Assessment of diving risks — based on selected haemostatic parameters

Безопасность ныряльщиков оценивали на основании проведения: - субъективного и объективного обследования; - оценки избранных гемостатических параметров фибринолиза; - радиологического обследования. При кратковременных погружения и погружениях в среде насыщении, а также при выполнении подводны...

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Дата:	2005
Автори:	Olszanski, R., Radziwon, P., Baj, Z., Gulyar, S., Konarski, M., Korzeniewski, K., Siermontowski, P.
Формат:	Стаття
Мова:	English
Опубліковано:	Фізико-хімічний інститут ім. О.В. Богатського НАН України 2005
Назва видання:	Актуальні проблеми транспортної медицини
Теми:	Профилактическая медицина
Онлайн доступ:	http://dspace.nbuv.gov.ua/handle/123456789/21498
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Назва журналу:	Digital Library of Periodicals of National Academy of Sciences of Ukraine
Цитувати:	Assessment of diving risks — based on selected haemostatic parameters / R. Olszanski , P. Radziwon, Z. Baj, S. Gulyar , M. Konarski, K. Korzeniewski , P. Siermontowski // Актуальні проблеми транспортної медицини. — 2005. — № 1. — С. 80-83. — Бібліогр.: 12 назв. — англ.

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Digital Library of Periodicals of National Academy of Sciences of Ukraine

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spelling	irk-123456789-214982013-02-13T02:52:07Z Assessment of diving risks — based on selected haemostatic parameters Olszanski, R. Radziwon, P. Baj, Z. Gulyar, S. Konarski, M. Korzeniewski, K. Siermontowski, P. Профилактическая медицина Безопасность ныряльщиков оценивали на основании проведения: - субъективного и объективного обследования; - оценки избранных гемостатических параметров фибринолиза; - радиологического обследования. При кратковременных погружения и погружениях в среде насыщении, а также при выполнении подводных работ, наблюдали изменения гемостатических показателей, что свидетельствует об образовании пузырьков газа в крови. Критерием оценки индивидуального риска развития декомпрессионной болезни может быть изменения гемостаза и фибринолиза кровяных пластинок, уменьшение количества тромбоцитов, увеличение процентного содержания микропластинок и экспрессии на частицах молекул ОЭ 62Р и ОЭ 61. Проведена оценка эффективности разработанных декомпрессионных режимов после моделированного погружения в насыщенной среде с использованием нитрокса, гелия и тройной смеси. 2005 Article Assessment of diving risks — based on selected haemostatic parameters / R. Olszanski , P. Radziwon, Z. Baj, S. Gulyar , M. Konarski, K. Korzeniewski , P. Siermontowski // Актуальні проблеми транспортної медицини. — 2005. — № 1. — С. 80-83. — Бібліогр.: 12 назв. — англ. 1818-9385 http://dspace.nbuv.gov.ua/handle/123456789/21498 626.02:612.015.46 en Актуальні проблеми транспортної медицини Фізико-хімічний інститут ім. О.В. Богатського НАН України
institution	Digital Library of Periodicals of National Academy of Sciences of Ukraine
collection	DSpace DC
language	English
topic	Профилактическая медицина Профилактическая медицина
spellingShingle	Профилактическая медицина Профилактическая медицина Olszanski, R. Radziwon, P. Baj, Z. Gulyar, S. Konarski, M. Korzeniewski, K. Siermontowski, P. Assessment of diving risks — based on selected haemostatic parameters Актуальні проблеми транспортної медицини
description	Безопасность ныряльщиков оценивали на основании проведения: - субъективного и объективного обследования; - оценки избранных гемостатических параметров фибринолиза; - радиологического обследования. При кратковременных погружения и погружениях в среде насыщении, а также при выполнении подводных работ, наблюдали изменения гемостатических показателей, что свидетельствует об образовании пузырьков газа в крови. Критерием оценки индивидуального риска развития декомпрессионной болезни может быть изменения гемостаза и фибринолиза кровяных пластинок, уменьшение количества тромбоцитов, увеличение процентного содержания микропластинок и экспрессии на частицах молекул ОЭ 62Р и ОЭ 61. Проведена оценка эффективности разработанных декомпрессионных режимов после моделированного погружения в насыщенной среде с использованием нитрокса, гелия и тройной смеси.
format	Article
author	Olszanski, R. Radziwon, P. Baj, Z. Gulyar, S. Konarski, M. Korzeniewski, K. Siermontowski, P.
author_facet	Olszanski, R. Radziwon, P. Baj, Z. Gulyar, S. Konarski, M. Korzeniewski, K. Siermontowski, P.
author_sort	Olszanski, R.
