扩血管与加压治疗对神经系统减压病疗效的临床分析

目的:探讨减压病的发病机理及治疗方案.方法:将60例神经系统减压病的患者随机分为2组:A组28例接受氟桂利嗪和加压治疗,B组32例只接受加压治疗.另收集未进行加压治疗的神经系统减压病患者36例作为比较,其中病初使用扩血管药物的20例为C组,未使用扩血管药物的16例为D组.采用欧洲卒中量表(ESS),Barthel指数(BI)评价神经功能恢复状况.结果:扩血管治疗组ESS分数迅速增加,组间(A组与B组,C组与D组)差异有统计学意义.结论:血管痉挛可能是减压病的重要病因之一,因而扩血管治疗对神经系统减压病有效.     

减压病高压氧综合治疗临床分析(附35例)

近5年来我院高压氧治疗减压病140余例,其中住院治疗有完整记录35例,重度30例,以再加压、高压氧及临床综合治疗,获得较满意的疗效,现就本病的分期分度分型、治疗及其疗效与教训等分析如下。 1 临床资料本组35例均为男性,年龄18-45岁,<35岁者占89％。潜水深度20-40m,水下作业时间15-240min。发病时间:有记录的为出水面后5-10min出现减压病症状。根据发病后住院时间、病情的轻重、发病损     

潜水减压病高压氧治疗的疗效观察

目的:高压氧治疗潜水减压病的临床疗效。方法:回顾性分析收治的42例潜水减压病患者的临床资料。结果:42例潜水减压病患者,经高压氧治疗,治愈率为52.38%,好转率为30.95%,其中14例轻型患者,治愈率为50.00%;19例中型患者,治愈率为21.05%;9例重型患者,治愈率为33.33%;7例无效患者,有6例因发病时间太久未及时治疗而造成永久性损伤,其余患者高压氧治疗后无明显后遗症。结论:高压氧治疗潜水减压病的临床疗效确切,无明显后遗症,值得临床推广应用。     

急性脊髓型减压病220例综合治疗效果观察

目的:观察急性脊髓型减压病的综合治疗效果.方法:对220例急性脊髓型减压病进行及时再加压、高压氧、药物、心理干预和功能训练治疗.结果:治愈99例,占45.O%;好转108例,占49.1%;无效13例,占5.9%.结论:对于急性脊髓型减压病,再加压治疗应越早越好;适当、及时进行高压氧治疗是提高治疗效果的重要手段;合理的药物、心理干预和功能训练也非常必要.     

电针结合中药熏蒸治疗脊髓型减压病排尿障碍疗效观察

目的 观察电针结合中药熏蒸法治疗脊髓型减压病排尿障碍的疗效.方法 采用电针结合中药熏蒸法治疗脊髓型减压病引起排尿障碍患者30例为治疗组采用膀胱训练法治疗脊髓减压病排尿障碍30例为对照组.结果 治疗组总有效率为96.7%,对照组总有效率为73.3%,2组差异有统计学意义(P<0.01).结论 采用电针结合中药熏蒸法治疗脊...     

集束化护理预防胃肠减压期间胃管滑脱的研究

目的：探讨集束化护理预防胃肠减压病人胃管滑脱的效果。方法选择2013年7月至2014年8月入住普外科的100例胃肠减压病人为试验组，采用集束化护理措施；选取2012年8月至2013年6月入住普外科100例胃肠减压病人为对照组，采用常规护理措施；比较两组胃管滑脱发生率。结果试验组胃管滑脱发生例数为4例（4％），对照组胃管滑脱发生例数为12例（12％），差异有统计学意义（ P＜0．05）。结论实施集束化护理措施可有效预防胃肠减压病人胃管滑脱。     

高压氧治疗潜水捕捞致减压病56例疗效分析

目的探讨高压氧治疗潜水捕捞致减压病的疗效。方法回顾性分析我科2011年7-9月间采用高压氧加压综合治疗56例潜水捕捞致减压病患者的临床资料。结果56例患者均采用高压氧加压综合治疗,其中痊愈32例（56％）,好转23例（42％）,无效1例（2％）。结论高压氧加压对潜水捕捞致减压病疗效确切,值得推广。     

我国与苏、美潜水减压病治疗表的疗效比较

我部自1974年起,分别用我国与苏、美潜水减压病治疗表(以下称三种表)对221例减压病患者进行了治疗。现将三种表治疗的效果报道如下。材料与方法(一)临床资料:221例减压病患者均系男性,20～30岁76例,31～40岁102     

