冠状动脉支架植入术在军事飞行人员中的应用及医学鉴定

Aero-medical assessment of military aviators with coronary heart disease after percuteneous coronary artery stents

目的初步探讨冠状动脉粥样硬化性心脏病（CHD）军事飞行人员支架术后医学鉴定的原则及方法。方法回顾分析7例低性能飞机军事飞行人员患CHD经支架术治疗后医学鉴定情况,随访观察恢复飞行情况,探讨其医学鉴定原则。结果 7例飞行人员冠心病患者41~55岁,诊断为无症状性心肌缺血3例,不稳定性心绞痛2例,急性前壁心肌梗死1例,急性广泛前壁心肌梗死1例;冠脉造影证实冠脉1支病变4例（其中1例分叉病变）,2支病变1例,3支病变2例。均分别行介入治疗,植入支架1~5枚,术后规律经他汀类药物降血脂、阿司匹林＋氯吡格雷双联抗血小板聚集、β受体阻断剂等药物治疗,经1个月康复疗养及6个月地面观察,返院化验血脂、血糖、肝肾功、血尿酸,复查心电图、次极量平板运动试验、ECT负荷心肌扫描、Holter、冠脉造影等检查,对其中4例无明显冠脉狭窄、病情平稳无临床症状、无心肌缺血客观表现、心血管系统功能正常,且冠心病危险因素控制良好者予以有条件恢复飞行,随访22~48个月,平均年飞行120~400 h,飞行耐力良好。结论低性能飞机军事飞行人员CHD患者经冠脉支架术行完全血运重建,术后恢复良好,心血管功能正常,危险因素得到有效控制,再发心血管事件风险显著减低,可在严格医学监督下恢复飞行。

Objective We aimed to study the principles and methods of aero-medical assessment of military aviators with coronary heart disease（CHD） after percuteneous coronary artery stents. Methods Clinical data about 7 military aviators of low performance aircrafts with CHD diagnosed by coronary angiography and performed with percuteneous coronary artery stents was analyzed. These aviators were followed up to further establish the principles of aero-medical assessment for their re-fl ying.Results 7 aviators aged from 41 to 55 years old,including 3 cases with latent coronary heart disease,2 cases with unstable angina,1 case with anterior wall acute myocardial infarction and 1 case with extensive anterior wall acute myocardial infarction.There were 4 cases with single-vessel lesion（including 1 bifucationg leision）,1 case with two-vessel lesion and 2 cases with three-vessel lesion.These aviators were all performed with percuteneous coronary artery stents and implanted 1-5 stents.After stent implantation,they were regularly treated with statins,aspirin,clopidgrel and betablocker after stents.After 1 month recovery and 6 month follow-up,ECG,treadmill exercise testing, ECT treadmill exercise testing,Holter and coronary angiography were done in these aviators.4 aviators with good cardiovascular function and well controlled risk factors return to flight under medical monitoring.With 22~48 months follow-up,they f lew 120~400 hours per-year with good f lying tolerances.Conclusion Military aviators of low performance aircrafts can return to flight under medical monitoring after complete revascularization by stents with good cardiovascular function,and well-controlled risk factors.