飞行人（学）员颅脑损伤16例分析及航空医学鉴定标准探讨

On aeromedical evaluation of 16 cases of aircrews （students） with traumatic brain injury and standard discussion

目的 探讨飞行人员颅脑损伤（traumatic brain injury,TBI）的医学鉴定标准. 方法 回顾分析2004年1月至2013年10月在空军总医院住院治疗的16例飞行人（学）员TBI的临床资料,并复习相关文献. 结果 16例TBI飞行人（学）员中重度5例,中度2例,轻度9例.飞行合格8例,暂时飞行不合格1例,飞行不合格7例.①5例重度TBI中4例有脑挫裂伤;其中1例合并颅内血肿并在10年后发生脑外伤后癫痫（post-traumatic epilepsy,PTE）,1例合并颅骨骨折、面神经、位听神经损伤,1例合并硬膜外血肿,1例合并嗅神经损伤.另1例颞骨骨折、硬膜外血肿;1例飞行合格,1例暂时飞行不合格,3例飞行不合格.②中度2例,均有30 min至24 h的意识丧失,1例继发脑外伤后综合征（post-traumatic brain injury syndrome,PTBIS）;1例飞行合格,1例飞行不合格.③轻度9例,4例无意识丧失,但其中3例继发PTBIS;5例意识丧失时间均在30 min内,其中2例继发PTBIS（1例合并继发PTE）;6例飞行合格,3例飞行不合格. 结论 飞行人员TBI医学鉴定要根据病情轻重,是否有后遗症,结合飞行机种、职别、飞行经验、个人意向及相关标准个别评定.

Objective To explore the aeromedical evaluation standard of the aircrews with traumatic brain injury （TBI）.Methods The clinic data of 16 cases of aircrews （students） with TBI were analyzed and related literatures were reviewed.Results In 16 TBI cases,the severe took 5 cases while the moderate and the mild was 2 and 9 respectively.The medical evaluation concluded 8 qualified cases and 1 temporarily grounding.The rest 7 were disqualified.①Four of 5 severe TBI cases had cerebral contusion：one was complicated by intracranial hematoma and he suffered posttraumatic epilepsy （PTE） by a traumatic brain injury 10 years later,one was combined with skull fracture,facial nerve and acoustic nerve damage,one was with olfactory nerve damage,and one was with epidural hematoma.The rest 1 had epidural hematoma combined with skull fracture.One case was qualified,1 was temporarily grounding and 3 were disqualified.②Two moderate cases had the lost consciousness experience for 30 min to 24 h.One had post-traumatic brain injury syndrome （PTBIS）.One case was qualified and another one disqualified.③Four of 9 mild cases were conscious,but 3 of them had PTBIS.Other five cases were unconsciousness within 30 min.Two of them had PTBIS and 1 had PTE.Six mild cases were qualified and another 3 were disqualified.Conclusions TBI aeromedical evaluation should be individually decided according to the severity,sequel and refer to aircraft type,duty in flight,experience and personal desire,as well as the related standards.