title	Assessment of diving risks — based on selected haemostatic parameters
title_short	Assessment of diving risks — based on selected haemostatic parameters
title_full	Assessment of diving risks — based on selected haemostatic parameters
title_fullStr	Assessment of diving risks — based on selected haemostatic parameters
title_full_unstemmed	Assessment of diving risks — based on selected haemostatic parameters
title_sort	assessment of diving risks — based on selected haemostatic parameters
publisher	Фізико-хімічний інститут ім. О.В. Богатського НАН України
publishDate	2005
topic_facet	Профилактическая медицина
url	http://dspace.nbuv.gov.ua/handle/123456789/21498
citation_txt	Assessment of diving risks — based on selected haemostatic parameters / R. Olszanski , P. Radziwon, Z. Baj, S. Gulyar , M. Konarski, K. Korzeniewski , P. Siermontowski // Актуальні проблеми транспортної медицини. — 2005. — № 1. — С. 80-83. — Бібліогр.: 12 назв. — англ.
series	Актуальні проблеми транспортної медицини
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first_indexed	2025-07-02T22:27:41Z
last_indexed	2025-07-02T22:27:41Z
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fulltext	ÀÊÒÓÀËÜÍÛÅ ÏÐÎÁËÅÌÛ ÒÐÀÍÑÏÎÐÒÍÎÉ ÌÅÄÈÖÈÍÛ � ¹ 1, 2005 ã. 8080808080 ACTUAL PROBLEMS OF TRANSPORT MEDICINE � # 1, 2005 Gas bubbles that appear in the blood during decompression, and after diving, cause changes to the haemostatic system. The level of haemostatic activation observed after decompression can be used in the verification of decompression tables, and to evaluate the risk of decompression sickness occurring in the pre- ÓÄÊ 626.02:612.015.46 ASSESSMENT OF DIVING RISKS — BASED ON SELECTEDASSESSMENT OF DIVING RISKS — BASED ON SELECTEDASSESSMENT OF DIVING RISKS — BASED ON SELECTEDASSESSMENT OF DIVING RISKS — BASED ON SELECTEDASSESSMENT OF DIVING RISKS — BASED ON SELECTED HAEMOSTATIC PARAMETERSHAEMOSTATIC PARAMETERSHAEMOSTATIC PARAMETERSHAEMOSTATIC PARAMETERSHAEMOSTATIC PARAMETERS Olszañski R (1), Radziwon P (2), Baj Z (3), Gulyar S (4), KonarskiOlszañski R (1), Radziwon P (2), Baj Z (3), Gulyar S (4), KonarskiOlszañski R (1), Radziwon P (2), Baj Z (3), Gulyar S (4), KonarskiOlszañski R (1), Radziwon P (2), Baj Z (3), Gulyar S (4), KonarskiOlszañski R (1), Radziwon P (2), Baj Z (3), Gulyar S (4), Konarski M (1), Korzeniewski K. (1), Siermontowski P (1)M (1), Korzeniewski K. (1), Siermontowski P (1)M (1), Korzeniewski K. (1), Siermontowski P (1)M (1), Korzeniewski K. (1), Siermontowski P (1)M (1), Korzeniewski K. (1), Siermontowski P (1) (1) Department of Maritime and Tropical Medicine of Military Institute of the Health Service, Gdynia, Poland, (2) Department of Hematology Medical University of Bialystok, Poland, (3) Medical University of Lodz, Poland, (4) Underwater Physiol.Dept., A.A.Bogomoletz Inst. Of Physiol. Ukr. Acad. Sci. Kiev, Ukraine. This study has been co-financed within the project 2 PO5D 10526 ÷àëè ïðàöþâàòè