Inner Ear Decompression Sickness

內耳減壓病

王賢和(Shyan-Her Wang)

《童綜合醫學雜誌》 10卷1期 (2016/06) Pp. 5-9

摘要

內耳減壓病是由於外在環境的壓力快速地下降，導致溶解於內耳組織液或血液中的氮氣形成氣泡而產生的疾病。 氣泡本身會造成血管和組織通道的阻塞，導致內耳的缺氧和結構性的破壞；此外，氣泡介面所引起的次發性發炎反應也會進一步造成內耳組織的傷害。氮氣氣泡於內耳內淋巴、外淋巴和迷路血液循環等組織中形成，造成前庭和聽力功能的傷害，出現包括眩暈、耳鳴、眼球震顫、步伐不穩和聽力喪失等的內耳症狀。內耳減壓病的診斷主要是依據詳細的潛水史和內耳症狀等。臨床上，內耳減壓病和中樞型前庭病變及內耳氣壓傷的鑑別診斷要謹慎地區別。治療上，主要是以快速的且足夠深度的再加壓治療為主，將體內的氣泡壓縮到很小，以減輕組織的傷害；之後再以足夠時間的高壓氧氣治療，以氧氣將致病過程中和再加壓過程中所累積的過量氮氣替換出來。

關鍵字

內耳減壓病 ； 再加壓治療 ； 高壓氧

並列摘要

Inner ear decompression sickness (IEDCS) is caused by bubble formation in the endolymph, perilymph, or labyrinth circulation while the ambient pressure drops too rapidly. The bubbles cause obstructions of the regional circulation and tissue passages, resulting in tissue hypoxia and structural damage. Furthermore, inflammatory effects of the bubble interface cause secondary injures to the surrounding tissues. Patients with IEDCS may exhibit symptoms and signs of vestibular disorders and cochlear deficits, such as vertigo, nystagmus, tinnitus, unstable gait, and hearing loss. The diagnosis of IEDCS depends on obtaining a comprehensive diving history and assessing the vestibular or auditory symptoms and signs. The differential diagnosis from central vestibular dysfunction and inner ear barotrauma should be carefully made with respect to clinical signs and physical examinations. Prompt recompression with an adequate treatment table is the gold standard for IEDCS treatment. The therapeutic depth should be deep enough to compress the bubbles to a very small size to clear the obstructions. Hyperbaric oxygen is then introduced and should last long enough to exchange the over-loaded nitrogen gas during the rapid surfacing and recompression process.

並列關鍵字

Inner ear decompression sickness ； Hyperbaric oxygen therapy ； Recompression therapy