关于高压氧舱对未发生减压病潜水员保健的伪科学

 文章转自:大漠教练潜水资讯

  作者:Leon Chow

The Nitrogen Saturation Myth 关于氮气饱和的伪科学  Q: I work as a divemaster on a small island. Last weekend some of my coworkers went to the local chamber for "wash-out treatments," despite not having any symptoms. We all dive a lot, but I'd never heard of anything like that before. Is that something I should do?  问题:我是一座小岛上的DM(潜导),上周末我的同事去了当地的一个减压舱进行“清洗疗法”(尽管没有任何症状,仍选择不定期进入减压舱进行减压治疗)。我们都是潜水老鸟,但是我以前从没听过这样的事情。这些所谓的减压治疗(保健)该不该去做?  A: There is a misconception among some divers — particularly recreational dive professionals and fisherman divers — that a degree of tissue nitrogen saturation will occur over weeks or months of frequent diving activity. Some of these divers believe they may benefit from occasional "wash-out treatments" in a hyperbaric chamber, but that is a fallacy. Such a concept is completely at odds with all credible diving and decompression research and is inconsistent with informed clinical practice standards. Efforts to determine the origin of this misunderstanding have thus far proven unsuccessful.

 回答:在一些潜水员中存在一些误区,特别是休闲潜水人士和渔民,他们认为人体组织在经过几个星期甚至几个月的频繁潜水活动会逐渐累积从而达到氮气饱和。其中一部分人就会觉得他们可以通过在减压舱中不定期进行的这种“清洗疗法”来释放组织中长年被困住的余氮,但这是伪科学。这种观念与所有可信的潜水与减压研究完全相悖,并且与已知的临床实验标准不符。迄今为止,仍未找到导致这种误解的源头。

 Similarly, there are reports of chamber operators actually propogating this myth by offering routine "nitrogren desaturation treatments" — for a price, of course. Decompression sickness (DCS) can certainly manifest as musculoskeletal pain, so any such presentation within 24 hours of diving would warrant prompt evaluation and perhaps treatment in a chamber. However, while chronic pain has many possible causes, diving-related trapped nitrogen is not one of them.  

无独有偶,有报道称减压舱操作人员通过提供常规的“氮饱和处理”程序来传播这则伪科学,当然是为了赚钱。减压病的症状包含肌肉骨骼疼痛,所以如果在潜水24小时内出现这些症状,应当立即就医确诊,并可以采取减压治疗。然而很多可能性会造成慢性疼痛,有氮气困在体内导致的减压症状并不是唯一因素。

 Inert gas uptake and elimination during air, nitrox and heliox diving will obey both Dalton's and Henry's gas laws. Should bubbles be produced upon decompression (whether there are symptoms of DCS or not), then Boyle's law also comes into play. Asymptomatic bubbles may remain in tissues for a day or so at most.
      在空气潜水、高氧潜水和氦氧潜水活动中,惰性气体在人体组织的溶解与排出都遵守亨利定理和道尔顿定理○1。无论是否有减压病症状,如果减压过程产生气泡,则波义耳定律○2也适用这种情况。无症状的气泡最多可以在组织中保留一天左右。 

Throughout the compression phase of a dive and while at depth, the associated increase in inert gas pressure in the breathing gas is delivered to the diver's lungs (Dalton's law). From there it is gradually taken up by the blood and delivered to the body's various tissues (Henry's law). The rate of inert gas uptake in the blood and other tissues depends on several variables. Key among them are speed of compression, type of inert gas breathed and its related solubility coefficient, body temperature, inherent tissue perfusion and level of exercise or work load.  

