民航飞行员行冠状动脉性心脏病冠状动脉旁路移植术或支架植入术后特许飞行三例

Three cases of waiver after coronary artery bypass or stent implantation

目的探讨患有冠状动脉性心脏病(以下简称冠心病)的民航飞行员行冠状动脉旁路移植术或冠状动脉支架植入术后特许飞行的航空医学鉴定和原则。方法选取3例诊断为冠心病行冠状动脉旁路移植术或冠状动脉支架植入术后特许飞行的病例,对飞行员的病史、冠心病危险因素、飞行情况和复查结果等进行分析,明确患有冠心病的民航飞行员行冠状动脉旁路移植术或冠状动脉支架植入术后特许飞行的原则。结果病例特点如下:1总飞行时间长,工作经验丰富;2年龄均>50岁;3冠状动脉狭窄程度均>80%,适宜行冠状动脉旁路移植术或冠状动脉支架植入术;4手术均成功,术后恢复良好,活动时无影响;5术后遵医嘱进行药物治疗,积极进行冠心病二级预防;6术后血管桥畅通,未发生旁路移植血管或支架内阻塞,检查均未见明显异常,放飞后飞行均正常。结论冠状动脉旁路移植术或冠状动脉支架植入术后飞行员的一般状况和飞行耐力良好,无后遗症,心血管疾病危险因素控制理想。在无明显缺血症状和缺血客观证据,严格控制飞行员各项心血管危险因素,进行专科随访、定期复查,且航空医师严密观察的前提下,可考虑批准特许飞行。

Objective To explore the evaluation and principles of waiver of commercial pilot after coronary artery bypass surgery or coronary artery stent implantation. Methods Three commercial pilots who underwent coronary artery bypass surgery or coronary artery stent implantation were enrolled in this study. The medical history, risk factors of coronary heart disease, flight condition and physical reexamination results were analyzed. Results The characteristics of the cases were as follows： ① these pilots had long total flight time and rich work experience;② their ages were more than 50 years; ③ the coronary artery stenosis was more than 80%, which was suitable for coronary artery bypass surgery or stenting;④successful surgeries and good postoperative recovery were achieved, and no impaired activity was found;⑤prescribed medication and secondary prevention of coronary heart disease were performed after surgery;⑥ no vascular occlusion or obvious abnormalities occured after surgery. The flights after surgery were successful. Conclusion A waiver considering can be given after coronary artery bypass graft or stent implantation without sequelae if： ① the pilot is in good general condition and has good flight endurance;② the pilot has controlled cardiovascular risk factors, and there is no obvious symptoms of ischemia or ischemia; and ③the pilot is in the premise of strict control of the cardiovascular risk factors, specialist follow-up, regular check and close observation by aviation doctors.