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Patologias disbáricas : alterações da função auditiva dos enfermeiros expostos a ambiente hiperbárico
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Introdução — A oxigenoterapia hiperbárica (OHB) é uma modalidade terapêutica que consiste na inalação de oxigênio puro (02 a 100%) a uma pressão superior à pressão atmosférica ao nível do mar, no interior de uma câmara hiperbárica. O trabalho em meio hiperbárico é considerado uma atividade de risco elevado. Os profissionais que trabalham em condições hiperbáricas estão sujeitos ao risco de poderem vir a desenvolver determinadas doenças profissionais, devido ás variações fisicas de pressão, a inalação de gases sob pressão, a variações de temperatura e da humidade do ar ambiente. Desta forma, torna-se necessário que a aptidão médica para exercer atividade em meio hiperbárico, seja um garante que o trabalhador apresenta boas condições de saúde, não o colocando em perigo durante a atividade operacional. Objetivos - Na elaboração deste estudo, foram delineados os seguintes objetivos: Avaliar eventual existência e determinar a incidência de patologias disbáricas, relacionadas com o sistema auditivo, manifestadas por um grupo de profissionais de saúde (enfermeiros), sujeitos de forma prolongada e repetitiva à exposição a ambiente hiperbárico; Determinar qual a relação entre o binómio número de sessões/tempo de exposição individual dos enfermeiros a ambiente hiperbárico (à 2,5 ATA e 100 minutos) e a manifestação de sintomatologia que evidencie patologias do sistema auditivo; Relacionar a eventual incidência de patologias disbáricas com a existência de comorbilidades; Métodos — Foi efetuado um estudo de coorte longitudinal e retrospetivo, correspondente a um período de oito anos (janeiro 2010 - dezembro 2017), que decoreu no Centro de Medicina Subaquática e Hiperbárica. A população alvo abrangida, incluiu um universo de 59 enfermeiros, de ambos os sexos. O grupo de estudo foi constituído por 21 enfermeiros, expostos de forma prolongada e repetitiva a ambiente hiperbárico (à 2,5 ATA e 100 minutos), durante o período do estudo. O grupo de controlo, contemplou 38 enfermeiros que nunca foram expostos a ambiente hiperbárico. Toda a população estudada efetuou dois ou mais audiogramas e timpanogramas, com um intervalo mínimo de 2 anos, durante o período em que decorreu o estudo e efetuaram pelo menos uma observação em consulta de ORL. Toda a sintomatologia sugestiva de patologia disbárica do foro da especialidade ORL foi registada, bem como as ocorrências de BTOM. A análise estatística dos resultados foi dos resultados foi descritiva. Os parâmetros avaliados foram a média e as frequências absoluta e relativa. Resultados — A média de idades foi de 35,5 anos para o grupo em estudo e de 29,1 para o grupo de controlo. Verificou-se uma maior prevalência de enfermeiros do sexo masculino no grupo de estudo em relação ao grupo de controlo (75% versus 55,2%). Verificou-se que 16 enfermeiros pertencentes ao grupo de estudo (76,2%), foram ou estavam medicados parcialmente ou na totalidade do período em que decorreu o estudo, comparativamente com 23,7 % do grupo de controlo. Em ambos os grupos as comorbilidades com maior prevalência foram a rinite alérgica e o desvio do septo nasal. Os enfermeiros pertencentes ao grupo de controlo mantiveram registos com um perfil audiológico e de pressão no OM, constantes durante o período em que decorreu o estudo. No grupo de estudo foram encontradas alterações ligeiras, sem significado clínico relevante, nos exames de avaliação audiológica efetuados. Há registo de quatro episódios de BTOM, todos ––unilaterais, no universo de enfermeiros do grupo de estudo, não se tendo verificado recorrências. Conclusões - Na população avaliada, verificou-se uma incidência pouco expressiva e de baixa gravidade de lesões no sistema auditivo que possam estar associadas a lesões disbáricas ou à exposição a elevados níveis de ruido. Constatou-se não haver relação entre o binómio número de sessões/tempo de exposição a ambiente hiperbárico e as alterações da função auditiva. Não existiu relação direta entre o binómio número de sessões/tempo de exposição a ambiente hiperbárico e a ocorrência de episódios de Barotraumatismo do Ouvido Médio. Considera-se fundamental a transposição para a legislação nacional das normas associadas à avaliação médica periódica destes profissionais de saúde, bem como a realização de estudos prospetivos, que permitam aferir de forma objetiva o eventual impacto da exposição ao ambiente hiperbárico na sua saúde.
