تحني
| تحني | |
|---|---|
| جنديان في البحرية الأمريكية في غرفة معادلة الضغط. | |
| التبويب والمصادر الخارجية | |
| ICD-10 | T70.3 |
| ICD-9-CM | 993.3 |
| DiseasesDB | 3491 |
| eMedicine | emerg/121 |
| Patient UK | تحني |
| MeSH | C21.866.120.248 |
سقم التحني يمكن تجنب الإصابة به بوساطة غرفة معادلة الضغط المشروحة في الصورة أعلاه بعد الغوص. ويرى في الصورة غواصان يقضيان الوقت في لعب الورق.
التحني Decompression sicknessK حالة مؤلمة وخطيرة تنتج عن تكون فقاعات غازية في مجرى الدم وأنسجة الجسم. وتحدث الحالة عندما ينخفض الضغط الجوي المحيط بالجسم بسرعة فائقة. ويطلق على سقم التحني أيضًا اسم سقم زوال الضغط أوسقم القيسون، حيث يصيب الغواصين والعاملين في القيسونات (الحجرات المحكمة). انظر: الحجرة المحكمة. ويصاب هؤلاء بالسقم إذا ما عادوا إلى سطح الماء أوإلى مستوى سطح الأرض بسرعة كبيرة. وقد يتعرض ركاب الطائرات أيضًا إلى سقم التحني إذا توقف نظام معادلة الضغط الجوي في الطائرة عن العمل.
فعندما ينخفض الضغط الجوي بسرعة كبيرة، يندفع غازالنيتروجين الموجود في شكل محلول في سوائل الجسم خارج المحلول ويكوّن فقاعات غازية، وتتسبب تلك الفقاعات في تمدد أوانقطاع الأنسجة أوإعاقة الدورة الدموية. ومن الأعراض الشائعة لسقم التحني حدوث آلام في المفاصل أوالعظام مع حكة أوالتهاب بالجلد وصعوبة في التنفس وشلل جزئي أوكلي. أما الأعراض الأقل شيوعًا فتضم الدوار والدوخة والقيئ والتشنجات والإغماء. وقد يتسبب السقم في الوفاة في بعض الحالات.
يرتدي رواد الفضاء الذين يقومون بأعمال خارج مركباتهم الفضائية بدلات خاصة تحتوي على ضغط غازي منخفض. وقبل أداء أي عمل خارج مركبة الفضاء يتنفس الرواد الأكسجين النقي لمدة ثلاث أوأربع ساعات لطرد أكبر كمية ممكنة من النيتروجين من الجسم، مما يقلل من احتمالات الإصابة بسقم التحني أثناء عملهم خارج مركبة الفضاء. وبالمثل، يمكن للعاملين في القيسونات والغواصين تنفس الأكسجين النقي قبل وأثناء صعودهم إلى سطح الماء للحد من احتمالات الإصابة بسقم التحني.
ويمكن تجنب السقم بزيادة الضغط الجوي، ويتم ذلك عادة في حجرات ضغط محكمة الإغلاق، حيث تؤدي زيادة الضغط الجوي إلى الضغط على فقاعات النيتروجين مما يسبب عودة جزء من النيتروجين مرة أخرى إلى سوائل الجسم. ويخفض الضغط بعد ذلك تدريجيًا بحيث يهجر النيتروجين الجسم بدون حدوث فقاعات كثيرة. وقد يتسبب تكرار الإصابة بسقم التحني في حدوث أضرار دائمة.
التصنيف
Decompression illness and dysbarism
العلامات والأمراض
| نوع التحني | مكان الفقاعات | الأعراض & العلامات (العلامات السريرية) |
|---|---|---|
| تحني | يصيب معظم أربطة الجسم (المرفقين, الأكتاف, hip, المعصمين, الركب, الكاحلين) |
|
| تحني الجلد | الجلد |
|
| عصبي | المخ |
|
| Spinal cord |
|
|
| Peripheral nerves |
|
|
| Inner ear, "the staggers" |
|
|
| Chokes | الرئتين |
|
التكرار
The distribution of symptoms of DCS observed by the U.S. Navy are as follows:
| النسبة المئوية للاصابة | Symptoms |
|---|---|
| 89% | local joint pain |
| 70% | arm symptoms |
| 30% | leg symptoms |
| 5.3% | dizziness |
| 2.3% | paralysis |
| 1.6% | shortness of breath |
| 1.3% | extreme fatigue |
| 0.5% | collapse/unconsciousness |
Onset
| Percentage of cases | Time to the onset of first symptoms |
|---|---|
| 42% | within 1 hour |
| 60% | within ثلاثة hours |
| 83% | withinثمانية hours |
| 98% | within 24 hours |
| 100% | within 48 hours |
The table does not differentiate between types of DCS, or types of symptom.