当你在水下一定深度和深度潜水时,呼吸气体中分压增加的惰性气体吸入肺部(道尔顿定律-压强变大,体积变小)。从肺部逐渐溶解在血液里,然后经血液输送到身体各类组织(亨利定律-溶解度与分压成正比)。惰性气体在血液和其他组织溶解速率由多种因素共同决定。关键因素是加压速度,呼吸的惰性气体种类和它的溶解系数,身体体温,固有组织灌注○3以及运动或工作负荷水平。

  In recreational diving, nitrogen uptake essentially ends once the diver begins his ascent to the surface. I say "essentially" because the body's "slower" tissues — those that are less well perfused or are supported by simple diffusion, for instance — may continue to take on nitrogen during the early and intermediate stages of ascent if their nitrogen pressures remain lower than the blood's. Thus, nitrogen in the blood will continue to transfer into these tissues until such time that blood nitrogen levels fall to the level of those tissues. It is at this point that slower tissues will begin offgassing. This is why it is important that ascents be mostly direct and largely linear. Divers who slowly meander back to the surface may accumulate levels of nitrogen in certain tissues in excess of those assumed by decompression tables. In this way, repetitive dives can lessen the protective capabilities of the table in use. 

 在休闲潜水中,一旦潜水员开始上升到水面,氮的吸收就基本上就结束了。我说“基本上”是因为人体的慢组织即那些灌注较差或仅支持简单扩散的组织。比如在上升早期和中期,如果慢组织里的氮气压力比血液中的还低,则慢组织可能会继续吸收氮气。因此,血液中的氮气还会继续转移到慢组织中直到两者的氮气水平持平。达到这个平衡之后,慢组织就开始释放氮气。这就是为什么大多时候都是直线上升很重要的原因。潜水员缓慢地蜿蜒的回到水面,可能导致某些组织中的氮气含量超过免减压表建议值。如此,重复潜水就会降低免减压表的保守等级。
 

 If a diver remains at depth more than 12 to 18 hours (in a seafloor habitat or a commercial oilfield saturation-diving complex, for example),all of their tissues — fast, intermediate and slow — will re-equilibrate with nitrogen (or helium) at the new depth. This is called saturation diving. Except for tiny variations that may occur with body-temperature fluctuations, it is physiologically impossible for any additional inert gas to be taken up without further change in depth. When a diver ascends from a saturation dive, inert-gas elimination occurs in the same manner as it does at the end of a recreational dive, as described by Henry's and Dalton's gas laws. 

 如果潜水员在水下深处停留超过12至18小时(例如在海底栖息地或者商业油田的饱和潜水中),则其所有组织(快、中、慢组织)会在该深度与氮气或者氦气达新的到平衡。这称为饱和潜水。在生理上,除了身体微弱的体温波动之外,在该深度下,身体不会再吸收更多的惰性气体。当潜水员从饱和潜水上升时,如亨利和道尔顿的气体定律所描述的,氮气排放的减压原理与休闲潜水结束时相同。

 Once a diver has returned to the surface, regardless of whether the dive was a short recreational dive or a long saturation dive, all tissue inert gas in excess of normal atmospheric pressure will be eliminated over the following 12 to 18 hours (i.e., his body's tissue nitrogen levels will be re-equilibrated to the ambient atmospheric pressure). After that period, no additional nitrogen above normal atmospheric (sea-level) pressure will remain in the body. 

潜水员回到水面后,无论潜水是短暂的休闲潜水还是长时间的饱和潜水,在接下来12至18小时内,所有超过正常大气压的组织惰性气体都将排出,人体组织中的氮气水平将与大气压达到平衡。在此期间之后,体内不会再有高于正常大气压(海平面)压力的氮残留。 

Residual nitrogen is never "trapped" in the body, so there is absolutely no basis to treat divers for chronic nitrogen saturation. It is a misunderstanding at best, and a hoax perpetrated on divers at worst. Don't fall for this.

