異常氣壓作業：
你必須知道的健康危害 Abnormal Pressure Work:
The Health Hazards You Must Know
「潛水夫病」這個詞，大家可能都聽過，但它背後涉及的學問，其實遠比想像中複雜。在台灣，從事潛水、隧道挖掘、到高空飛行等工作，都屬於「異常氣壓作業」。這裡將說明在高壓和低壓環境下，身體會發生什麼變化，以及台灣法規是如何保護我們的。 You may have heard of “the bends,” but the science behind it is more complex than you might think. In Taiwan, jobs like diving, tunnel excavation, and high-altitude flying are all classified as “abnormal pressure work.” This guide explains what happens to your body in high and low-pressure environments and how Taiwanese regulations protect workers.
高壓作業：氣體作怪的致命風險 High-Pressure Work: The Deadly Risks of Gas
在高壓環境下工作，例如潛水或在加壓隧道裡，你的身體會因為亨利定律，將大量的氮氣等惰性氣體溶解到血液和組織中。當你減壓速度太快時，這些溶解的氣體來不及排出，就會在體內形成氣泡，引發一系列問題。 When working in high-pressure environments, like diving or in a pressurized tunnel, your body dissolves large amounts of inert gases like nitrogen into your blood and tissues due to Henry’s Law. If you decompress too quickly, these dissolved gases can’t be expelled fast enough and form bubbles inside your body, causing a range of problems.
急性危害：減壓病（俗稱潛水夫病） Acute Hazard: Decompression Sickness (The Bends)
這就是大家熟知的「潛水夫病」。氣泡會對身體造成傷害，引發： This is commonly known as “the bends.” The gas bubbles can cause injury, leading to:
- 關節疼痛：這是最常見的症狀，疼痛劇烈難忍。Joint pain: This is the most common symptom, often severe and unbearable.
- 皮膚問題：皮膚發癢、出現紅疹。Skin problems: Itching and rashes on the skin.
- 嚴重神經病變：如果氣泡影響到中樞神經，可能會導致癱瘓、大小便失禁，甚至危及生命。Severe neurological issues: If bubbles affect the central nervous system, it can lead to paralysis, incontinence, and can even be life-threatening.
慢性危害：異壓性骨壞死 Chronic Hazard: Dysbaric Osteonecrosis
比減壓病更可怕的是一種慢性疾病：異壓性骨壞死。它通常沒有明顯症狀，但長年累月的氣泡累積會阻塞骨頭裡的微血管，導致骨頭缺氧壞死，最終造成關節塌陷和終身殘疾，需要進行人工關節置換。台北捷運工程的工人，就曾因為壓氣工法的減壓程序不當，而有大規模的骨壞死案例。 Even more dangerous than decompression sickness is a chronic condition: dysbaric osteonecrosis. It often has no obvious symptoms, but the long-term accumulation of bubbles can block microvessels in the bones, leading to bone death from oxygen deprivation. This can result in joint collapse and permanent disability, requiring joint replacement surgery. Workers on the Taipei MRT project experienced widespread cases of osteonecrosis due to improper decompression procedures in compressed air work.
低壓作業：缺氧的致命威脅 Low-Pressure Work: The Deadly Threat of Hypoxia
相對於高壓，在低壓環境下（例如高空）工作，最主要的風險是缺氧。大氣壓力降低，氧氣分壓也隨之降低，導致身體無法獲得足夠的氧氣。 Compared to high pressure, the main risk of working in a low-pressure environment (like at high altitude) is hypoxia (oxygen deficiency). As atmospheric pressure decreases, the partial pressure of oxygen also drops, preventing the body from getting enough oxygen.
高空缺氧：你只有幾秒鐘的反應時間 High-Altitude Hypoxia: You Only Have Seconds to React
在飛機座艙失壓時，機組員和乘客會瞬間暴露在極低氣壓下。這時，你能夠保持清醒並採取自救措施的時間，稱為「有效意識時間」。在海拔超過1萬公尺的高空，這個時間可能只有短短的10秒左右。一旦超過這個時間，你可能還沒昏迷，但已經因為認知功能受損而無法戴上氧氣面罩，後果不堪設想。 During a cabin depressurization in an aircraft, the crew and passengers are instantly exposed to extremely low pressure. The time you have to remain conscious and take self-rescue measures is called the “time of useful consciousness.” At altitudes above 10,000 meters (about 33,000 feet), this time can be as short as 10 seconds. Beyond this, even if you are not yet unconscious, your cognitive function may be impaired to the point where you cannot put on an oxygen mask, with dire consequences.
如何保護自己？法定健康檢查是關鍵 How to Protect Yourself? Legal Health Checks are Key
對於異常氣壓作業，台灣法規已將其列為「特別危害健康作業」，這代表雇主必須為你安排特殊的健康檢查。 For abnormal pressure work, Taiwanese law classifies it as a “special health hazard,” meaning your employer must arrange for special health examinations for you.
特別澄清：不用驗血或驗尿 Clarification: No Blood or Urine Tests
對於這種物理性危害，跟化學性危害不同，沒有特定的血液或尿液生物標記來監測。所以，健康檢查的重點在於： Unlike chemical hazards, there are no specific blood or urine biomarkers to monitor for this type of physical hazard. Therefore, the focus of the health examination is on:
- 詳細的病史詢問：檢查會仔細詢問你的工作經歷、過去有沒有氣胸、氣喘、癲癇等病史，因為這些都是在高低壓環境下工作的禁忌症。Detailed Medical History: The examination will carefully inquire about your work experience and any history of conditions like pneumothorax, asthma, or epilepsy, as these are contraindications for working in high or low-pressure environments.
- 影像學檢查：這部分特別重要。檢查會包含胸部X光來評估你的肺部狀況，以及針對資深工人進行長骨X光，來篩檢慢性的異壓性骨壞死。Imaging Tests: This part is crucial. The check-up includes a chest X-ray to assess your lung condition and, for experienced workers, long bone X-rays to screen for chronic dysbaric osteonecrosis.
綜合防護：三管齊下最安心 Comprehensive Protection: A Three-pronged Approach
要保護自己，必須遵循「控制層級」原則，從最根本的方法開始： To protect yourself, it’s essential to follow the “hierarchy of controls,” starting with the most fundamental methods:
- 工程控制（最重要）：透過工程手段來保護你。例如，在隧道工作時，使用氣閘室來控制加減壓的程序；或是在潛水時，使用飽和潛水系統來消除重複減壓的風險。Engineering Controls (Most Important): Protecting you through engineering means. For example, using airlocks in tunnel work to control compression and decompression procedures, or using saturation diving systems to eliminate the risks of repeated decompression.
- 行政管理：制定並嚴格遵守安全的作業程序。例如，使用經過驗證的減壓表，並規定合理的工時與休息時間。Administrative Controls: Establishing and strictly following safe work procedures. For example, using validated decompression tables and stipulating reasonable working hours and rest periods.
- 個人防護具（最後一道防線）：這是不可妥協的。
- 潛水員：需要配備潛水服、供氣頭盔，以及應急備用氣源，確保生命支持系統的穩定。
- 飛航組員：必須確保氧氣面罩隨時可用，並清楚知道在失壓時，你只有幾秒鐘的反應時間。
- Divers: Need to be equipped with diving suits, air-supply helmets, and an emergency backup air source to ensure the stability of the life support system.
- Flight Crew: Must ensure oxygen masks are readily available and be aware that they only have a few seconds to react during depressurization.