ïñèõîëîãè. Ìåòîäèêè ïðî- âåäåííÿ ïðîôåñ³éíîãî ïñèõîô³ç³îëîã³÷íîãî äîáîðó íàâåäåí³ ó “Ìåòîäè÷íèõ ðåêîìåíäà- ö³ÿõ ùîäî âèä³â ³ ïîðÿäêó ïðîâåäåííÿ ïñèõî- ô³ç³îëîã³÷íèõ îáñòåæåíü ³ äîáîðó ïðàö³âíèê³â ëîêîìîòèâíèõ áðèãàä”, çàòâåðäæåíèõ íàêà- çîì Óêðçàë³çíèö³. Îáñòåæåííÿ ïðîâîäÿòü íà àâòîìàòèçîâàíîìó êîìïëåêñ³ “Äîïóñê”, íà ÿêîìó ðåàë³çîâàí³ âñ³ ìåòîäèêè, âèçíà÷åí³ ó ñóì³ñíîìó íàêàç³ ÌÎÇ Óêðà¿íè òà Äåðæíàã- ëÿäîõîðîíïðàö³ “Ïåðåë³ê ðîá³ò, äå º ïîòðå- áà â ïðîôåñ³éíîìó äîáîð³”. Îáñòåæåííÿ ïðî- âîäÿòü òàêîæ ó ë³êóâàëüíèõ çàêëàäàõ çàë³ç- íèöü ë³êàð³ íåâðîïàòîëîãè òà ïñèõ³àòðè. Íà 2006 ð³ê çàïëàíîâàíî ñòâîðåííÿ ùå 6-12 ê³ìíàò ïñèõîô³ç³îëîã³÷íîãî äîáîðó ó ïåðøó ÷åðãó, â ïàñàæèðñüêèõ äåïî Óêðçàë- ³çíèö³. Ïðîãðàìîþ ïåðåäáà÷åíî ñòâîðåí- íÿ ê³ìíàò ïñèõîô³ç³îëîã³÷íîãî ðîçâàíòàæåí- íÿ ëîêîìîòèâíèõ áðèãàä ó áàçîâèõ ëîêîìî- òèâíèõ äåïî, äå çà ðåçóëüòàòàìè îáñòåæåíü ïðîâîäÿòü ïñèõîô³ç³îëîã³÷íå ðîçâàíòàæåííÿ òà, êîðåãóþ÷è çàõîäè ç ìåòîþ ïðîô³ëàêòèêè ïîðóøåíü ôóíêö³îíàëüíîãî ñòàíó, çàáåçïå- ÷åííÿ âèñîêî¿ ïðàöåçäàòíîñò³ ïðîòÿãîì ðî- áî÷î¿ çì³íè é â³äíîâëåííÿ ï³ñëÿ ¿¿ çàê³í÷åííÿ. Êîðåãóþ÷è çàõîäè ïîêàçàí³ âñ³ì ïðàö³âíèêàì òà, ñêëàäàþòüñÿ ç ìåòîä³â ïñèõîëîã³÷íî¿ ñà- ìîðåãóëÿö³¿, ïñèõîåìîö³éíîãî ðîçâàíòàæåí- íÿ é ìîá³ë³çàö³¿ òà åëåìåíò³â êîãí³òèâíîãî ïðîôåñ³éíîãî òðåí³íãó. Ïñèõîëîãè ïðîâî- äÿòü òàêîæ ïñèõîëîã³÷íå êîíñóëüòóâàííÿ, ùî ïîëÿãàº â íàäàíí³ ïðàö³âíèêó ïñèõîëîã³÷íî¿ äîïîìîãè ó âèð³øåíí³ ïðîáëåì åêçèñòåíö³- àëüíîãî õàðàêòåðó, ì³æîñîáèñò³ñíèõ êîíôë³êò³â, âíóòð³øíüî ñ³ìåéíèõ ïðîáëåì, ïðîôåñ³éíîãî îð³ºíòóâàííÿ é âèáîðó òîùî. Îñîáè, áóëè ó÷àñíèêàìè ÷è ë³êâ³äàòî- ðàìè âèðîáíè÷èõ âèïàäê³â ³ç òðàâìóâàííÿì ³/ ÷è ñìåðòåëüíèì ðåçóëüòàòîì àáî ìàëè ãîñ- òðó ïñèõîòðàâìó âèðîáíè÷îãî ÷è íåâèðîáíè- ÷îãî õàðàêòåðó íàïðàâëÿþòüñÿ íà ðåàá³ë³òà- ö³éíó ïðîãðàìó. Ó çàëåæíîñò³ â³ä òÿæêîñò³ ñòà- íó ïðàö³âíèêà ðåàá³ë³òàö³éíà ïðîãðàìà ì³ñòèòü ó ñîá³: âèçíà÷åííÿ ð³âíÿ ïðîôåñ³éíî çíà÷èìèõ ÿêîñòåé; ïñèõîëîã³÷íó ä³àãíîñòèêó é êîðåêö³þ, ïñèõîòåðàï³þ â ò.÷. ç êîãí³òèâíèì òðåí³íãîì; ô³ç³îòåðàï³þ; ïðè íåîáõ³äíîñò³ äî öüîãî äîäàþòü òðàäèö³éíó ôàðìàêîòåðàï³þ, ó òîìó ÷èñë³ ïñèõîôàðìàêîòåðàï³þ. Ãîëîâ- íîþ ìåòîþ ïñèõîòåðàï³¿ º ðåàë³çàö³ÿ ðåçåðâ- íèõ ñèë ³ ìîæëèâîñòåé ïðàö³âíèêà, â³äòâîðåí- íÿ éîãî ö³ë³ñíîñò³ ÿê îñîáèñòîñò³, ï³äâèùåí- íÿ éîãî ìîòèâàö³¿ é îïòèì³çàö³¿ åìîö³éíîãî ñòàíó. Çàâåðøåííÿ ðåàá³ë³òàö³éíî¿ ïðîãðàìè ïåðåäáà÷àº â³äíîâëåííÿ äîïóñêíîãî ð³âíÿ ïðîôåñ³éíî çíà÷èìèõ ÿêîñòåé ³ îòðèìàííÿ äîçâîëó íà ïîïåðåäí³é âèä ä³ÿëüíîñò³. Çàïëàíîâàíî ñòâîðåííÿ ðåàá³ë³òàö³é- íèõ öåíòð³â íà êîæí³é çàë³çíèö³. Íà ñüîãîäí³ äâà öåíòðè íà Äîíåöüê³é òà Ï³âäåííî-Çàõ³äí³é çàë³çíèöÿõ óæå ïðàöþþòü. Ðåàë³çàö³ÿ îñíîâíèõ çàâäàíü Ïðîãðà- ìè äàñòü çìîãó çìåíøèòè âïëèâ ëþäñüêîãî ÷èííèêà íà áåçïåêó ðóõó ïî¿çä³â çà ðàõóíîê ï³äâèùåííÿ ïðàöåçäàòíîñò³ é íàä³éíîñò³ ðî- áîòè ëîêîìîòèâíèõ áðèãàä, çáåðåæåííÿ çäî- ðîâ’ÿ òà çíèæåííÿ ð³âíÿ çàõâîðþâàíîñò³ ëî- êîìîòèâíèõ áðèãàä òà ðàö³îíàëüíî âèêîðèñ- òîâóâàòè òðóäîâ³ ðåñóðñè. clinical phase. During decompression and after completion, the blood of