Sowden L M, Kindwall E P, Francis T J
Institute of Naval Medicine, Hants, UK.
Aviat Space Environ Med. 1996 Jan;67(1):74-80.
For many years there has been a widely held but largely unsubstantiated belief that pain in the upper limb in decompression sickness (DCS) is associated with bounce diving, whereas compressed air workers, saturation divers and high altitude aviators are more susceptible to involvement of the lower limbs.
The hypothesis of counter current exchange of inert gas, modulated by changes in tissue temperature, has been evaluated as a possible mechanism to explain the reported distribution of limb pain in DCS.
An extensive review of over 19,000 cases of limb pain decompression illness has been undertaken from case reports stored in the diving accident database at the Institute of Naval Medicine, in the published literature, and from unpublished clinical and experimental reports.
There was a predominance of upper limb involvement in bounce divers and, in contrast to traditional teaching, in aviators. By contrast, the lower limbs were more commonly involved in compressed air workers and saturation divers.
Each of the occupational exposures has been discussed individually with reference to counter-current exchange and other factors as potential influences on the distribution of disease. We conclude that counter-current exchange of inert gas may be implicated in the distribution of limb pain in DCS.
多年来，人们普遍认为减压病（DCS）中的上肢疼痛与反复潜水有关，但这一观点在很大程度上未经证实，而压缩空气作业工人、饱和潜水员和高空飞行员更容易出现下肢受累。
惰性气体逆流交换的假说，受组织温度变化调节，已被评估为一种可能的机制，以解释DCS中报道的肢体疼痛分布情况。
对存储在海军医学研究所潜水事故数据库中的病例报告、已发表文献以及未发表的临床和实验报告中的19000多例肢体疼痛减压病病例进行了广泛回顾。
反复潜水者以及与传统观点相反的飞行员中，上肢受累占主导。相比之下，压缩空气作业工人和饱和潜水员下肢受累更为常见。
已分别讨论了每种职业暴露情况，涉及逆流交换和其他因素对疾病分布的潜在影响。我们得出结论，惰性气体逆流交换可能与DCS中肢体疼痛的分布有关。