二例急性脊髓损伤型减压病的救治与探讨

脊髓损伤型减压病属于重度急性减压病,及时加压治疗是其唯一有效的方法,可以使90%以上的急性减压病获得治愈.延误时机将导致组织严重损害而产生持久的后遗症.我院于2004年8月救治2例急性脊髓损伤型减压病,经及时加压,高压氧及其他辅助治疗,获得良好疗效,现报告如下:     

急性脊髓型减压病136例临床分析

目的观察急性脊髓型减压病的综合治疗效果。方法对136例急性脊髓型减压病进行及时加压、高压氧、药物等综合治疗。结果治愈61例（占44.85%）,好转72例（占52.94%）,无效4例（占2.94%）。结论对于急性脊髓型减压病,加压治疗应越早越好。同时,合理的高压氧治疗、药物、心理干预和功能训练等综合治疗也非常重要。     

超声气泡检测在潜水减压研究中的应用

即使没有违背减压方案,潜水减压结束后潜水员体内也会产生气泡,发生静脉气体栓塞.由于气泡数量少或这些气泡尚未造成明显的减压病症状和体征,大部分情况下潜水员并未感觉存在静脉气体栓塞.然而,减压后体内气泡的数量、部位、持续时间等与潜水后减压病的发生风险有关,越来越多的研究通过检测潜水减压后体内气泡的相关参数来评估减压应激程度...     

氦氧混合气在医学实践中的应用

氦氧混合气具有独特的理化特性，不仅可作为呼吸气体用于潜水作业，还在哮喘、慢性阻塞性肺疾病、减压病等多种疾病的治疗和预防中展现出良好的效果。随着更多理化效应被发现，相关应用还在持续扩展。本文对氦氧混合气在医学实践中的应用进行综述，为后续更多拓展提供借鉴。     

Differential diagnostic problems of decompression sickness--examples from specialist physicians' practices in diving medicine

It can be expected that the differential diagnosis problem of decompression sickness will increase in the future due to the increasing number of divers. During the last 30 years, 232 divers were treated for decompression sickness (DCS) at the Naval Medical Institute (NMI) in Split, Croatia. In 66 cases (28%), physicians at various diving sites reached diagnosis with difficulty, and 86 divers (37%) came directly to the NMI without seeing a physician first. Physicians at remote diving locations frequently have only basic knowledge of diving medicine and are often inexperienced. The language barrier was a major obstacle in obtaining a medical history and examination of foreign divers. Consultations at the NMI proved a major contribution to correct diagnosis and treatment. We present six illustrative cases from NMI Archives that demonstrate how prejudices, panic, and inexperience could create problems in establishing DCS diagnosis.     

Recreational scuba injuries.

Decompression illness, which includes decompression sickness and arterial gas embolism, can be a complex and difficult diagnostic dilemma. The signs and symptoms are not well known and mimic other illnesses which often results in delay when seeking medical evaluation. Additionally, most physicians are not exposed to diving medicine and may not recognize a decompression illness injury. The Divers Alert Network (DAN) offers information to the diving public and telephone consultation for physicians who require assistance in the evaluation of scuba divers and management of dive accident cases. Divers Alert Network also publishes the national annual report on scuba diving morbidity and mortality. Services provided without charge are sponsored by the DAN membership. This article introduces the physician to decompression illness and the basic care and treatment of the injured scuba diver.     

不同加、减压方法临床选用的探讨

目的明确常规高压氧治疗是选用阶段停留加、减压法还是采用均匀变速加、减压法.方法理论分析两种方法的气体脱饱和梯度面积,比较两种方法动物出舱时的组织间液氧分压及动物对两种方法的反应.结果阶段停留减压法的体内气体脱饱和梯度面积明显大于均匀变速减压法,出舱时腹水的氧分压、均匀变速法明显高于阶段停留法,均匀变速法动物反应较轻.结论常规高压氧治疗宜采用均匀变速及治疗压较高的其他治疗法,阶段停留减压法适宜于潜水减压若减压病及治疗压较高的其他治疗.     

