民航飞行员颅内未破裂动脉瘤的相关危险因素及外科干预研究进展

Research progress on the related risk factors and surgical treatment for the civil pilots with unruptured intracranial aneurysm

目的 综述近年来国内外颅内未破裂动脉瘤（unruptured intracranial aneurysm,UIA）的分类、相关危险因素及外科干预方案,为我国民航飞行员UIA的外科治疗方案与体检鉴定原则提供依据. 资料来源与选择 国内外该领域的相关文献. 资料引用 引用公开发表的文献19篇.资料综合 颅内动脉瘤是自发性蛛网膜下腔出血的常见原因之一,其确切的发病机制、影响因素仍不清楚.现代流行病学研究表明,UIA与破裂动脉瘤的自然病程、治疗方案及预后是完全不同的.近年来,UIA的发病率和患病率都有升高的趋势,影像技术的广泛应用改善了对UIA的诊断.UIA可分为3类：①偶然发现的无症状性动脉瘤;②表现为占位、不适和梗死等症状的UIA;③因蛛网膜下腔出血而发现的颅内多发动脉瘤中未破裂的动脉瘤.UIA破裂的相关危险因素包括：动脉瘤的直径、发生位置、高血压病、发病年龄、种族与性别差异及形成时间等. 结论 不同人群UIA的相关危险因素及外科干预治疗方案也不尽相同.民航飞行员的UIA外科干预原则：①动脉瘤直径＞5 mm;②动脉瘤直径≤5 mm,应根据动脉瘤症状、发生部位、体/颈比值等制订不同的治疗方案.

Objective To review the classification,the related risk factors and surgical intervention of unruptured intracranial aneurysms （UIA） upon the cases at home and aboard and to guide the treatment and physical examination assessment principle for China＇s civil aviation pilots.Literature resource and selection The related articles published at home and abroad.Literature quotation Nineteen published references were cited.Literature synthesis Intracranial aneurysm was a common cause of idiopathic subarachnoid hemorrhage.But the definite pathogenesis and impact factors were not clear.Modern epidemiological studies have shown that UIA and ruptured aneurysm had completely different course of the disease,treatment and prognosis.In recent years,either the incidence or prevalence of UIA has shown increased trend.The widely used imaging technology has improved the diagnosis for UIA.UIA could be classified into 3 types：①accidental asymptomatic aneurysm;② UIA manifested as occupying,uncomfortable or infarcted symptoms;③unruptured aneurysms of intracranial multiple aneurysms,which was found due to the subarachnoid hemorrhage.Related risk factors of UIA rupture included..diameter of aneurysm,location of occurrence,hypertension,age of onset,race and gender difference,formation time,etc..Conclusions The impact factors and the surgical choice are not the same in different population.The principles of UIA surgical intervention for civil pilots are as follows：①aneurysm with the diameter 〉5 mm.②if aneurysm diameter ≤5 mm,the treatment should be decided in accordance with the symptoms,occurrence location,body/neck ratio,etc..