潜水急救刍议

本文针对海南发生的一例潜水意外死亡,就潜水急救有关的认识、管理、普及、技术问题进行分析,指出不足,建议深刻认识潜水急救、加强潜水安全管理并开展潜水急救的研究,以便更好地为潜水旅游服务.     

对潜水医学中几个问题的探讨

国外潜水的最大深度为 710m[1 ] ;1989年 ,我国氦氧模拟饱和潜水深度与时间为 35 0m、72h[2 ] 。在海平面 10 0m以下进行深潜水 ,与一般的潜水不同 ,要进行饱和潜水。本文对有关问题及其职业危害等进行探讨。一、饱和潜水[3]随着人体所处环境气压的增加 ,气体在人体内的溶解量也相应增加 ,并与人体在高气压环境中的停留时间相关 ;时间愈长 ,溶解量愈接近饱和。为了减少气体在体内各组织的溶解量 ,各国对各种深度的潜水都规定了适宜的工作时间与减压时间 ;潜水愈深 ,减压时间相应增加。深潜水时 ,潜水工作效率降低 ,即潜水工作效率 =水下工作…     

大连地区潜水捕捞作业人员急性减压病影响因素分析

目的 分析辽宁省大连地区潜水捕捞作业人员急性减压病发病情况及影响因素,为相关部门制定相应干预措施提供理论依据,控制和减少急性减压病的发生.方法 抽取大连地区沿海6个县区(旅顺口区、金州区、庄河地区、西岗区、甘井子区、长海县)共171家用人单位的642人进行问卷调查.结果 642名潜水作业人员,年度总下水次数392 845次,急性减压病的年发生次数507次,急性减压病的年平均发生率为1.3‰(人次);发病人数488例,占总人数的76％,其中轻度261例,占40.6％,中度91例,占14.2％,重度136例,占21.2％;潜水深度越深,潜水时间及潜水间隔时间越长,急性减压病的发病率越高;从事潜水作业之前对潜水知识非常了解以及潜水后严格规范减压的潜水作业人员急性减压病的发病频率低(P＜0.05或P＜0.01).潜水深度(OR=1.112)、潜水方式(OR=3.950)是急性减压病发病的主要危险因素.结论 潜水深度、潜水方式可能是大连地区潜水捕捞作业人员急性减压病的主要影响因素,潜水深度越深及重装潜水更易发生急性减压病.     

我国潜水医师培训模式探讨

目的探讨建立我国潜水医师培训的模式和制度。方法分析我国潜水医师培训现状,参照发达国家培训模式,建立适合我国实情的潜水医师培训模式,并在实践中应用完善。结果探讨建立了适合我国的潜水医师培训模式,并在实践中得到初步应用。结论探讨建立的潜水医师培训模式符合潜水医师职业培训要求、适合我国国情,应拟继续在实践中修正完善。     

常规氦氧潜水减压病10例

我们对在常规氦氧潜水实验、训练和现场作业中所发生的１０例常规氦氧潜水减压病的特点及治疗结果作一介绍。一、潜水概况１０名常规氦氧潜水减压病患者年龄为１９～３７岁,其中在加压舱内模拟深潜实验３例、潜水现场７例,潜水深度８０～１４６ｍ,水下作业时间为３０～...     

潜水工人的骨与关节X线检查

潜水工人的骨与关节Ｘ线检查倪金星成佩芳笔者对我部１９９４年以来苏、皖两省港务工程公司等３个打捞队共４１名潜水工人体检中Ｘ线检查结果进行了调查，旨在对潜水职业病的防治引起重视。一、对象与方法１．对象：４１名潜水工人均为男性。年龄最小２３岁，最大５８岁，...     