الأسباب
مغادرة بيئة الضغط العالي
Schematic of a caisson
النزول الى العمق
الصعود إلى مكان المرتفع
عوامل مهيئة
بيئية
فردية
Atrial septal defect (PFO) showing left-to-right shunt. A right-to-left shunt may allow bubbles to pass into the arterial circulation
الآلية
This surfacing diver must enter a recompression chamber to avoid the bends.
غازات خاملة أخرى
Isobaric counterdiffusion
سقم معادلة الضغط
الأعراض
الوقاية
الآثار المترتبة على استنشاق أكسجين نقي
Breathing pure oxygen to remove nitrogen from the bloodstream
العلاج
The decompression chamber at the Neutral Buoyancy Lab.
الأعراض
فهم الأوبئة
التاريخ
The Eads Bridge. 42 workers injured by caisson disease
المجتمع والثقافة
تأمين طبي
انظر أيضا
- Hyperbaric chamber
- Hyperbaric medicine
- Decompression illness
- Ebullism
الهوامش
المصادر
-
^ خطأ استشهاد: وسم
<ref>غير سليم؛ لا نص تم توفيره للمراجع المسماةpmid12562679 -
^ خطأ استشهاد: وسم
<ref>غير سليم؛ لا نص تم توفيره للمراجع المسماةpowell2008-70 - ^ Tables based on US Navy tables have a safety stop at 15 قدم (4.6 م); BSAC tables have a safety stop atستة مترs (20 قدم); Bühlmann tables have a safety stop at ثلاثة مترs (9.8 قدم)
المراجع
- الموسوعة المعهدية الكاملة
- Hamilton, Robert W; Thalmann, Edward D (2003). "10.2: Decompression Practice". In Brubakk, Alf O; Neuman, Tom S (eds.). Bennett and Elliott's physiology and medicine of diving, 5th Revised edition. United States: Saunders Ltd. pp. 455–500. ISBN . OCLC 51607923.
- Francis, T James R; Mitchell, Simon J (2003). "10.4: Pathophysiology of Decompression Sickness". In Brubakk, Alf O; Neuman, Tom S (eds.). Bennett and Elliott's physiology and medicine of diving, 5th Revised edition. United States: Saunders Ltd. pp. 530–56. ISBN . OCLC 51607923.
- Francis, T James R; Mitchell, Simon J (2003). "10.6: Manifestations of Decompression Disorders". In Brubakk, Alf O; Neuman, Tom S (eds.). Bennett and Elliott's physiology and medicine of diving, 5th Revised edition. United States: Saunders Ltd. pp. 578–99. ISBN . OCLC 51607923.
- Marx, John (2010). Rosen's emergency medicine: concepts and clinical practice (7th ed.). Philadelphia, PA: Mosby/Elsevier. ISBN .
- Powell, Mark (2008). Deco for Divers. Southend-on-Sea: Aquapress. ISBN .
وصلات خارجية
- Decompression Sickness: Prevention, Risks, Exercise, PFO, References, Links
- Environmental Physiology Medical Literature
- What causes the bends?
- Divers Alert Network: diving medicine articles
- Dive Tables from the NOAA
خطأ استشهاد: وسوم <ref> موجودة لمجموعة اسمها "note"، ولكن لم يتم العثور على وسم <references group="note"/> أوهناك وسم </ref> ناقص
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- ^ Francis & Mitchell p. 578
- ^ Francis & Mitchell p. 579
- ^ Francis & Mitchell p. 580
- ^ Marx p. 1908
- ^ Pulley, Stephen A (27 November 2007). "Decompression Sickness". Medscape. Retrieved 15 May 2010.
- ^ نطقب:Cite manual
- ^ Powell p. 71
- ^ Powell p. 70
-
^ Doolette, David J; Mitchell, Simon J (2003). "Biophysical basis for inner ear decompression sickness". Journal of Applied Physiology. 94 (6): 2145–50. doi:10.1152/japplphysiol.01090.2002. PMID 12562679. Retrieved 15 May 2010. Unknown parameter
|doi_brokendate=ignored (help) - ^ نطقب:Cite manual
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-
^ Brubakk, Alf O. (2003). Bennett and Elliott's physiology and medicine of diving, 5th Rev ed. United States: Saunders Ltd. ISBN . Unknown parameter
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^ Pollock, Neal W; Natoli, Michael J; Gerth, Wayne A; Thalmann, Edward D; Vann, Richard D (2003). "Risk of decompression sickness during exposure to high cabin altitude after diving". Aviation, Space, and Environmental Medicine. 74 (11): 1163–8. PMID 14620473. Retrieved 18 May 2010. Unknown parameter
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