心肌缺血的评定方法在飞行人员医学鉴定中的意义

The significance of diagnostic methods of myocardial ischemia in medical assessment of aircrew

目的探讨有胸痛症状或心电图异常的飞行人员采用的常用临床指标和冠状动脉造影对飞行结论的诊断价值.方法1991～2004年50例行冠状动脉造影的飞行人员患者,根据其心前区不适和(或)无创性检查提示可能存在心肌缺血分为仅有检查异常组、仅有症状组和症状检查均异常组,比较3组间的冠状动脉造影正常率以及对飞行结论的影响;按飞行结论的不同比较心血管危险因素、负荷试验结果和冠状动脉造影狭窄的发生率.结果3组冠状动脉造影正常率分别为94%、71%和60%,差异有显著性意义(P＜0.01);飞行结论不合格人员中危险因素、胸痛、冠状动脉狭窄的发生率明显多于合格者(P＜0.01,P=0.01和P＜0.01),心电图ST-T改变和负荷试验阳性率差异无显著性意义.结论飞行鉴定中要重视有胸痛症状合并有心电图、负荷试验异常者,并结合危险因素综合判断;因造影的结果直接影响到飞行结论,应积极而合理地进行冠状动脉造影.

Objective To investigate the roles of chest pain, ECG, treadmill test and coronary angiography（CAG） in medical assessment of aircrew with suspected coronary heart disease（CHD）. Methods Fifty aircrew cases underwent coronary angiography in 1991- 2004 were divided into 3 groups： ①cases （group A, n= 16） only with abnormal findings in non-invasive test for CHD; ②cases （group B, n = 14） only with chest pain symptom; ③ cases （group C, n = 20） with both ab/aormal findings and symptoms. The normal rate of coronary artery angiography and the influence on conclusion of flying status in 3 groups were compared. In addition, the correlations between conclusion of flying status （qualified or disqualified） and clinical features of aircrew were calculated. Results The normal rates of coronary angiography in 3 groups were 94%, 71% and 60% respectively. The differences among them were significant. As compared with qualified for flying group, the incidences of having risk factors, chest pain and coronary stenosis were significantly higher in disqualified group; however the differences between incidences of abnormal EEG, exercise test finding of two groups were non-significant. Conclusions During medical assessment of suspected CHD, attention should be paid to aircrew having obvious precordial symptoms together with multiple risk factors. Coronary angiography, a kind of invasive diagnostic method but of decisive value for conclusion on flying status, should be used more actively and reasonably in aircrew with suspected CHD.