divers may contain a certain number of organically tolerated asymptomatic bubbles which are referred to as silent bubbles. They do not produce any pathological symptoms, but once they exceed 8181818181 ACTUAL PROBLEMS OF TRANSPORT MEDICINE � # 1, 2005 ÀÊÒÓÀËÜÍÛÅ ÏÐÎÁËÅÌÛ ÒÐÀÍÑÏÎÐÒÍÎÉ ÌÅÄÈÖÈÍÛ � ¹ 1, 2005 ã. participation of 50 divers, - seven saturated heliox dives in the Baltic Sea, with the participation of 28 divers. Simulated saturated dives differed from one another in the time of stay at plateau: from 48 hours to 119 hours 20 minutes. It was found that after 48 hours of stay in hyperbaric conditions the body of a diver gains a level of gas balance, regardless of the duration of plateau, which differed from one dive to another. The duration of decompression was planned as though divers had stayed in plateau only 48 hours and following the plateau pressure values (from 0,28MPa to 1,1 Mpa). The duration of the shortest decompression was 25 hours and 27 minutes, of the longest one — 104 hours and 16 minutes. Simulated short air dives were carried out under a pressure of 0,7 Mpa, which responds to the depth of 60 meters. The duration of stay under this pressure (plateau) was 35 minutes. The same pressure and the duration of stay (plateau) were used in simulated short trimix dives. The composition of the trimix mixture was : O2 – 22%, N2 – 42%, He-36%. The total time of decompression for both types of dives was 3 hours and 7 minutes. Saturated heliox dives were performed in the Baltic Sea during regular underwater work carried out by divers. Depending on the operations to be performed the divers remained from 20 to 40 days under a pressure of 0,83 MPa (depth of 73 m). The decompression time was equal for all the dives and was 68 hours and 23 minutes. The safety of divers was assessed on the basis of the following: - subjective and objective examination — to exclude the decompression sickness symptoms, - assessment of the selected haemostatic parameters of fibrinolysis, - radiological examinations — to exclude aseptic necrosis of the bones. The parameters determined in the environment of the hyperbaric chamber were as follows: - oxygen partial pressure, - nitrogen and helium partial pressure, - temperature in the chamber and relative humidity. Results and DiscussionResults and DiscussionResults and DiscussionResults and DiscussionResults and Discussion The examinations presented proved a statistically significant reduction in the number of blood platelets and an elevation of blood platelet sensitivity to ADP after simulated air exposures. Also after simulated air exposures an increased activation of platelets was observed the diameter of the capillaries they cause micro- emboli which cause the development of local hypoxia (2, 5, 6). The most popular and used criterion for evaluation of decompression sickness risk in divers, is the absence of decompression sickness type I symptoms (bends.) Another