飞行人(学)员鼻科疾病诊治和医学鉴定规范

Standard on diagnosis,treatment and medical evaluation of nasal cavity and sinus diseases in aircrew and student pilots

目的规范飞行人(学)员鼻科疾病诊断、治疗和医学鉴定行为,提高航卫保障质量。方法分析我院40年飞行人(学)员鼻科疾病住院资料,借鉴国内外该领域的研究成果,总结笔者的临床航空医学经验,提出统一的操作规范。结果①飞行人员人(学)员鼻科疾病的诊断分为急性和慢性[包括慢性鼻-鼻窦炎(不伴鼻息肉)和慢性鼻-鼻窦炎(伴鼻息肉)];Ⅰ类(地面生活有症状或体征,包括Ia地面生活有症状和体征,Ib仅有体征)和Ⅱ类(地面生活无症状,飞行中出现气压伤表现,包括Ⅱa鼻窦气压伤、Ⅱb耳气压伤和Ⅱc鼻窦气压伤合并耳气压伤);鼻窦气压伤分为原发性(窦口本身病变所致)和继发性(窦口周围病变所致,包括Ⅰ型-鼻腔结构异常型、Ⅱ型-炎症型、Ⅲ型-变态反应型、Ⅳ型-肿瘤型,窦外型和窦内型),及轻度和重度。②飞行人(学)员鼻科疾病应根据急慢性、分类分型和分度特点及有无并发症采用无创或微创治疗。③飞行人(学)员鼻科疾病应根据疗效、功能检查(包括鼻窦气压功能)进行医学鉴定。结论按规范进行飞行人(学)员鼻科疾病诊断、治疗和医学鉴定,可以降低停飞率,提高复飞率。

Objective To unify proceeding on diagnosis,treatment and medical evaluation of nasal cavity and sinus diseases in aircrew and student pilots,in order to increase quality for aeromedical support.Method The medical case data kept in our hospital were analyzed from 1966 to 2007.The overseas data were refered and our experiences were summarized,in order to draw off procedure norm.Result ①The diagnosis of nasal cavity and sinus diseases were divided into acute and chronic[includeing chronic rhino-sinusitis（no polyp） and chronic rhino-sinusitis（with polyp）];Class I（with symptoms and signs on ground,including Ia with symptoms on ground,Ib only with signs on ground） and class Ⅱ（no symptoms on ground but with symptoms of secondary barotraumas while flying,including Ⅱa secondary barosinusitis,Ⅱb secondary barotrauma of ear,Ⅱc secondary barosinusitis and barotrauma of ear） in aircrew and student pilots.The barosinusitis was divided into primary（the barotraumas resulting from abnormal of sinus ostium） and secondary（the barotraumas resulting from diseases around sinus ostium,includeing type I-the type of anatomical abnormalities in nasal cavity,type Ⅱ–the type of inflammation,type Ⅲ-the type of allergy,type Ⅳ-the type of tumour;the in-sinus type and the out-sinus type）;and the mild grade and the severe grade.②The nasal cavity and sinus diseases should be treated by no-operation or minimally invasive operation in aircrew and student pilots,according to acute and chronic,classification,typing,and graduation.③The medical evaluation of nasal cavity and sinus diseases should be accomplished in aircrew and student pilots,according to effect of treatment and function test（includeing atmosphere pressure adjustment functions of nasal sinus）.Conclusion The rate of medical grounding may be decreased and the rate of recovery flying may be increased,if proceeding norm on diagnosis,treatment and medical evaluation of nasal cavity and sinus diseases can be perform in aircrew and student pilots.