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長期潛水工作者之健康問題

Medical Issues in the Long-term Underwater Work

摘要


隨著科技的進步,對於水下作業之專業人員的需求亦日益增加,舉凡國防(潛水救難爆破),環保(汙水放流管置放),航運(港灣工程)及深海鑽探、打撈及海下科技研究等,均需要專業潛水人員的投入,因此,長期潛水工作者之健康問題值得非常的重視。 長期潛水工作者除了可能面臨急性潛水意外傷害之外,亦可能遭受漸進之慢性異常組織病變。急性潛水意外傷害包括擠壓症(中、內耳,副鼻寶及肺等組織),動脈氣體栓塞症、嚴重型減壓病(中樞神經系統、脊髓、呼吸系統)等。此些急性潛水意外傷害除了急性期的緊急危害外,均可能導致影響身體功能之長期後遺症。中、內耳擠壓症可能引起傳導型聽力障礙、神經感覺型聽力障礙、平衡功能失調、暈眩症等。副鼻竇擠壓症可造成慢性鼻竇炎,引起鼻咽部腫脹疼痛。肺擠壓症及呼吸系統減壓病可能造成肺組織的慢性纖維化病變,影響肺功能,並可有胸悶、胸痛、乾咳及呼吸緊繃等症狀。中樞神經系統減壓病及動脈氣體栓塞症可導致類似腦血管阻塞(中風)的後遺症,可引起頭痛、頭暈、噁心、嘔吐、舌歪、嘴斜、面神經麻痺、言語障礙、步態不穩、左右側半身偏癱等。脊髓減壓病可引起下背痛、下半身麻痺、大小便失禁或無法自解等。 職業潛水員長期從事潛水工作後,除了可能發生上述急性潛水意外傷害之外,亦可能罹患漸進之慢性異常組繳病變!尤其是長骨骨骼系統、呼吸系統及精神神經系統: (一)異壓性骨壞死:骨骼系統可能因爲潛水後不當減壓,造成氣泡於長骨骨骼組織內形成,影響長骨的血流供應,引起缺血性骨壤死。 (二)肺功能降低:肺功能起初可能增強少許,但長期下來肺功能會減退,包括二氧化碳的滯留增加、通氣量減低及氣體交換減少等。 (三)精神神經系統衰退:由於長期潛水可能造成漸進性的腦病變,可能引起倦怠、記憶力衰退、注意力無法集中、情緒激躁、不注重外表、肢體酸痛無力、性功能衰退、失眠、夢遊、行爲異常等。

並列摘要


According to the technologic improvement, many special circumstances need professional underwater workers to involve, including underwater rescue or explosion, harbor construction, and oil exploration, etc. Therefore, we must care about the medical issues in the long-term underwater work. Long-term underwater workers face not only the danger of acute decompression illness but also of chronic tissue abnormalities. Acute decompression illness includes barotrauma (middle, inner ear, nasal sinuses and lung), arterial air embolism, and severe decompression sickness (central nervous system, spinal cord and respiratory). These acute injuries can induce emergent situation, and chronic sequelae of body dysfunction may add insult to these acute injuries. Middle and inner ear barotrauma may bring about conductive and neurosensory hearing impairment, balance dysfunction, and vertigo. Nasal sinus barotrauma may induce chronic sinusitis which leads to pain and swelling in nasopharynx. Lung barotrauma and respiratory decompression illness can result in chronic pulmonary fibrous abnormalities, and chest tightness, chest pain, dyspnea and impaired lung function can occur due to these lung injuries. Central nervous decompression illness and arterial air embolism can induce residual symptoms and signs like those in stroke. Spinal cord decompression illness can induce low back pain, paralysis, and even incontinence. In addition to these chronic sequalae due to acute injuries, chronic progressive tissue damage can develop in the long-term underwater work, especially in long bone skeletal system, respiratory system, and psychoneural system. (1) Dysbaric osteonecrosis: Inadequate decompression after diving may induce bubble formation in the long bone tissues. These air bubbles can obstruct or occlude the blood supply for bone tissues, and osteonecrosis can occur due to ischemia. (2) Pulmonary function impairment: Pulmonary functions, including carbon dioxide retention, ventilation, and gas exchange, may impair due to long-term underwater work. (3) Psycho-neurological impairment: Progressive encephalomyelopathy may occur in long-term underwater workers. These neurological consequences may induce fatigue, memory problems, irritability, concentration difficulties,

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