تحني

(تم التحويل من مرض تخفيف الضغط)
تحني
Decompression chamber.jpg
جنديان في البحرية الأمريكية في غرفة معادلة الضغط.
التبويب والمصادر الخارجية
التخصصالعلاج بالأكسجين عالي الضغط, طب الطوارئ, طب العمل[*]
ICD-10T70.3
ICD-9-CM993.3
DiseasesDB3491
eMedicineemerg/121
Patient UK

فشل عرض الخاصية P1461: لم يتم العثور على الخاصية P1461.

تحني
MeSHC21.866.120.248
مرض التحني يمكن تجنب الإصابة به بوساطة غرفة معادلة الضغط الموضحة 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 مرض التحني أيضًا اسم مرض زوال الضغط أو مرض القيسون، حيث يصيب الغواصين والعاملين في القيسونات (الحجرات المحكمة). انظر: الحجرة المحكمة. ويصاب هؤلاء بالمرض إذا ما عادوا إلى سطح الماء أو إلى مستوى سطح الأرض بسرعة كبيرة. وقد يتعرض ركاب الطائرات أيضًا إلى مرض 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 أو انقطاع الأنسجة أو إعاقة الدورة الدموية. ومن الأعراض الشائعة لمرض التحني حدوث آلام في المفاصل أو العظام مع حكة أو التهاب بالجلد وصعوبة في التنفس وشلل جزئي أو كلي. أما الأعراض الأقل شيوعًا فتشمل الدوار والدوخة والقيئ والتشنجات والإغماء. وقد يتسبب المرض 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 أو أربع ساعات لطرد أكبر كمية ممكنة من النيتروجين من الجسم، مما يقلل من احتمالات الإصابة بمرض 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 بمرض التحني.

ويمكن تجنب المرض 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 يترك النيتروجين الجسم بدون حدوث فقاعات كثيرة. وقد يتسبب تكرار الإصابة بمرض التحني في حدوث أضرار دائمة.


. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

التصنيف

Decompression illness and dysbarism

العلامات والأمراض

Signs and symptoms of decompression sickness
نوع التحني مكان الفقاعات الأعراض & العلامات (العلامات السريرية)
تحني يصيب معظم أربطة الجسم
(المرفقين, الأكتاف, hip,
المعصمين, الركب, الكاحلين)
  • Localized deep pain, ranging from mild (a "tingle") to excruciating. Sometimes a dull ache, but rarely a sharp pain.
  • Active and passive motion of the joint aggravates the pain.
  • The pain may be reduced by bending the joint to find a more comfortable position.
  • If caused by altitude, pain can occur immediately or up to many hours later.
تحني الجلد الجلد
  • Itching, usually around the ears, face, neck, arms, and upper torso
  • Sensation of tiny insects crawling over the skin (formication)
  • Mottled or marbled skin usually around the shoulders, upper chest and abdomen, with itching
  • Swelling of the skin, accompanied by tiny scar-like skin depressions (pitting edema)
عصبي المخ
Spinal cord
  • Abnormal sensations such as burning, stinging, and tingling around the lower chest and back
  • Symptoms may spread from the feet up and may be accompanied by ascending weakness or paralysis
  • Girdling abdominal or chest pain
Peripheral nerves
Inner ear,[1][note 1] "the staggers"
  • Loss of balance
  • Extreme vertigo
  • Hearing loss
Chokes الرئتين
  • Burning deep chest pain (under the sternum)
  • Pain is aggravated by breathing
  • Shortness of breath (dyspnea)
  • Dry constant cough

التكرار

The distribution of symptoms of DCS observed by the U.S. Navy are as follows:[2]

DCS symptoms by frequency
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

Onset of DCS symptoms
Percentage of cases Time to the onset of first symptoms
42% within 1 hour
60% within 3 hours
83% within 8 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

للمزيد من المعلومات: Isobaric counterdiffusion


مرض 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.
للمزيد من المعلومات: Hyperbaric medicine




الأعراض

علم الأوبئة

التاريخ

The Eads Bridge. 42 workers injured by caisson disease

المجتمع والثقافة

تأمين طبي

انظر أيضا


. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

الهوامش

[note 1] [3] }}

المصادر

  1. ^ خطأ استشهاد: وسم <ref> غير صحيح؛ لا نص تم توفيره للمراجع المسماة pmid12562679
  2. ^ خطأ استشهاد: وسم <ref> غير صحيح؛ لا نص تم توفيره للمراجع المسماة powell2008-70
  3. ^ Tables based on US Navy tables have a safety stop at 15 feet (4.6 m); BSAC tables have a safety stop at 6 metres (20 ft); Bühlmann tables have a safety stop at 3 metres (9.8 ft)

[1] [2] [3] [4] [5] [6] [7] [8] [9] [10] [11] [12] [13] [14] [15] [16] [17] [18] [19] [20] [21] [22] [23] [24] [25] [26]

[27] [28] [29] [30] [31] [32] [33] [34] [35] [36] [37] [38] [39] [40] [41] [42] [43] [44] [45]

[46] [47] [48] [49] [50] [51]

[52] [53] [54] [55] [56]

[57] [58] [59] [60] [61] [62] [63] [64] [65] [66] [67] [68] [69] [70] [71] [72] [73] [74] [75] [76] [77] [78] [79] [80] [81]

[82] [83] [84] [85] [86] [87] [88] }}

المراجع

  • الموسوعة المعرفية الشاملة
  • 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 0702025712. 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 0702025712. 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 0702025712. OCLC 51607923.
  • Marx, John (2010). Rosen's emergency medicine: concepts and clinical practice (7th ed.). Philadelphia, PA: Mosby/Elsevier. ISBN 9780323054720.
  • Powell, Mark (2008). Deco for Divers. Southend-on-Sea: Aquapress. ISBN 1905492073.

وصلات خارجية


خطأ استشهاد: وسوم <ref> موجودة لمجموعة اسمها "note"، ولكن لم يتم العثور على وسم <references group="note"/>

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  2. ^ Francis & Mitchell p. 578
  3. ^ Francis & Mitchell p. 579
  4. ^ Francis & Mitchell p. 580
  5. ^ Marx p. 1908
  6. ^ Pulley, Stephen A (27 November 2007). "Decompression Sickness". Medscape. Retrieved 15 May 2010.
  7. ^ قالب:Cite manual
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  9. ^ Powell p. 70
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