中美联合饱和-巡回潜水实验中的异常肺循环(论著)

Unusual pulmonary circulation in divers in two collaborative ChineseAmerican saturationexcursion dives

目的：分析探讨１９８８年与１９９５年在我院实施的两次中美联合饱和－巡回潜水实验（Ｃｈｉｓａｔ１和２）中巡潜后减压与饱和减压对肺循环的影响。方法：主要应用常规四电极法肺阻抗图（ＩＰＧ）观察比较实验前对照、巡潜后和减压过程中的肺阻抗变化。参试潜水员共８名（编号１～８），共作两次实验（１～４号潜水员参加实验一，５～８号潜水员参加实验二）。结果：在实验一中，４名潜水员中的３名于巡潜后和减压过程中，出现一种恰如肺动脉高压症的异常肺阻抗平顶波。于出舱后３０小时波型恢复正常，未见减压病症状。在实验二的饱和减压过程中，在８号潜水员又连续７次测到类似平顶波，且其相应参数右心室收缩时间间期（ＲＳＴＩ），Ｑ－Ｂ和Ｂ－Ｙ间期比值（Ｑ－Ｂ／Ｂ－Ｙ）和肺动脉平均压（ＰＡＰｍ）均处于高水平，并均达到甚至明显超出国人正常值的上限；可认为是减压性肺动脉高压。结论：发生在饱和减压全过程的减压性肺动脉高压，将明显降低惰性气体经肺毛细血管－肺泡气体交换脱饱和排出体外的效率与安全性，使减压病发生的可能性大为增加。在实验二中，８号潜水员在饱和减压中多次被测到有Ⅲ级静息气泡音和减压性肺动脉高压表现；于返回海平面后又主诉左膝关节疼痛并主动要求再加压治疗，?

Aim:To evaluate the effects of decompression following excursions and saturation decompression procedure on pulmonary circulation(PC) in Chisat 1 and Chisat 2 experiments carried out at CUTI in 1988 and 1995.Methods:Lung impedance plethysmogram (IPG) was used to observe comparatively the changes of ΔZ curve figure before(as control),after excursion and during the decompression procedure.8 divers joined in the two experiments(Chisat 1 and Chisat 2),with divers No.1￣4 in Chisat 1 and divers N0.5￣8 in Chisat 2.Results:In Chisat 1,unusual systolic flattop curves,like those in patients with pulmonary artery hypertension(PHT),were discovered in 3 of 4 divers.These unusual curves were only seen post excursions and during saturation decompression,and returned to normal shape without any symptoms of DCS 30 h after surfacing.In Chisat 2,the flattop curves were observed again during saturation decompression for 7 times in diver No.8,and at the same time,the parameters of RSTI,QB/BY and mean pulmonary arterial blood pressure (PAPm)were all at very high level parallel to or even significantly above the maximum upper limits for Chinese healthy adults.It was therefore considered as decompressional PHT.Conclusion:Such decompressional PHT which appeared throughout the saturation decompression procedure would significantly reduce the efficiency and security of inert gas desaturation by means of blood gas exchange between pulmonary capillaries and alveoli,and hance would cause higher incidence of DCS.In fact,diver No.8 had showed several times grade 3 bubble scores at rest as well as symptoms of decompressional PHT during the saturation decompression period.He had complained of left joint pain and requested for recompression treatment after surfacing.Although his joint pain lasted just for a week and disappeared without being treated. But it is the author′s opinion that the possibility of DCS can still not be ruled out in this case. The relationship between unusual PC and occurrence of DCS was discussed.