criterion is developed by means of detecting the presence of gas bubbles in the blood by Doppler’s test. However, gas bubbles may appear in divers even when there are no symptoms of decompression sickness (DCS) present. Again DCS may occur even with no gas bubbles detected in the Doppler’s test. This testifies to the lack of any correlation between this test and the DCS manifestation (4, 12). Other evidence indicating that the Doppler’s test and the lack of bends do not suffice to perform a safe decompression, is a manifestation of aseptic necrosis of the bones in divers after a period of time. The risk of aseptic necrosis of the bones as a late consequence of diving makes it necessary to search for other indices to recognize sub-clinical signs of gas bubbles present in the body. Selected parameters of homeostasis may be the particular index needed to identify and determine the risk of decompression sickness (7, 8). So it seems justifiable to search for changes that result from the presence of gas bubbles in the blood. The intravascular bubbles cause haemostatic changes. So in order to assess decompression sickness risk the level of blood platelet haemostasis and the level of plasmatic haemostasis in divers after decompression may be very important. Changes in the haemostatic parameters and fibrynolysis may indicate a mistaken decompression schedule, and thus may serve as a basis for the evaluation of divers safety under hyperbaric conditions (1,2,3,5,9,10,11) Material and methodsMaterial and methodsMaterial and methodsMaterial and methodsMaterial and methods The study data was obtained as a result of simulated saturated diving, using various breathing media, short simulated diving on air and trimix and saturated heliox diving (operational) in the Baltic Sea. The following were tests were carried out: : - five simulated air saturated dives, with the participation of 21 divers, - twelve simulated nitrox saturated dives, with the participation of 31 divers, - thirteen simulated heliox saturated dives, with the participation of 39 divers, - ten simulated short air dives, with the participation of 50 divers, - ten simulated short trimix dives, with the ÀÊÒÓÀËÜÍÛÅ ÏÐÎÁËÅÌÛ ÒÐÀÍÑÏÎÐÒÍÎÉ ÌÅÄÈÖÈÍÛ � ¹ 1, 2005 ã. 8282828282 ACTUAL PROBLEMS OF TRANSPORT MEDICINE � # 1, 2005 manifested as an increased component expression of the receptor to fibrinogen (ZD61), as a higher percentage of the platelets with the PADGEM molecule, an increment of the percentage of micro-platelets and of platelet aggregates, a decrease of the factor XII concentration, and a decrease in the concentration and activity of PAI-1. Analogical changes in the short dives were observed only in the divers breathing air, whereas in those breathing trimix no changes in the haemostatic parameters examined were found. After the saturated heliox and nitrox dives with no changes in the haemostatic system, some corrections to the decompression time