飞行人员肺结核的临床特点及航空医学鉴定

Clinical characteristics and medical evaluation of pulmonary tuberculosis in pilots

目的通过21例飞行人员肺结核的临床诊治过程,探讨飞行人员肺结核的临床特点及医学鉴定原则。方法回顾性分析空军特色医学中心21例飞行人员肺结核的诊治、随访过程及医学鉴定结果,并进行文献复习。结果21例患者占同期飞行人员住院患者的0.24%(21/8582),占传染病患者的25.93%(21/81)。6例为体检发现;临床感染类型包括继发性肺结核15例(71.43%),结核性胸膜炎3例(14.29%),肺结核合并结核性胸膜炎2例(9.52%),肺结核合并支气管结核1例(4.76%)。临床表现绝大多数症状轻微,较多的是发热7例(33.33%)、咳嗽、咳痰11例(52.38%);病变部位主要在右上肺7例(33.33%)、左上肺5例(23.81%);胸部影像表现为斑片9例(40.91%)、结节及条索影5例(23.81%),空洞及钙化5例(23.81%)。全部患者住院及门诊完成治疗,8例(38.10%)在治疗期间出现1种或多种并发症。21例患者中,飞行合格17例,复飞率80.95%。结论飞行人员肺结核感染是传染病的一个主要部分,部分患者发病隐匿,症状轻微。及时给予抗结核治疗可以临床治愈,飞行合格。但因药物导致的并发症常见,也是停飞的最主要的原因。

Objective To investigate the clinical characteristics and medical evaluation principles of pulmonary tuberculosis among pilots.Methods The clinical characteristics,treatment plans,follow-up and medical evaluation results of 21 cases of pulmonary tuberculosis treated in our hospital were retrospectively analyzed,and a literature review was conducted.Results This study enrolled 21 cases of pulmonary tuberculosis,accounting for 0.24%(21/8582)of the hospitalized pilots and 25.93%(21/81)of pilots with infectious diseases during the same period.Six cases were detected by physical examination.These cases of infection included 15 cases of secondary tuberculosis(71.43%),3 cases of tuberculous pleurisy(14.29%),2 cases(9.52%)of tuberculosis combined with tuberculosis pleurisy,and 1 case(4.76%)of tuberculosis combined with bronchial tuberculosis.Most of the patients showed mild symptoms,with 7 cases(33.33%)of fever and 11 cases(52.38%)of coughing and expectoration.The lesions were mostly located in the right upper lung(7 cases,33.33%)and the left upper lung(5 cases,23.81%).Chest imaging showed 9 cases(40.91%)with patches,5 cases(23.81%)with nodules and streaks,and 5 cases(23.81%)with cavitation and calcification.All the patients completed treatment as inpatients or outpatients,and 8 cases(38.10%)had one or more complications during treatment.Among the 21 patients,17 cases were qualified for flight,accounting for 80.95%.Conclusion Pulmonary tuberculosis makes up a large proportion of infectious diseases in pilots.Some patients have insidious diseases and mild symptoms.Quick anti-tuberculosis treatment can help cure such tuberculosis.However,drug-caused complications are common,which is the main cause of flight disqualification.