 残留的氮气不会永远“滞留”在体内,因此绝对没有治疗潜水员慢性氮饱和的依据。充其量,这是一种偷换概念的伪科学,而最糟糕的是,这种骗局会在潜水员身上发生。不要为此而受骗。— Dick Clarke, President, National Baromedical Services——Dick Clarke,国家口腔医疗服务协会主席

   注释○1-1:亨利定律:在一定温度下,气体在液体中的饱和浓度与液面上该气体的平衡分压成正比。它是英国的W.亨利在1803年在实验基础上发现的经验规律。实验表明,只有当气体在液体中的溶解度不是很高时该定律才是正确的,才是的气体实际是稀释溶液中的挥发性溶质,气体压力则是溶质的蒸气压。所以亨利定律还可表述为:在一定温度下,稀薄溶液中溶质的蒸气分压与溶液浓度成正比。     注释○1-2:道尔顿气体分压定律:在任何容器内的气体混合物中,如果各组成分之间不发生化学反应,则每一种气体都均匀地分布在整个容器内,它所产生的压强和它单独占有整个容器时所产生的的压强相同。也就是说,一定量的气体在一定容积的容器中的压强仅与温度有关。例如,零摄氏度时,1mol氧气在22.4L体积内的压强是101.3kPa,如果向容器内加入1mol氮气并保持容器体积不变,则氧气的压强还是101.3kPa,但容器内的总压强增大一倍。附上气体压强公式(等量等体积的气体的压强仅与温度有关,且正比关系):
  注释○2:波义耳定律也称又称 Mariotte's Law,在定量定温下,理想气体的体积与气体的压力成反比。是由英国化学家波义耳(Boyle),在1662年根据实验结果提出,称之为波义耳定律。这是人类历史上第一个被发现的“定律”。  注释○3:组织灌注是指充足的血流量经过身体各器官血管以维持气管的功能。

高压氧舱小科普:     高压氧舱在医学上已确认可以具有比较好治疗效果的治疗的适应症:1、各种中毒,如一氧化碳中毒、二氧化碳中毒、硫化氢中毒、氰化物中毒、氨气中毒、光气中毒、农药中毒、化学药物中毒等。2、溺水、自缢、电击伤、麻醉意外以及其它原因引起的脑缺氧、脑水肿、潜水减压病等。3、心血管系统:冠心病、心绞痛、心肌梗塞、心源性休克。4、消化系统:胃、十二指肠溃疡、术后溃疡。5、感染:气性坏疽、破伤风及其它厌氧菌感染,病毒性脑炎等。6、空气栓塞。7、脑血栓形成、脑栓塞、脑萎缩、脑供血不全、脑挫伤、脑外伤后综合症、骨髓炎、截瘫、周围神经损伤、多发性神经炎。8、皮肤移植、断肢(指)再植术、脉管炎、顽固性溃疡、骨筋膜间隔区综合征、术后伤口不愈、动脉栓塞、骨愈合不良、放射性骨髓炎、挤压伤。9、新生儿窒息、3岁之前的脑瘫等。10、中心性视网膜脉络膜炎、视网膜动脉栓塞、突发性耳聋、牙周炎、口腔溃疡。11、皮肤科疾病:玫瑰糠疹、寻常唑疮、结节性红斑、硬皮病、神经性或糖尿病皮炎等等。    与其他治疗结合有时可出现较满意疗效的疾病有:多发性硬化、神经根炎、肌营养不良、血管性头痛、锥-基动脉供血不全、颈椎病。部分老年及小儿哮喘,慢性溃疡性结肠炎。糖尿病并发症(血管炎、神经炎)、无菌性骨坏死、肠梗阻;高危妊娠,3岁之前的脑瘫;葡萄膜炎、视网膜静脉血栓形成、视神经炎、视神经萎缩等。       高压氧舱对以上疾病有的疗效好,可根治;有的与其它方法合并可有很好的疗效;有的只起辅助治疗作用,能缓解病情或阻止疾病的发展。那种认为高压氧舱能包治百病或贬低其作用的做法都是不严肃的。

原文来自DAN(潜水员警报网):http://www.alertdiver.com/?articleNo=1632
  翻译:Leon Chow ,Shenzhen, China

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最后编辑于:2019/12/27作者: Aks

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