were introduced. In some dives the correction of time allowed a reduction to the decompression time by as much as 10 hours. The haemostatic changes may be interpreted as an indicator of the decompression sickness hazard, as evidenced by the three cases of decompression sickness which occurred after the air dives. Regarding the risk of decompression sickness after the short dives to 60m depth, it is recommended that instead of air a safer breathing mixture — trimix (O 2 -22%, N 2 – 42%, He-36%) should be used. In comparison to a helium-containing breathing mixture, the use of air as a breathing medium in diving, is more liable to cause the development of decompression gas bubbles and may be the reason for the risk of decompression sickness and of aseptic necrosis of the bones to occur. Conclusions:Conclusions:Conclusions:Conclusions:Conclusions: 1. In divers subjected to simulated short and saturated dives, as well as performing underwater work in conditions of saturation, changes in a number of haemostatic parameters are observed, which may well indicate the development of gas bubbles in the blood of divers. 2. The criteria to assess an individual’s risk of decompression sickness may be the changes in platelet haemostasis and in fibrinolysis, particularly reduction of the blood platelets number, increase of the percentage of micro- platelets and of expression on platelet CD 62P and CD 61 molecules. 3. Decompression schedules after the simulated saturated dives with the use of nitrox, heliox and trimix subjected to tests are correct. Piœmiennictwo:Piœmiennictwo:Piœmiennictwo:Piœmiennictwo:Piœmiennictwo: 1. Baj Z., Olszañski R., Majewska E., Konarski M. (2000): The effect of air and nitrox divings on platelet activation tested by flow cytometry. Aviat. Space. Environ. Med. 71, 925 — 8. 2. Bookspan J. (2002): Diving and hyperbaric medicine review for physicians. Chicago, USA. 3. Bosco G., Yang Z.J., Savini F., Nubile G., Data P.G., Wang J.P., Camporesi E.M. (2001): Environmental stress on diving-induced platelet activation. Undersea Hyper. Med. 28, 4: 207 — 211. 4. Brubakk A.O., Eftedal O. (2001): Comparison of three different ultrasonic methods for quantification of intravascular gas bubbles. Undersea Hyper. Med. 28, 3, 131 — 136. 5. Doolette D. (2000): Uncertainties in predicting decompression illness. Spums J 30, 1, 31 — 36. 6.Jankowski L.W., Nishi RY., Eaton DJ., Griffin AP. (1997): Exercise during decompression reduces the amount of venous gas emboli. Undersea Hyper. Med. 24, 2, 59 — 65. 7. Kawashima M., Tamura H., Noro Y., Takao K., Yoshida K., Tsunosue T., Kitano M., Mano Y., Ehner C. (1998): Diving profile and dysbaric osteonecrosis [w:] High pressure biology and medicine (red. P. Bennett, I. Demchenko, R. Marquis), 185 — 194. 8. Kitano M., Kawashima M., Taya Y., Lehner C.E. (1998): Bone marrow changes in the tibiae of sheep with experimentally induced decompression sickness [w:] High pressure biology and medicine (red. P. Bennett, I. Demchenko, R. Marquis), 195 — 205. 