飞行员踏板运动试验ST段改变恢复时间与冠状动脉病变的关系

Relationship between recovery time of ST segment change and coronary lesions in the treadmill exercise test for pilots

目的 探讨飞行员踏板运动试验恢复期ST段改变与冠状动脉病变的关系. 方法 选取226例踏板运动试验阳性和可疑阳性的民航飞行员为研究对象,按ST段压低恢复时间分为即刻组、＜3 min组和≥3 min组.结合3组后期冠状动脉多层螺旋CT扫描血管成像（multi-slice spiral CT coronary angiography,MSCTA）及冠状动脉造影（coronary angiography,CAG）结果,进行统计分析. 结果 ①226例飞行员中,即刻组24例,＜3 min组105例,≥3 min组97例.踏板运动试验结论阳性32例,可疑阳性194例.冠状动脉造影阳性81例,冠状动脉造影阴性145例.确诊冠心病18例,结论：飞行不合格.②18例冠心病患者中,运动中及恢复期出现ST段改变者15例,恢复期≥3 min出现ST段改变者3例;63例冠状动脉粥样硬化伴狭窄中,ST段改变恢复期＜3 min能恢复至基线水平19例;ST段改变恢复期＜3 min未能恢复至基线水平者44例,其中79.55％（35/44）运动中及恢复期出现ST段改变,20.45％（9/44）恢复期≥3 min出现ST段改变.③3组MSCTA阳性率比较差异有统计学意义（χ2=63.034,P=0.000）.≥3 min组的MSCTA阳性率高于即刻组及＜3 min组（χ2=39.754、18.766,P＜0.01）;≥3 min组CAG阳性率高于＜3 min组（χ2=11.039,P=0.012）;≥3 min组的阳性预测值明显高于即刻组及＜3 min组（χ2=61.039,P＜0.01）. 结论 如果踏板运动试验使得飞行员ST段发生的改变在3min内不能恢复到基线水平,或3min恢复期后又发生ST段改变,且持续时间超过2min,提示出现冠状动脉病变的可能性大.关注恢复期ST变化及规范进行踏板试验操作对早期发现飞行员冠状动脉病变,保障飞行安全具有重要的意义.

Objective To investigate the relationship between recovery time of ST segment changes and coronary lesions for treadmill exercise test （TET）.Methods Two hundred and twentysix civil aviation pilots with TET positive or suspected positive were selected as subjects.They were divided into immediate group,〈 3 min group and ≥ 3 min group according to the ST segment depression recovery time.The examination results of multi-slice spiral CT coronary angiography （MSCTA） and coronary angiography （CAG） of 3 groups were statistically analyzed.Results ①In all 226 cases,cases of immediate group,〈3 min group and ≥3 min group were 24,105,and 97 respectively.In TET,there were 32 cases of TET positive and 194 cases of suspected positive.Eighty-one positive and 145 negative cases of coronary angiography were detected.Eighteen cases were finally diagnosed as coronary heart disease and then disqualified.②In 18 cases of coronary heart disease,15 cases of ST segment changes appeared in exercising and recovery phase and 3 cases appeared in the recovery phase longer than 3 min.In 63 cases of coronary artery atherosclerotic with stenosis,the ST segment changes,19 cases with ST segment change could recover to the baseline within 3 min and 44 cases could not.79.55% （35/44） cases with ST segment changes appeared in exercising and recovery phase and the case appeared in the recovery phase longer than 3 min accounted for 20.45% （9/44）.③ The positive incidence of MSCAT showed significant difference among 3 groups （χ2 =63.034,P=0.000）.The positive incidence of MSCTA in ≥3 min group was higher than that in immediate group and in 〈3 min group （χ2 =39.754,18.766,P〈0.01）.The positive incidence of CAG in ≥3 min group was higher than that in 〈3 min group （χ2 =11.039,P=0.012）.The predictive value of the positive in ≥3 min group was significantly higher than that in 〈 3 min group （χ2 =61.039,P〈0.01）.Conclusions For pilot＇s TET,if his ST segment change couldn＆#39;t recover to baseline within 3 min or as the ST segment change happened beyond 3 min recovery and lasted for more than 2 min,it would indicate the possibility of coronary lesions.Paying more attention on recovery of ST segment change recovery in TET and performing normative TET would be significant for early detection of coronary lesions and ensuring flight safety.