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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。
Objective To analyze the clinical characteristics of patients with acute decompression sickness after repeated diving, and to explore the options of treating multiple patients at the same time when conventional treatment can not be implemented according to individualized treatment plans. Methods Statistics were made on the factors and clinical symptoms that affected the curative effect and relapse rate. The treatment regimen was selected according to the response of the symptoms and signs to the applied pressure. A group, B group, C group and D group were divided according to the different treatment regimens. Results In this group, 90 cases were cured (78.26%), 25 cases (21.74%) were improved, 0 was ineffective and 19 cases (16.52%) were relapsed. (1) There was a positive correlation between age, length of service, depth of diving, underwater working time and initial or recurrent and curative effect (P <0.05 or P <0.01), and age, seniority, labor intensity, (P <0.05 or P <0.01). However, there was a negative correlation between latency and curative effect and relapse (P <0.01). (2) Age, depth of dive, primary or recurrent and pain (P <0.05); (3) 48.0% of the changes in curative effect were explained by four factors: treatment regimen, length of service, diving depth and incubation period; (4) The cure rates of group D, group C and group B were significantly higher than those of group A in different treatment pressures, but the recurrence rates were significantly lower than those of group A (P <0.01, P <0.05) The same treatment pressure in different treatment time, the cure rate of D group was significantly higher than that of B group, the recurrence rate was significantly lower than that of B group; (6) The same treatment pressure in the same treatment time, the cure rate of D group was significantly higher than that of C group. Conclusion In oxygen chamber conditions are limited, its treatment should be preferred D group of oxygen inhalation Ⅳ program, without excessive adherence to each individual’s symptoms and signs of response to pressure at the same time into the cabin. And according to the patient’s clinical symptoms appropriate to extend the stay under high pressure, usually not more than 120min.