Introduction — Hyperbaric Oxygen Therapy (HBOT) is a therapeutic modality consisting of inhalation of pure oxygen (100%) at a pressure higher than atmospheric pressure at sea level within a hyperbaric chamber. Working in a hyperbaric environment is considered a high risk activity. Professionals working in hyperbaric conditions are at risk of developing certain occupational diseases due to physical pressure variations, inhalation of pressurized gases, temperature and ambient air humidity variations. Thus, it is necessary that the medical aptitude to exercise in hyperbaric environment, is a guarantee that the worker presents good health conditions, don 't putting him in danger during the operational activity. In preparation of this study, the following objectives were outlined: Evaluate the possible existence and determine the incidence of dysbaric disorders related to the hearing system, manifested by a group of health professionals (nurses), who were subjected to prolonged and repetitive exposure to hyperbaric environment; Determine the relationship between the number of sessions/time of individual exposure of nurses to a hyperbaric environment (Ž 2.5 ATA and 100 minutes) and the manifestation of symptoms that show pathologies of the hearing system; Relate the possible incidence of dysbaric pathologies with the existence of comorbidities. Methods - A longitudinal and retrospective cohort study was conducted over a period of eight years (January 2010 - December 2017), which took place at Centro de Medicina Subaquática e Hiperbárica. The target population covered included a universe of 59 male and female nurses. The study group consisted of 21 nurses, exposed to a hyperbaric environment (È 2.5 ATA and > 100 minutes) during the study period. The control group included 38 nurses who were never exposed to a hyperbaric environment. All nurses in the study group performed two or more audiograms and tympanograms at least 6 months apart during the study period and made at least one observation in ENT consultation. All symptomatology suggestive of dysbaric pathology of the ENT specialty was recorded, as well as occurrences of BTOM. Statistical analysis of the results was descriptive. The evaluated parameters were the average and the absolute and relative frequencies. Results - The mean age was 35.5 years for the study group and 29.1 for the control group. There was a higher prevalence of male nurses in the study group compared to the control group (75% versus 55.2%). It was found that 16 nurses from the study group (76.2%) were partially or fully medicated during the study period, compared with 23. 0/0 of the control group. In both groups the most prevalent comorbidities were allergic rhinitis and nasal septum deviation. The nurses in the control group kept records with an audiological and pressure profile in the 0M, constant during the study period. In the study group, slight alterations with no relevant clinical significance were found in the audiological assessment performed. There were four unilateral BTOM episodes in the study group of nurses, with no recurrences. Conclusions - In the evaluated population, there was a low severity incidence of damage to the hearing system that may be associated with dysbaric lesions or exposure to high noise levels. There was no relationship between the number of sessions / time of exposure to hyperbaric environment and the changes in hearing system. There was no direct relationship between the binomial number of sessions / time of exposure to the hyperbaric environment and the occurrence of Middle Ear Barotraumatism episodes. It is considered essential to transpose into national legislation the norms associated with the periodic medical assessment of these health professionals, as well as to conduct prospective studies that allow the objective assessment of the possible impact of exposure to the hyperbaric environment on their health.
Introduction — Hyperbaric Oxygen Therapy (HBOT) is a therapeutic modality consisting of inhalation of pure oxygen (100%) at a pressure higher than atmospheric pressure at sea level within a hyperbaric chamber. Working in a hyperbaric environment is considered a high risk activity. Professionals working in hyperbaric conditions are at risk of developing certain occupational diseases due to physical pressure variations, inhalation of pressurized gases, temperature and ambient air humidity variations. Thus, it is necessary that the medical aptitude to exercise in hyperbaric environment, is a guarantee that the worker presents good health conditions, don 't putting him in danger during the operational activity. In preparation of this study, the following objectives were outlined: Evaluate the possible existence and determine the incidence of dysbaric disorders related to the hearing system, manifested by a group of health professionals (nurses), who were subjected to prolonged and repetitive exposure to hyperbaric environment; Determine the relationship between the number of sessions/time of individual exposure of nurses to a hyperbaric environment (Ž 2.5 ATA and 100 minutes) and the manifestation of symptoms that show pathologies of the hearing system; Relate the possible incidence of dysbaric pathologies with the existence of comorbidities. Methods - A longitudinal and retrospective cohort study was conducted over a period of eight years (January 2010 - December 2017), which took place at Centro de Medicina Subaquática e Hiperbárica. The target population covered included a universe of 59 male and female nurses. The study group consisted of 21 nurses, exposed to a hyperbaric environment (È 2.5 ATA and > 100 minutes) during the study period. The control group included 38 nurses who were never exposed to a hyperbaric environment. All nurses in the study group performed two or more audiograms and tympanograms at least 6 months apart during the study period and made at least one observation in ENT consultation. All symptomatology suggestive of dysbaric pathology of the ENT specialty was recorded, as well as occurrences of BTOM. Statistical analysis of the results was descriptive. The evaluated parameters were the average and the absolute and relative frequencies. Results - The mean age was 35.5 years for the study group and 29.1 for the control group. There was a higher prevalence of male nurses in the study group compared to the control group (75% versus 55.2%). It was found that 16 nurses from the study group (76.2%) were partially or fully medicated during the study period, compared with 23. 0/0 of the control group. In both groups the most prevalent comorbidities were allergic rhinitis and nasal septum deviation. The nurses in the control group kept records with an audiological and pressure profile in the 0M, constant during the study period. In the study group, slight alterations with no relevant clinical significance were found in the audiological assessment performed. There were four unilateral BTOM episodes in the study group of nurses, with no recurrences. Conclusions - In the evaluated population, there was a low severity incidence of damage to the hearing system that may be associated with dysbaric lesions or exposure to high noise levels. There was no relationship between the number of sessions / time of exposure to hyperbaric environment and the changes in hearing system. There was no direct relationship between the binomial number of sessions / time of exposure to the hyperbaric environment and the occurrence of Middle Ear Barotraumatism episodes. It is considered essential to transpose into national legislation the norms associated with the periodic medical assessment of these health professionals, as well as to conduct prospective studies that allow the objective assessment of the possible impact of exposure to the hyperbaric environment on their health.
Descrição
Tese de mestrado, Medicina Hiperbárica e Subaquática, Universidade de Lisboa, Faculdade de Medicina, 2020
Palavras-chave
Oxigenoterapia hiperbárica Câmara hiperbárica Ambiente hiperbárico Patologias disbáricas Sistema auditivo Teses de mestrado - 2020