Overseas visitors admitted to Queensland hospitals for water-related injuries

OBJECTIVE: To determine the number of overseas visitors admitted to Queensland hospitals for water-related injuries over three years, the causes of their injuries, the resulting conditions treated, and the type of hospitals to which they were admitted. DESIGN: Retrospective analysis of admissions of overseas visitors to Queensland hospitals over the three financial years 1995/96, 1996/97 and 1997/98. PATIENTS: 296 overseas visitors admitted for water-related injuries, identified from hospital records by their usual place of residence. MAIN OUTCOME MEASURES: Number of admissions, causes of injuries, conditions treated, and bed days occupied by these patients at different types of hospitals (metropolitan, regional and rural public hospitals, and private hospitals). RESULTS: The 296 overseas visitors accounted for a total of 596 separate admissions, many of these the result of patients with decompression illness being admitted several times to a regional hospital hyperbaric chamber for treatment as day patients. The largest number of injuries involved the use of diving equipment. The main conditions treated were decompression illness (54.7%), fractures and dislocations (15.5%), and drowning and non-fatal submersion (14.9%). Overall, overseas visitors admitted to hospital following a water-related incident occupied 1215 bed days; 90% of these admissions were to regional hospitals. CONCLUSIONS: The main reason for admission of overseas visitors is for decompression illness, suggesting that the prevention of injuries among scuba divers requires further coordinated efforts by health and tourism authorities.     

Decompression illness secondary to occupational diving: recommended management based current legistation and practice in Malaysia

Occupational divers are exposed to hazards which contribute to the risk of developing decompression illnesses (DCI). DCI consists of Type I decompression sickness (DCS), Type II DCS and arterial gas embolism (AGE), developed from formation of bubbles in the tissues or circulation as a result of inadequate elimination of inert gas (nitrogen) after a dive. In Malaysia, DCI is one of the significant contributions to mortality and permanent residual morbidity in diving accidents. This is a case of a diver who suffered from Type II DCS with neurological complications due to an occupational diving activity. This article mentions the clinical management of the case and makes several recommendations based on current legislations and practise implemented in Malaysia in order to educate medical and health practitioners on the current management of DCI from the occupational perspective. By following these recommendations, hopefully diving accidents mainly DCI and its sequalae among occupational divers can be minimized and prevented, while divers who become injured receive the proper compensation for their disabilities.     

大鼠脊髓减压病模型的探索研究

目的：探讨建立大鼠脊髓减压病模型的加减压方案。方法：SD大鼠随机分为正常对照组、安全减压组和快速减压组,快速减压组分别采用3种加减压方案建立大鼠减压病模型,取脊髓胸腰段,HE染色后观察病理变化。结果：采用方案Ⅱ（经308空气加压至1MPa,高压下停留5．5min,50s减至常压出舱）制备的大鼠减压病模型,大体解剖可见所有大鼠脊髓有较多淤血和出血点,病理切片显示广泛的脊髓损伤。结论：方案Ⅱ制备的减压病模型大鼠死亡率低而且普遍发生脊髓损伤,可以作为建立脊髓减压病模型的加减压方案之一。     

兔减压病模型及其评估体系的建立

目的 建立潜水减压病新西兰白兔模型及其评估体系。方法 选取25只新西兰白兔建立潜水减压病模型,采用DWC150型动物实验加压舱模拟潜水,压缩空气加压至500 kPa暴露60 min后,以200 kPa/min匀速减至常压。选取6只正常新西兰白兔置于加压舱内给予常压通气,作为正常对照组。减压出舱后,采用超声检查观察流经右心室的气泡量,对气泡量、后肢功能状态、呼吸功能、肺和脊髓组织病理检查结果进行评分,并检测血常规和凝血功能。结果 采用本减压方案,新西兰白兔减压病的发病率为76%（19/25）,死亡率为28%（7/25）。造模后,超声检查发现动物静脉系统内存在大量气泡,且气泡量评分高于正常对照组（Z=-3.702,P=0.002）;新西兰白兔减压病模型的后肢运动功能和呼吸功能发生改变,其Tarlov评分、呼吸功能评分均差于正常对照组（Z=-2.172、-3.702,P均<0.05）;肺湿干质量比较正常对照组增加（t=4.52,P<0.01）。H-E染色结果示,减压后24 h新西兰白兔肺组织可见肺泡腔出血、肺泡间隔增厚,脊髓组织可见空泡样改变。与高气压暴露前比较,减压出舱后6 h、12 h减压病新西兰白兔的白细胞计数均增加（t=3.933、2.838,P=0.003、0.019）,减压后1 h红细胞计数、红细胞比容均减少（t=-2.606、-2.481,P=0.031、0.038）;血小板计数呈先降后升的趋势（F=3.024,P=0.039）,减压后12 h时与高气压暴露前比较差异有统计学意义（t=2.545,P=0.031）。结论 成功建立了新西兰白兔减压病模型,以及包括行为学、肺和脊髓组织病理学、炎性指标和凝血功能指标在内的减压病模型评估体系。