Knauth M, Ries S, Pohimann S, Kerby T, Forsting M, Daffertshofer M, Hennerici M, Sartor K
Department of Neuroradiology, University of Heidelberg, Klinikum Heidelberg, Germany.
BMJ. 1997 Mar 8;314(7082):701-5. doi: 10.1136/bmj.314.7082.701.
To investigate the role of a patient foramen ovale in the pathogenesis of multiple brain lesions acquired by sport divers in the absence of reported decompression symptoms.
Prospective double blind cohort study.
Diving clubs around Heidelberg and departments of neuroradiology and neurology.
87 sport divers with a minimum of 160 scuba dives (dives with self contained underwater breathing apparatus).
Presence of multiple brain lesions visualised by cranial magnetic resonance imaging and presence and size of patent foramen ovale as documented by echocontrast transcranial Doppler ultrasonography.
25 subjects were found to have a right-to-left shunt, 13 with a patent foramen ovale of high haemodynamic relevance. A total of 41 brain lesions were detected in 11 divers. There were seven brain lesions in seven divers without a right-to-left shunt and 34 lesions in four divers with a right-to-left shunt. Multiple brain lesions occurred exclusively in three divers with a large patent foramen ovale (P = 0.004).
Multiple brain lesions in sport divers were associated with presence of a large patent foramen ovale. This association suggests paradoxical gas embolism as the pathological mechanism. A patent foramen ovale of high haemodynamic relevance seems to be an important risk factor for developing multiple brain lesions in sport divers.
探讨在未报告减压症状的情况下，卵圆孔未闭在运动潜水员多发脑损伤发病机制中的作用。
前瞻性双盲队列研究。
海德堡周边的潜水俱乐部以及神经放射科和神经科。
87名运动潜水员，至少进行过160次水肺潜水（使用自给式水下呼吸器潜水）。
通过头颅磁共振成像显示的多发脑损伤情况，以及经颅多普勒超声造影记录的卵圆孔未闭的存在情况和大小。
发现25名受试者存在右向左分流，其中13人有具有高血流动力学相关性的卵圆孔未闭。在11名潜水员中总共检测到41处脑损伤。在7名无右向左分流的潜水员中有7处脑损伤，在4名有右向左分流的潜水员中有34处损伤。多发脑损伤仅发生在3名有大型卵圆孔未闭的潜水员中（P = 0.004）。
运动潜水员的多发脑损伤与大型卵圆孔未闭的存在有关。这种关联提示反常气体栓塞为病理机制。具有高血流动力学相关性的卵圆孔未闭似乎是运动潜水员发生多发脑损伤的重要危险因素。
