飞行员阻塞性睡眠呼吸暂停低通气综合征的临床诊治及医学鉴定

Clinical treatment and medical assessment of pilot cases with obstructive sleep apnea-hypopnea syndrome

目的回顾近年来飞行员阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的临床诊疗情况及医学鉴定,以期提高航医对本病的认识。方法收集我院2003年3月至2006年3月收治的21例OSAHS飞行员,所有患者均经多导睡眠图(PSG)确诊,依据中华医学会呼吸病学分会睡眠呼吸疾病组制定的OSAHS诊治指南(草案)进行病情分度,按不同病情程度组收集临床资料及医学鉴定结果。结果21例OSAHS患者中,轻度患者8例,均无临床主诉及症状,未经治疗,医学鉴定结果为合格。中度患者3例,重度患者10例。13例中、重度患者中,4例因睡眠异常为主诉入院;3例经过短期无创通气(NIV)治疗,6例行腭咽腔成形术(UPPP)治疗;5例医学鉴定为合格,4例为暂不合格,4例为不合格。结论阻塞性睡眠呼吸暂停低通气综合征,尤其是中、重度患者可能损害飞行操作能力,出现飞行隐患。各级航卫部门应加强对本病的认识,以便早发现,早治疗,并提出医学鉴定原则。

Objective To review the clinical treatment and medical assessment of pilots with obstructive sleep apnea-hypopnea syndrome （OSAHS） hospitalized in recent years. Methods Medical records of 21 pilot cases with OSAHS hospitalized during March 2003 to March 2006 were collected and reviewed. All cases were diagnosed by polysomnography （PSG） and grouped into mild, moderate and severe according to Diagnosis and Treatment of OSAHS Manual （protocol） drafted by Sleep Apnea Disease Group, Chinese Society of Respiratory Disease, Chinese Medical Association. Results Eight out of 21 cases were grouped as mild OSAHS, all of them had no OSAHS related chief complaint or symptoms. No treatment was given and all of them were qualified for flying. Among 3 moderate and 10 severe OSAHS cases, 4 cases were hospitalized due to OSAHS related symptoms and chief complaint, 3 cases were treated by non invasive ventilation （NIV） for a short period （10-30 d）, 6 cases were treated by uvulopalatopharyngoplasty （UPPP）. The results of medical assessment were qualified for flying 5 cases, temporal grounding 4 cases, grounding 4 cases. Conclusions OSAHS especially moderate and severe cases can compromise the performance of pilots and flying safety. The cognition of it should be strengthened in all levels of aero medical facilities, so as to improve the discovery, treatment of it and put forward a guideline for medical assessment.