倾斜试验在飞行员晕厥鉴定中的应用

Assessment of pilots with history of syncope by tilt table test

目的 将自行研制的多功能双向式倾斜床和研究确定的头高位倾斜 (HU T)试验方案用于飞行员晕厥的专项医学鉴定方面 ,以评价其实际应用效果和推广价值。 方法 对 2 2名有空中或地面晕厥史飞行员 (晕厥组 )和 2 0名健康飞行员 (对照组 )进行倾斜试验。受试者平卧于倾斜床上 ,以2 5°/s转体至头向上 75°(HU T)并作心电、血压、心率变异和经颅多普勒脑血流测量与对比分析。 结果 晕厥组飞行员的体重指数和 HUT暴露时程明显小于对照组 (P<0 .0 1) ;在 HUT暴露前平均RR间期标准差 (SDNN)在晕厥组明显小于对照组 (P<0 .0 1) ;在 HU T暴露后 ,血压、心率、心率变异性和脑血流速率指标在两组间存在明显差异 (P<0 .0 1)。本研究所采用的倾斜床试验 (TTT)技术方案 (+75°,3s,2 0 m in)对飞行员晕厥的诊断敏感性为 6 3.6 % (14/2 2 ) ,特异性为 10 0 % (2 0 /2 0 )。 结论 结合 TTT进行同步心电、血压、心率变异性和经颅彩色多普勒脑血流显像分析是有效和可行的 ,可为飞行员晕厥的专项医学鉴定提供客观、准确和定量的技术途径与判断手段 。

Objective To detect the feasibility of using tilt table test (TTT) for medical assessment of pilots with history of syncope. Methods Twenty two pilots with history of syncope (syncope group) and 20 healthy pilots (control group) were tested with self developed tilt table. The subjects lying on the table underwent passive head up tilt (HUT) up to 75° in 3 s and lasting for 20 min or up to arising of positive response. BP, HR, HRV and cerebral blood flow velocity (CBFV, measured by transcranial Doppler image) were recorded before, during and after head up tilt. Results The body mass index (BMI) and time of head up tilt during TTT in pilots of syncope group were significantly lower than those of control group. Before HUT exposure, the SDNN in syncope group was significantly less than that of control group. There were significant differences in HR, BP, HRV, CBFV between two groups on various phases of TTT. Syncope or presyncope state in the course of HUT occurred in 14/22 pilots of syncope group and none in control group. Conclusions It is suggested that TTT is effective for assessment of pilots with history of syncope. Its sensitivity is 63.6%(14/22), and specificity 100%,(20/20).