FISIOLOGI

PENYELAMAN
EFEK TERHADAP HEMATOLOGY DAN BIOKIMIA DARAH
× A 14-day exposure to 5.2 % oxygen and nitrogen at pressure of 4 ATA
has been shown to cause hemoconcentration with slight elevation of
Hb, Hct, RBC, plasma proteins, and cholesterol because of a decrease
of plasma volume with diuresis. Loss of intracellular fluid has been
observed, but this reverses partially during the post-exposure period.
× Weight loss has been observed in divers compressed to 49.5 ATA (488
msw) in He-oxygen environments. This loss was shown to be 3.7–
10.2 kg in 14 days of hyperbaric exposure.
× Diuresis occurs in practically all saturation dives and is associated with natriuresis at
pressures greater than 31 ATA .Three mechanisms may be involved in the development of
this diuresis:
× 1. Inhibition of ADH release
× 2. Inhibition of tubular reabsorption of NA+ (pressure inhibits active transcapillary
transport of NA+)
× 3. Inhibition of hydrostatic action of ADH on the tubules
× Fluid loss induced by diving and/or weightlessness might also add substantially to the
pressure-induced diuresis. Because the sense of thirst is impaired in hyperbaric
environments, and the resultant fluid imbalance reduces performance of divers,
countermeasures against fluid loss should be taken during operational saturation diving.
EFEK TERHADAP METABOLISME AMMONIA
× Long-term exposure to hyperbaric conditions has
been shown to increase blood urea in US Navy
divers. This is interpreted as evidence of
hyperammonemia because urea is formed with
ammonia buffering.
EFEK TERHADAP SEL DARAH DAN TROMBOSIT
× Increase of neutrophils , blood platelets, and fibrinogen concentration
in the blood plasma immediately after diving is of temporary
character, being a typical reaction observed during diving. The values
usually return to normal spontaneously.
× Environmental stress such as cold water may contribute to platelet
activation, which plays an important role in the pathogenesis of
prethrombotic states and thus may be responsible for decompression
illness during compressed air diving.
EFEK TERHADAP RESPIRASI
× At pressures from 80 to 100 bar, oxygen transport is
likely to be compromised by changes in hemoglobin
affinity.
× Breathing of high concentrations of oxygen (pO 2 over
500 mbar) causes retention of CO2 in the tissues, which
leads to hyperventilation. However, if the subject is
exercising, reduced chemoreceptor activity leads to
impaired alveolar ventilation.
× Rapid changes in environmental pressure produce an inequality between
inspiratory and expiratory volumes; compression causes hypercapnia while
decompression causes hypocapnia. The following infl uence the respiratory
effects of pressure:
× Position of the diver. The upright position causes less dyspnea than the prone
position.
× Physical activity, which increases the tendency for CO 2 accumulation.
× Gas density. The higher the density of the gas mixture breathed, the greater
the airway resistance is; it therefore requires more energy to breathe denser
mixtures.
× The increased ventilation observed in experimental animals breathing He-
oxygen mixtures at extremely high pressures (up to 10 MPa) is responsible
for fatigue of the respiratory muscles and may lead to ventilatory failure.
× Adaptation has been shown to occur during a 14-day exposure to a high
nitrogen pressure environment of 4 ATA with naturally inspired oxygen
tensions. This modification of respiratory control is exemplifi ed by a
diminished ventilator response to CO 2 . The diminished response is more
likely related to the density of respiratory gas than to the narcotic influence
of the respired nitrogen.
× Multiple diving exposures affect both the vital capacity and the
forced rotatory flow rate of smaller lung volumes.
× This is evidence for the narrowing of the airways that may be
secondary to diving-induced loss of elasticity of the lung tissue.
× Longitudinal studies of lung function in oxygen divers have
shown that substantial exposure to elevated oxygen partial
pressure while diving is not associated with an accelerated
decline in lung function.
EFEK TERHADAP KARDIOVASKULAR
× Exposure to hyperbaric environments has been shown to cause a
variety of disturbances in the electrical activity of the mammalian
heart. Arrhythmias under these conditions are considered to be the
result of an increase in parasympathetic tone.
× Increased hydrostatic pressure also decreases excitability and
conduction through direct effects on the myocardial cell
membrane.
× Some conclusions of the studies of the effects of moderate hyperbaric exposure
on the rat heart are as follows:
× • Cardiac contractility is increased during hyperbaric exposures despite
administration of calcium and sodium channel blockers, thus reducing the
possibility of involvement of these channels in the mechanism of this effect.
Starling’s mechanism or neurotransmitter involvement was also excluded.
× • Repeated hyperbaric exposures causes hypertrophy of the heart.
× • Left ventricular pressure increased at 5 bar and the degree of rise varied with
the breathing gases used.
× • Heart rate remained unchanged in all normoxic experiments.
× Doppler-echocardiographic studies in healthy divers indicate that circulating
gas bubbles are associated with cardiac changes, suggesting a right
ventricular overload and an impairment of ventricular diastolic performance.
× Postdive humoral and hematologic changes are consistent with the
hypothesis that “silent” gas bubbles may damage pulmonary endothelium
and activate the reactive systems of the human body.
× The increased environmental pressure seems responsible for the
hemodynamic rearrangement causing reduction of cardiac output seen in
diving humans because most of the changes are observed during diving
× Left ventricular diastolic function changes suggest a
constrictive effect on the heart possibly accounting for
cardiac output reduction. Breath holding (BH) induces
progressive left ventricular (LV) enlargement both in air
and whole-body immersion, associated with reduced LV
ejection fraction and progressive hindrance to diastolic
filling
 EFEK TERHADAP ENDOKRIN
× • Increase in the circulating levels of epinephrine, norepinephrine, and dopamine.
× • Decrease in ADH secretion without a change in aldosterone excretion.
× • Severe hyperbaric conditions associated with deep dives have a profound effect on
male reproductive function due to fall in the quality of semen and oligozoospermia.
× • Decrease of thyroxine levels in the blood.
× • Increase in the insulin and angiotensin I level in plasma.
× • Increase in the circulating concentration of atrial naturetic factor (ANF, a diuretic
hormone). This may explain the diuresis observed in divers.
 EFEK KE SKELETAL
× Dysbaric osteonecrosis is a type of avascular necrosis caused by
ischemia and subsequent infarction of bone. This usually involves
the head of the femur. The disruption of blood flowin bone has been
attributed to the formation of nitrogen bubbles as a result of diving,
but blood pressure at the femoral head has been shown to be reduced
by prolonged exposure to compressed air. Dysbaric osteonecrosis
has been reported in 25 % of workers who perform in high-pressure
environments
 EFEK KE NEURO-PSIKIATRI
× Scuba diving was shown to have adverse long-term
neuropsychological effects only when performed in extreme
conditions, i.e., cold water, with >100 dives per year, and maximal
depth <40 m.
× Deterioration of both mental and motor function has been reported in
dives to 10 and 13 ATA—while breathing air and at rest. Hyperbaric
air at 7 ATA does not impair short-term or long-term memory in test
subjects, but, long-term memory is impaired at 10 ATA although it
recovers on switching to an 80/20 He-oxygen mixture.
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