潜水致减压性骨坏死2例报告

潜水作业是一项特殊的生产技术门类 ,减压性骨坏死是潜水员最常见的职业病之一 ,现将 2例潜水致减压性骨坏死病例报告如下。1　发病情况病例 1,男 ,5 4岁 ,潜水工龄 32年 ,潜水深度30ｍ左右 ,平均每天潜水 4～ 5ｈ。 1999年 4月潜水 4 0ｍ ,潜水 5ｈ ,未减压直接出水 ,出水 2ｍｉｎ后开始恶心 ,继而出现腰痛 ,潜水帽摘下后即失去知觉 ,急送医院 ,诊断为急性减压病。由于经济原因 ,未进行加压治疗 ,病人自动出院。随着时间推移 ,病人开始出现全身麻木 ,四肢活动不灵 ,排尿困难。 2 0 0 0年 7月 ,去当地医院进行检查 ,双股骨、肱骨、肩、髋的…     

快乐潜水 强心健肺

曾经有人问我潜水是什么感觉，我告诉她：你能想象做一条鱼儿在水中自由自在的游动是什么感觉吗？这就是潜水。     

饱和潜水对潜水员某些生理功能影响的研究进展

Bond于1957年提出,潜水员在高气压下长期暴露,体内各组织体液中溶解的惰性气体或中性气体达到完全饱和的程度。在此基础上,只要压力(深度)不变,无论暴露时间如何延长,其减压时间是相等的,这种潜水方式称为“饱和潜水”。目前,饱和潜水技术日趋成熟。已应用于海洋开发和大深度救捞作业     

不同潜水作业致减压性骨坏死的综合分析

减压性骨坏死是潜水人员在长期水下高气压环境工作中,惰性气体在机体的组织和血液中形成气泡压迫和栓塞供氧血管,导致相关骨细胞缺血性营养障碍逐步形成的慢性病变。为了更好地保护潜水人员的身体健康,降低发病率,我们对２种不同潜水作业所致的减压性骨坏死患者进行了...     

联勤医院海潜科建设思考

加强联勤医院海潜科建设是军队卫生联勤保障改革的重要任务之一,联勤医院海潜学科的建设现状与海军潜艇、潜水人员的医疗保障需要尚有较大差距。本文初步分析目前海潜科存在的主要问题,对这些问题提出了相应的对策,并提出几个需要重点注意的问题。希望引起有关人员对海潜科建设的关注,并供政策制定和管理机关参考。     

Western Australian recreational scuba diving fatalities, 1992 to 2005

Objective: To investigate recreational scuba diving fatalities within Western Australia (WA) between 1992 and 2005.
Methods: Coroners reports for 24 diving fatalities were reviewed to determine anthropometry, certification status and breaches of safe practices for each.
Results: Certification status was known for 20 divers and of these six (30%) were uncertified. Certified divers breached significantly fewer safe diving practices than uncertified divers ( p <0.01). Existing regulatory mechanisms require training certification only for dives made from commercial dive boats, yet the number of deaths involving shore dives or private craft (n=15) were triple the number diving from commercial boats (n=5).
Conclusion: Uncertified divers are less regulated and breach more safe practices than certified divers.
Implications: We recommend changes to existing regulations governing dives made from shore and private craft in WA, requiring that all divers be certified.     

氦氧饱和潜水环境对小鼠血清皮质酮及白介素-2含量的影响

[目的]观察不同深度、不同时间氦氧饱和暴露处理小鼠血清皮质酮及白介素-2（IL-2）含量的变化,探讨饱和潜水环境对免疫功能影响的规律和可能机制。[方法]将30只6～8周龄的昆明种雄性小鼠随机分为5组,分别为对照组,100m氦氧饱和暴露24h组、72h组和400m氦氧饱和暴露24h组、72h组。以酶联免疫吸附试验（ELISA）测定各组小鼠血清皮质酮及IL-2的含量。[结果]100m氨氧混合气暴露24h及72h后小鼠血清皮质酮含量均较对照组升高（P〈0．05）,而IL-2含量未见明显变化;400m氨氧饱和暴露24h及72h后小鼠血清皮质酮含量明显升高（P〈0．01）,IL-2含量明显降低（P〈0．01）,两种深度下暴露72h与24h组之间的皮质酮及IL-2含量差异均无统计学意义（P〉0．05）。[结论]饱和潜水环境可以引起机体的应激反应,它可能是大深度饱和环境致机体免疫功能抑制的一个重要因素。     

