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1.病例报告 患者男,28岁,潜水工龄10年,因着管供式轻潜水装具不减压反复潜水4h,水深约25m,重体力劳动。未减压出水后出现胸闷、憋气、双下肢不能活动,剑下皮肤麻木、腹胀、无大小便及肛门排气1天。入院,查体:T36。5℃,P 90次/分,BP 18/11kPa,表情痛苦,被动体位,心肺(-),蛙状腹,脐周皮肤青紫,腹部叩诊鼓音,肠鸣音减弱,双下肢肌力0级,剑下痛、温、触觉消失,病理反射未引出。诊断:脊髓型减压病伴胃肠气压伤。立即采用我国加压治疗表Ⅵ吸氧方案加压治疗。同时给予导尿、抗凝剂,补钾等治疗,舱压升至0.7MPa,腹胀基本缓解,随着减压腹胀渐又出现。出舱后剑下痛、温、触觉改善,双下肢肌力Ⅰ～Ⅱ级,脐周青紫消失,余体征同加压治疗前。给予胃肠减压,肛管排气,维持水与电解质平衡,持续吸O_2等综合治疗,腹胀无明显缓解。于住院第4天再次采用同一方案加压治疗。但在压力降至0.08MPa时到加压治疗结束,多次扶舱壁站立并有6次肛门排气,增加腹压时排气
1. Case report Male, 28 years old, diving length of 10 years, due to tube-type diving diving equipment without decompression repeated diving 4h, water depth of about 25m, heavy manual labor. Chest tightness, suffocation, no lower extremity activity, numbness of the skin under the sword, abdominal distension, absence of urine and anal exhaust for 1 day after decompression of effluent. Admission, physical examination: T36.5 ℃, P90 beats / min, BP18 / 11kPa, painful facial expression, passive body position, cardiopulmonary (-), frog belly, periapical skin bruising, abdominal percussion drumming, , Lower limb muscle strength 0, swords under the pain, warm, touch disappears, pathological reflex did not lead. Diagnosis: Spinal cord decompression sickness with gastrointestinal pressure injury. Immediately use our pressurized table Ⅵ oxygen therapy pressure treatment. At the same time give catheterization, anticoagulants, potassium and other treatment, cabin pressure rose to 0.7MPa, abdominal distension basically relieved, with decompression abdominal distention gradually emerged. After the sword out of the capsule pain, warm, tactile improvement, lower extremity muscle strength Ⅰ ~ Ⅱ level, umbilical weeks blue disappeared, I sign with the pressure before treatment. Gastrointestinal decompression, anal canal exhaust, maintaining water and electrolyte balance, continuous suction O_2 and other comprehensive treatment, no significant relief of abdominal distension. On the 4th day of hospitalization, the same regimen was used again for pressure treatment. However, when the pressure dropped to 0.08MPa to the end of the pressure treatment, several times to hold the bulkhead wall and there are 6 anus exhaust, increased abdominal pressure exhaust