飞行员急性主动脉夹层一例并文献复习

A pilot case of acute aortic dissection and literature review

目的提高对飞行员急性主动脉夹层(acuteaortic dissection,AAD)临床特征和诊断的认识。方法报道1例直升机飞行员发生主动脉夹层的临床特征、诱发因素、诊断及治疗过程,并复习相关文献。结果本例飞行员为男性,32岁,否认高血压病史,临床表现为持续性剧烈胸痛,主动脉CT血管成像提示胸‑腹主动脉夹层动脉瘤。给予严格卧床,控制血压,并于确诊1周后行主动脉夹层腔内隔绝术。术后肢体活动、肾功能、胃肠功能、心电图、超声心动图均未见异常。航空医学鉴定结论:飞行不合格。结论主动脉夹层在飞行员中极其罕见,但对于胸痛发作患者的诊断应仔细谨慎,并考虑此病的可能。招飞体检过程及航医在实践中应重视胸痛症状,增强对主动脉夹层等少见疾病的诊断意识。

Objective To improve the understanding of the clinical characteristics and diagnosis of acute aortic dissection(AAD)in pilots.Methods This paper reported the clinical features,predisposing factors,diagnosis and treatment of a helicopter pilot with aortic dissection.The related literatures were reviewed.Results The pilot was a 32-year-old male who denied a history of hypertension and presented with persistent severe chest pain.CT angiography of the aorta suggested thoracic-abdominal aortic dissection.Strict bed rest,blood pressure control and thoracic endovascular aortic repair were performed one week after the diagnosis.There were no abnormalities in limb activity,renal function,gastrointestinal function,electrocardiogram and transthoracic echocardiography after endovascular intervention.The pilot was finally disqualified in aviation.Conclusions Aortic dissection is extremely rare in pilots and should be carefully considered in the diagnosis of chest pain.During the pilot recruiting process and the practice of flight surgeon,more attention should be paid on the possibility of such rare disease as aortic dissection in case of the symptoms of chest pain appeared.