9. Olszañski R., Radziwon P., Baj. Z., Kaczmarek P., Giedrojæ J., Galar M., K³oczko J. (2001): Changes in the extrinsic and intrinsic coagulation pathways in humans after decompression following saturation diving. Blood Coagul Fibrinolysis 12, 5, 1 — 6. 10. Olszañski R., Radziwon P., Galar M.,, K³os R., K³oczko J.(2002): Diving up to 60 m depth followed by decompression has no effect on pro-enzyme and total trombin activatable fibrynolysis inhibitor antigen concentrationTAFI antigen concentration Blood Coagulation and Fibronolysis, 14, 1 — 3, 2003 11. Softeland E, Framstad T, Nordvik A, Strand I, Thorsen T, Holmsen H. (1994): Nitrogen microbubbles induce a disappearance of single platelets (aggregation) with porcine platelets: a comparative study of the effects of anticoagulants and blood collection methods. Thromb. Res. 1, 76, 1, 61 — 70. 12. Stuhr L.E., Gerdts E., Nordrehaug J.E. (2000): Doppler-echocardiographic findings in professional divers. Undersea Hyper. Med. 27, 3, 131 — 5. 8383838383 ACTUAL PROBLEMS OF TRANSPORT MEDICINE � # 1, 2005 ÀÊÒÓÀËÜÍÛÅ ÏÐÎÁËÅÌÛ ÒÐÀÍÑÏÎÐÒÍÎÉ ÌÅÄÈÖÈÍÛ � ¹ 1, 2005 ã. ÐåôåðàòÐåôåðàòÐåôåðàòÐåôåðàòÐåôåðàò Ìåòîäèêà îöåíêè ðèñêîâ ïðè ïîãðóæåíè-Ìåòîäèêà îöåíêè ðèñêîâ ïðè ïîãðóæåíè-Ìåòîäèêà îöåíêè ðèñêîâ ïðè ïîãðóæåíè-Ìåòîäèêà îöåíêè ðèñêîâ ïðè ïîãðóæåíè-Ìåòîäèêà îöåíêè ðèñêîâ ïðè ïîãðóæåíè- ÿõ, îñíîâàííàÿ íà èçó÷åíèè ðÿäà ïàðà-ÿõ, îñíîâàííàÿ íà èçó÷åíèè ðÿäà ïàðà-ÿõ, îñíîâàííàÿ íà èçó÷åíèè ðÿäà ïàðà-ÿõ, îñíîâàííàÿ íà èçó÷åíèè ðÿäà ïàðà-ÿõ, îñíîâàííàÿ íà èçó÷åíèè ðÿäà ïàðà- ìåòðîâ ãåìîñòàçàìåòðîâ ãåìîñòàçàìåòðîâ ãåìîñòàçàìåòðîâ ãåìîñòàçàìåòðîâ ãåìîñòàçà Áåçîïàñíîñòü íûðÿëüùèêîâ îöåíèâàëè íà îñíîâàíèè ïðîâåäåíèÿ: - ñóáúåêòèâíîãî è îáúåêòèâíîãî îáñëåäî- âàíèÿ; - îöåíêè èçáðàííûõ ãåìîñòàòè÷åñêèõ ïàðà- ìåòðîâ ôèáðèíîëèçà; - ðàäèîëîãè÷åñêîãî îáñëåäîâàíèÿ. Ïðè êðàòêîâðåìåííûõ ïîãðóæåíèÿ è ïî- ãðóæåíèÿõ â ñðåäå íàñûùåíèè, à òàêæå ïðè âûïîëíåíèè ïîäâîäíûõ ðàáîò, íàáëþäàëè Ñåðåä ÷èííèê³â, ÿê³ âïëèâàþòü íà ð³âåíü çäîðîâ’ÿ íàñåëåííÿ, âàæëèâå ì³ñöå íàëåæèòü åëåêòðîìàãí³òíèì âèïðîì³íþâàííÿì (ÅÌÂ) [1, 2]. Îäíèì ç îñíîâíèõ íàïðÿìê³â êîìïëåêñó äîñë³äæåíü ïðè ã³ã³ºí³÷íîìó ðåãëàìåíòóâàíí³ ÅÌÂ º âèçíà÷åííÿ ôàêòè÷íî ³ñíóþ÷îãî íàâàíòàæåííÿ íà íàñåëåííÿ [3]. Ðåàëüíèì äæåðåëîì îñòàíí³õ º áåðåãîâ³ ðàä³îëîêàö³éí³ ñòàíö³¿ (ÁÐËÑ) ìîðñüêîãî ôëîòó. ÁÐËÑ ïðàöþþòü â ³ìïóëüñíîìó ðåæèì³ âèïðîì³íþâàííÿ íà äîâæèí³ õâèëü 3 òà 10 ñì ç øâèäê³ñòþ îáåðòàííÿ àíòåíè 16 îá/ õâ. Ó çâ’ÿçêó ç òèì, ùî ÁÐËÑ ðîçòàøîâàí³ ÿê ïðàâèëî íà òåðèòîð³ÿõ ïîðòó íà â³äñòàí³ 100- 1000 ì â³ä ñåëèùíèõ çîí, âîíè º äæåðåëîì åëåêòðîìàãí³òíîãî çàáðóäíåííÿ íå ò³ëüêè â ïîðòó, à é â íàñåëåíèõ ïóíêòàõ ïîáëèçó. Ïðè öüîìó åëåêòðîìàãí³òíà îáñòàíîâêà âèçíà÷àºòüñÿ òåõí³÷íèìè õàðàêòåðèñòèêàìè ñòàíö³¿, ðåæèìàìè åêñïëóàòàö³¿, óìîâàìè ðîçì³ùåííÿ, òèïîì íàâêîëèøíüî¿ çàáóäîâè, îñîáëèâîñòÿìè ðåëüºôó òà ðîñëèííîãî ïîêðèòòÿ ì³ñöåâîñò³. Ð³âåíü íàïðóæåíîñò³ åëåêòðîìàãí³òíî¿ åíåðã³¿ (ÅÌÅ) çàëåæèòü â³ä ì³ñöåçíàõîäæåííÿ äæåðåëà âèïðîì³íþâàííÿ — íà òåðèòîð³¿ íàñåëåíèõ ì³ñöü â³í ìîæå ñêëàäàòè 10 — 100 ìêÂò/ñì2. Çàáåçïå÷åííÿ íåîáõ³äíèõ ñàí³òàðíî- ã³ã³ºí³÷íèõ óìîâ ïðîæèâàííÿ íàñåëåííÿ â çîíàõ ðîçì³ùåííÿ ÁÐËÑ ïîâèííî îáóìîâëþâàòèñü íàóêîâèì îáãðóíòóâàííÿì áåçïå÷íèõ äëÿ çäîðîâ’ÿ ëþäèíè íîðìàòèâíèõ ð³âí³â íà îñíîâ³ âèçíà÷åííÿ á³îëîã³÷íî¿ ä³¿ ÅÌÂ â åêñïåðèìåíòàëüíèõ äîñë³äæåííÿõ [4, 5]. Ìåòîþ áóëà ðîçðîáêà ãðàíè÷íî äîïóñòèìîãî ð³âíÿ (ÃÄÐ) ÅÌÂ ç óðàõóâàííÿì ðåæèìó ðîáîòè ÁÐËÑ. Â åêñïåðèìåíò³â íà á³ëèõ ùóðàõ ìîäåëþâàëîñü åëåêòðîìàãí³òíå ïîëå (ÅÌÏ) 10-ñì ä³àïàçîíó. Íà îñíîâ³ àíàë³çó ïàðàìåòð³â ìîäåëüîâàíîãî ïîëÿ ç ïîçèö³é ïîãëèíåíî¿ òà ïàäàþ÷î¿ åíåðã³¿ âñòàíîâëåíî íàéìåíøèé åôåêòèâíèé ð³âåíü äëÿ óìîâ 4-õ ì³ñÿ÷íî¿ ä³¿ ïî 16 ãîäèí íà äîáó, ÿêèé äîð³âíþº 100 ìêÂò/ñì2. Çà ìåòîäîì ìàòåìàòè÷íîãî ïëàíóâàííÿ åêñïåðèìåíòó áóëè âèâ÷åí³ òàê³ ð³âí³ ÅÌÅ: 100, 500 ³ 2500 ìêÂò/ñì2. Òâàðèí ðîçïîä³ëÿëè íà ãðóïè â³äïîâ³äíî ä³þ÷îãî ð³âíÿ. Îïðîì³íåííÿ çä³éñíþâàëè äèñòàíö³éíèì ìåòîäîì, ÿêèé äîçâîëÿº çâåðõó íà âñ³õ òâàðèí ðàçîì áåç âçàºìíîãî åêðàíóâàííÿ, ùî â³äïîâ³äàº óìîâàì ä³¿ ôàêòîðà íà íàñåëåííÿ. Àíàë³ç îòðèìàíèõ ðåçóëüòàò³â ïîêàçàâ, ùî ó âñ³õ ï³ääîñë³äíèõ òâàðèí çìåíøóºòüñÿ ïðèð³ñò ìàñè ò³ëà â ïîð³âíÿíí³ ç êîíòðîëåì. Ñïîñòåð³ãàâñÿ ðîçâèòîê ïðîöåñ³â ãàëüìóâàííÿ â öåíòðàëüí³é íåðâîâ³é ñèñòåì³, çíèæåííÿ ðóõîìî¿ àêòèâíîñò³. Ïðè ïðîäîâæåíí³ âïëèâó âèïðîì³íþâàííÿ õàðàêòåð â³äïîâ³äíî¿ ðåàêö³¿ íà 3-ìó — 4-ìó ì³ñÿöÿõ ï³äâèùóºòüñÿ ïîð³ã åëåêòðîøê³ðÿíî¿ ÷óòëèâîñò³. ÓÄÊ 613.047 ÁÅÐÅÃÎÂ² ÐÀÄ²ÎËÎÊÀÖ²ÉÍ² ÑÈÑÒÅÌÈ ÌÎÐÑÜÊÎÃÎ ÔËÎÒÓ ßÊÁÅÐÅÃÎÂ² ÐÀÄ²ÎËÎÊÀÖ²ÉÍ² ÑÈÑÒÅÌÈ ÌÎÐÑÜÊÎÃÎ ÔËÎÒÓ ßÊÁÅÐÅÃÎÂ² ÐÀÄ²ÎËÎÊÀÖ²ÉÍ² ÑÈÑÒÅÌÈ ÌÎÐÑÜÊÎÃÎ ÔËÎÒÓ ßÊÁÅÐÅÃÎÂ² ÐÀÄ²ÎËÎÊÀÖ²ÉÍ² ÑÈÑÒÅÌÈ ÌÎÐÑÜÊÎÃÎ ÔËÎÒÓ ßÊÁÅÐÅÃÎÂ² ÐÀÄ²ÎËÎÊÀÖ²ÉÍ² ÑÈÑÒÅÌÈ ÌÎÐÑÜÊÎÃÎ ÔËÎÒÓ ßÊ ÄÆÅÐÅËÎ ÂÏËÈÂÓ ÅËÅÊÒÐÎÌÀÃÍ²ÒÍÈÕ ÂÈÏÐÎÌ²ÍÞÂÀÍÜ ÍÀÄÆÅÐÅËÎ ÂÏËÈÂÓ ÅËÅÊÒÐÎÌÀÃÍ²ÒÍÈÕ ÂÈÏÐÎÌ²ÍÞÂÀÍÜ ÍÀÄÆÅÐÅËÎ ÂÏËÈÂÓ ÅËÅÊÒÐÎÌÀÃÍ²ÒÍÈÕ ÂÈÏÐÎÌ²ÍÞÂÀÍÜ ÍÀÄÆÅÐÅËÎ ÂÏËÈÂÓ ÅËÅÊÒÐÎÌÀÃÍ²ÒÍÈÕ ÂÈÏÐÎÌ²ÍÞÂÀÍÜ ÍÀÄÆÅÐÅËÎ ÂÏËÈÂÓ ÅËÅÊÒÐÎÌÀÃÍ²ÒÍÈÕ ÂÈÏÐÎÌ²ÍÞÂÀÍÜ ÍÀ ÍÀÑÅËÅÍÍßÍÀÑÅËÅÍÍßÍÀÑÅËÅÍÍßÍÀÑÅËÅÍÍßÍÀÑÅËÅÍÍß Äóìàíñüêèé Þ.Ä., Òîìàøåâñüêà Ë.À.Äóìàíñüêèé Þ.Ä., Òîìàøåâñüêà Ë.À.Äóìàíñüêèé Þ.Ä., Òîìàøåâñüêà Ë.À.Äóìàíñüêèé Þ.Ä., Òîìàøåâñüêà Ë.À.Äóìàíñüêèé Þ.Ä., Òîìàøåâñüêà Ë.À. ²íñòèòóò ã³ã³ºíè òà ìåäè÷íî¿ åêîëîã³¿ ³ì.Î.Ì.Ìàðçåºâà ÀÌÍ Óêðà¿íè, Êè¿â èçìåíåíèÿ ãåìîñòàòè÷åñêèõ ïîêàçàòåëåé, ÷òî ñâèäåòåëüñòâóåò îá îáðàçîâàíèè ïóçûðü- êîâ ãàçà â êðîâè. Êðèòåðèåì îöåíêè èíäèâè- äóàëüíîãî ðèñêà ðàçâèòèÿ äåêîìïðåññèîí- íîé áîëåçíè ìîæåò áûòü èçìåíåíèÿ ãåìîñ- òàçà è ôèáðèíîëèçà êðîâÿíûõ ïëàñòèíîê, óìåíüøåíèå êîëè÷åñòâà òðîìáîöèòîâ, óâå- ëè÷åíèå ïðîöåíòíîãî ñîäåðæàíèÿ ìèêðî- ïëàñòèíîê è ýêñïðåññèè íà ÷àñòèöàõ ìîëåêóë CD 62P è CD 61. Ïðîâåäåíà îöåíêà ýôôåê- òèâíîñòè ðàçðàáîòàííûõ äåêîìïðåññèîííûõ ðåæèìîâ ïîñëå ìîäåëèðîâàííîãî ïîãðóæå- íèÿ â íàñûùåííîé ñðåäå ñ èñïîëüçîâàíèåì íèòðîêñà, ãåëèÿ è òðîéíîé ñìåñè.

Assessment of diving risks — based on selected haemostatic parameters

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