Lung function over the first 3 years of a professional diving career

OBJECTIVES—To characterise diving exposure and pulmonary function in professional divers at the start of their formal education and during the first 3 years of their professional career.
METHODS—The study included 87 men at the start of their education as professional divers. At follow up 1 and 3 years after the school 83 and 81 divers respectively were re-examined. Assessment of lung function included dynamic lung volumes and flows and transfer factor for carbon monoxide (Tl_CO).
RESULTS—69 Divers had preschool SCUBA diving experience and had a median number of 70 dives (range 2-3000) to a median maximal depth of 40 (range 10-73) metres. During the 15 week introductory diving course, they had 44 dives (range 38-50) in the depth range 10-50 metres. The median number of dives over the follow up period was 95 (range 0-722) to a maximal median depth of 38 (range 0-98) metres. At the start of the diving course there were no differences in forced vital capacity (FVC), forced expired volume in 1 second (FEV₁), and in Tl_CO between the 69 pre-exposed divers and the 18 never exposed divers. The FVC was significantly larger than predicted in both groups. At follow up at 3 years there was a significant reduction in mean (SD) FEV₁ of 1.8% (6.5), in forced mid-expiratory flow rate (FEF_25-75%) of 6.5% (11.7) and in forced expiratory flow at 75% of FVC expired (FEF_75%) of 10.4% (16.8). There was no change in FVC. The Tl_CO was significantly decreased by 4.6% (8.8). No significant effects were found of cumulative diving exposure, including the number of dives, on the relative changes of any of the lung function variables.
CONCLUSIONS—The results indicate that divers initially belong to a selected group with large FVC. Exposure to diving may contribute to changes in pulmonary function, mostly affecting small airways conductance.


Keywords: diving; follow up study; pulmonary function     

Diving bradycardia of elderly Korean women divers,haenyeo, in cold seawater: a field report

The purpose of the present field study was to explore diving patterns and heart rate of elderly Korean women divers (haenyeo) while breath-hold diving in cold seawater. We hypothesized that the decreasing rate in heart rate of elderly haenyeos during breath-hold diving was greater and total diving time was shorter than those of young haenyeos from previous studies. Nine haenyeos participated in a field study [68 ± 10 yr in age, ranged from 56 to 83 yr] at a seawater temperature of 10 to 13 °C. Average total diving time including surface swimming time between dives was 253 ± 73 min (155–341 min). Total frequency of dives was 97 ± 28 times and they dived 23 ± 8 times per hour. All haenyeos showed diving bradycardia with a decreased rate of 20 ± 8% at the bottom time (101 ± 20 bpm) when compared to surface swimming time (125 ± 16 bpm) in the sea. Older haenyeos among the nine elderly haenyeos had shorter diving time, less diving frequencies, and lower heart rate at work (p<0.05). These reductions imply that haenyeos voluntarily adjust their workload along with advancing age and diminished cardiovascular functions.     

An integrated comparative physiology and molecular approach pinpoints mediators of breath-hold capacity in dolphins

Background and objectivesIschemic events, such as ischemic heart disease and stroke, are the number one cause of death globally. Ischemia prevents blood, carrying essential nutrients and oxygen, from reaching tissues, leading to cell and tissue death, and eventual organ failure. While humans are relatively intolerant to ischemic events, other species, such as marine mammals, have evolved a unique tolerance to chronic ischemia/reperfusion during apneic diving. To identify possible molecular features of an increased tolerance for apnea, we examined changes in gene expression in breath-holding dolphins.MethodologyHere, we capitalized on the adaptations possesed by bottlenose dolphins (Tursiops truncatus) for diving as a comparative model of ischemic stress and hypoxia tolerance to identify molecular features associated with breath holding. Given that signals in the blood may influence physiological changes during diving, we used RNA-Seq and enzyme assays to examine time-dependent changes in gene expression in the blood of breath-holding dolphins.ResultsWe observed time-dependent upregulation of the arachidonate 5-lipoxygenase (ALOX5) gene and increased lipoxygenase activity during breath holding. ALOX5 has been shown to be activated during hypoxia in rodent models, and its metabolites, leukotrienes, induce vasoconstriction.Conclusions and implicationsThe upregulation of ALOX5 mRNA occurred within the calculated aerobic dive limit of the species, suggesting that ALOX5 may play a role in the dolphin’s physiological response to diving, particularly in a pro-inflammatory response to ischemia and in promoting vasoconstriction. These observations pinpoint a potential molecular mechanism by which dolphins, and perhaps other marine mammals, respond to the prolonged breath holds associated with diving.     

