Hampson N B, Dunford R G
Hyperbaric Department, Virginia Mason Medical Center, Seattle, Washington, USA.
Undersea Hyperb Med. 1997;24(1):29-33.
A syndrome of acute pulmonary edema has been previously reported among scuba divers in cold, European waters. Because of the temperatures involved, the name "cold-induced pulmonary edema" was coined in the original 1989 description. We report six individuals who developed the identical syndrome, five while diving in Puget Sound and one in the Gulf of Mexico. The four women and two men ranged in age from 24 to 60 yr. They experienced one to six episodes apiece, each with the development severe dyspnea at depth without excessive exertion. Associated symptoms included cough, weakness, expectoration of froth, chest discomfort, orthopnea, wheezing, hemoptysis, and dizziness. Emergency medical evaluation of four divers revealed rales on examination and pulmonary edema on chest radiograph. In one diver with pulmonary edema on chest radiograph, pulmonary capillary wedge pressure was normal when measured acutely. Symptoms resolved either spontaneously over 1-2 days or with standard medial treatment for pulmonary edema. Prior history of cardiovascular disease was negative except for hypertension and mitral valve prolapse in one diver. Cardiac evaluations following recovery from the acute episodes were normal. Episodes in the cold waters of Puget Sound sometimes occurred despite the use of dry suits. Furthermore, one diver developed recurrent episodes in 27 degrees C water off Cozumel, Mexico. Development of pulmonary edema while scuba diving constitutes a distinct clinical entity which may occur in either "cold" or "warm" water. It is not associated with a decompression mechanism. Personnel caring for divers should be aware of the syndrome in order to provide optimal medical management.
此前曾有报道称，在欧洲寒冷海域潜水的潜水员中出现过一种急性肺水肿综合征。鉴于当时的水温情况，在1989年最初的描述中创造了“冷诱导肺水肿”这一名称。我们报告了6名出现相同综合征的患者，其中5人在普吉特海湾潜水时发病，1人在墨西哥湾潜水时发病。这4名女性和2名男性年龄在24岁至60岁之间。他们每人经历了1至6次发作，每次发作时在水下深度时均出现严重呼吸困难，且无过度劳累情况。相关症状包括咳嗽、乏力、咳出泡沫痰、胸部不适、端坐呼吸、喘息、咯血和头晕。对4名潜水员进行的紧急医疗评估显示，检查时有啰音，胸部X光片显示有肺水肿。在一名胸部X光片显示有肺水肿的潜水员中，急性测量时肺毛细血管楔压正常。症状在1至2天内自行缓解，或通过标准的肺水肿药物治疗得到缓解。除一名潜水员有高血压和二尖瓣脱垂外，心血管疾病既往史均为阴性。急性发作恢复后的心脏评估均正常。尽管使用了干式潜水服，普吉特海湾冷水环境中的发作仍时有发生。此外，一名潜水员在墨西哥科苏梅尔岛水温27摄氏度的水中出现了反复发作。潜水时发生肺水肿是一种独特的临床病症，可能发生在“冷”水或“暖”水中。它与减压机制无关。照顾潜水员的人员应了解这种综合征，以便提供最佳的医疗管理。
