diagnosis in diagnosis.
Diagnosis (Berl). 2017 Nov 27;4(4):239-240. doi: 10.1515/dx-2017-0005.
10
Underwater and hyperbaric medicine as a branch of occupational and environmental medicine.水下与高压医学作为职业与环境医学的一个分支。
Ann Occup Environ Med. 2013 Dec 19;25(1):39. doi: 10.1186/2052-4374-25-39.