鼻窦气压伤的研究进展

Research progress of sinus barotrauma

目的 回顾国内外有关鼻窦气压伤(sinuses barotrauma,SB)的研究进展,提出进一步的研究建议. 资料来源与选择 国内外公开发表的相关专著、研究论文、综述和标准. 资料引用 引用标准1项,公开发表文献57篇. 资料综合 阐述有关SB的历史演变和流行病学,比较了SB的发病率及各鼻窦SB的构成比；探讨SB病理损伤分级,结合临床航空医学,将SB分为轻、重两度,并依据原发性和继发性病变进行了分型；分析SB病因及病理生理学,概述SB临床表现、影响因素及并发症；总结SB的鉴别手段与诊断方法,如内窥镜广泛应用于SB的诊断及治疗,SB临床路径的提出及《职业性航空病诊断标准》的颁布,使SB诊治更加规范化；综述SB防治措施和航空医学鉴定方面的文献,对低压舱检查的注意事项和飞行人员SB航空医学鉴定原则进行了概括. 结论 SB的诊疗水平有了较大提高,航空医学鉴定趋于规范化,飞行人员停飞率明显降低,但有关不同升降高度和速率所致SB的发病特点有待进一步研究.

Objective To summarize the research progress of sinus barotrauma (SB) and give the advices for further research.Literature resource and selection Monographs,research papers,reviews and standard in this field published at home and abroad.Literature quotation One standard and fifty seven published papers were cited.Literature synthesis The viewpoints of historical evolution and epidemiology of SB were illustrated.While,the incidences of SB in aviation and maritime medicine as well as in civil and military flights were compared between China and foreign countries.The composition ratio of SB was analyzed in different sinuses.The different viewpoints of pathological damage classification were sort out.According to clinical aviation medicine,SB was rated as mild and severe.Then,it was classified according to the primary and secondary pathology.Pathogenesis and pathophysiology of SB were analyzed.Clinical manifestations,influencing factors and complication of SB were generally stated.Identification and diagnosis methods were generalized,such as endoscopy,was widely used in the diagnosis and treatment of SB.With proposing the clinical pathways of SB and promulgating "Diagnosis Standards of Occupational Aviation Disease" of SB in recent years,the diagnosis and treatment level of the SB was more standardized.The kinds of prevention measures and medical identifications of SB were reviewed.The cautions on hypobaric chamber test and the principle of medical evaluations of SB for flying personnel were summarized.Conclusions The diagnosis and treatment levels of SB have had a great progress,the medical identification become standardized,and flying personnel's grounding rate due to SB have obviously declined.However,it is necessary to take the further studies on the disease features of SB induced by altitude change and change rate.