模拟300米氦氮氧饱和潜水人员的营养研究

四名男性健康潜水员,在模拟300米氦氮氧饱和潜水舱内居住21天,在300米停留7天,在舱内每人每日热能供应拟订20928kJ(5000kcal),饮食为二日四餐选食制,并于进舱前(加压前)3个月和舱内(加压或高压暴露期)供应市售九合维生素,每日2丸(每丸含量:VA2500IU、VB_12mg、VB_21mg、VB_61mg、VC35mg、VD_2200IU、VE1mg、VPP10mg、D-泛酸钙2mg)。采用膳食调查,测量体重等方法,其结果是在舱内(加压或高压暴露期)摄入食物总量略低于进舱前(加压前)而明显高于出舱后(常压)。潜水员喜食高碳水化物,高蛋白、低脂肪和富含维生素等食物,喜食瓜果、饮料,对脂肪类食物食欲降低。体重较国内外所报导的仅略有降低。建议在大深度饱和潜水作业时可试行选食制,并给予复合维生素制剂,补充膳食中维生素的不足。     

模拟大深度饱和潜水试验前后潜水员的营养状况

目的了解执行模拟大深度饱和潜水前后潜水员的营养状况,为潜水员的合理营养供给提供参考依据。方法模拟试验在500m饱和潜水系统内进行,约19 d。检测参加模拟大深度饱和潜水试验前及出舱后1周潜水员的体质指数(BMI)和血清生化指标,并以GJB 4126-2000《军人营养状况生化评价》及体格检查标准综合评价"。结果潜水员的体质量、体质指数(BMI)在出舱后1 d分别为(69.5±8.4)kg、(23.1±2.1),在出舱后7 d分别为(69.5±8.8)kg、23.1±2.2,均明显低于进舱前的(72.2±9.0)kg、24.0±2.1,差异有显著性(P<0.05)。潜水员的血尿酸水平在出舱后1 d、7 d分别为(384.3±4.5)μmol/L和(288.1±32.5)μmol/L,皆明显低于进舱前的水平〔(482.8±75.2)μmol/L〕,差异有显著性(P<0.05)。其他血液指标如血红蛋白、总蛋白、白蛋白、肌酐、尿素氮、甘油三酯、总胆固醇的水平在试验前后均无明显变化。结论潜水员的血尿酸水平在参加模拟大深度饱和潜水试验前偏高;同时体质量和体质指数在试验后又明显下降,因此其营养状况尚需采取某些措施加以改善。     

模拟400m氦氧饱和潜水对大鼠抗氧化能力的影响

[目的]观察模拟400m氦氧饱和潜水对大鼠抗氧化能力的影响。[方法]将大鼠在加压舱4．1MPa氦氧环境中饱和暴露24h,以常压和4．1MPa常氧高氦环境作为对照。出舱后测定大鼠肝、脑和肺中超氧化物歧化酶（SOD）、谷胱甘肽过氧化物酶（GSH—px）活性和还原型谷胱甘肽（GSH）、丙二醛（MDA）及8-羟基脱氧鸟苷（8-OhdG）含量。[结果]4．1MPa氦氧饱和暴露后大鼠脑SOD活性和肝、脑和肺GSH—Px活性降低（P〈0．05）,脑和肺GSH含量减少（P〈0．05）。4．1MPa常氧高氦暴露后大鼠各指标未见明显改变（P〉0．05）。各组MDA和8-OhdG含量差异无统计学意义（P〉0．05）。[结论]模拟400m氦氧饱和潜水24h使大鼠产生了氧化应激反应,抗氧化能力降低,其原因可能与该环境中的高分压氧有关。