反复潜水后急性减压病的临床分析

目的分析反复潜水后急性减压病患者的临床特点，探讨在常规按个体化治疗方案不能实施的情况下同时治疗多个患者的方案选择。方法统计影响疗效和复发率的因素及临床症状，依照症状和体征对所加压力的反应情况选择治疗方案，根据不同治疗方案分A组、B组、C组、D组。结果本组治愈90例（78．26％），好转25例（21．74％），无效0例，复发19例（16．52％）。（1）年龄、工龄、潜水深度、水下工作时间及初发或再发与疗效呈正相关（P〈0.05或P〈0.01），并且年龄、工龄、劳动强度、潜水深度、初发或再发、疼痛程度与复发否也呈正相关（P〈0.05或P〈0.01）；而潜伏期与疗效及复发否呈负相关（P〈0.01）；（2）年龄、潜水深度、初发或再发与疼痛程度呈正相关（P〈0.05，P〈0.01）；潜伏期与疼痛程度呈负相关（P〈0．05）；（3）治疗方案、工龄、潜水深度和潜伏期4个因素可解释疗效变化的48．0％：（4）不同治疗压力中D组、C组、B组治愈率较A组明显提高，而复发率明显低于A组，差异均有统计学意义（P〈0.01，P〈0.05）；（5）相同治疗压力不同治疗时间中D组治愈率明显高于B组，复发率明显低于B组；（6）相同治疗压力相同治疗时间中D组治愈率较C组治愈率明显提高。结论在氧舱条件受限的情况下，其治疗应首选D组的吸氧Ⅳ方案，不必过分拘泥于每个个体症状和体征对压力的反应情况同时进舱。并且根据患者的临床症状适当延长高压下停留时间，一般不超过120min。

Clinical characterization and treatment of acute decompression sickness after group repeated dives

OBJECTIVE: To clinically characterize the divers who suffer from decompression sickness in group after diving, optimize therapeutic treatment settings for grouped patients where the conventional individualized treatment cannot be implemented. METHODS: Clinical parameters of patients such as age, professional seniority in dive, labor intensity, diving depth and their symptoms were statistically categorized to identify the factors that correlate with treatment efficacy and recurrence rate. In accordance with the symptoms and the reactions to pressure, 4 treatment programs were applied: Program A, Program B, Program C, Program D. RESULTS: (1) age, professional seniority, diving depth, length of service, dive frequency were positively correlated with the treatment efficacy (P<0.05, P<0.01), and these parameters together with pain intensity were also positively correlated with recurrence risk (P<0.05, P<0.01), while long latency time of the disease often related with poor therapeutic outcome and high recurrence rate (P<0.01), (2) pain intensity were positively affected by age, diving depth and dive frequency (P<0.05, P<0.01), whereas negatively affected by disease latency time (P<0.01), (3) Four elements in this clinic project, selection of treatment program, length of service, diving depth and disease latency time of patient, were responsible for (or: could account for) 48.0% change of treatment efficacy, (4) Among Programs using different therapeutic pressure, Program D, C and B had better outcomes than Program A (P<0.01, P<0.05). Also, less patients in Program D, C and B suffered from recurrence with relative to Program A (P<0.01, P<0.05), (5) Between Programs adopting same hyperbaric pressure and treatment duration time, Program D was more efficient and fewer recurrent cases were found in it if compared to Program B (P<0.05), (6) In programs with same pressure and duration time settings, Program D was remarkably superior to program C in regard of its treatment efficacy. CONCLUSIONS: In condition with only limited clinic supplies, Program D could be the first choice to provide the hyperbaric oxygen as an ideal group treatment, and it is not very necessary for the clinician to provide individualized therapy. An appropriate extension of stay in hyperbaric chamber may apply to some patients but depending on the clinical symptoms, however, no longer time than 120 min is recommended.