飞行人员颅内动脉瘤临床特点与医学鉴定的回顾性分析

Retrospective analysis on clinical characters and aeromedical evaluations of the flying personnel with intracranial aneurysms

目的回顾空军特色医学中心住院及文献报道的飞行人员颅内动脉瘤(intracranial aneurysms,IAs)的临床特点和航空医学鉴定情况。方法通过空军特色医学中心的电子病例检索系统和国内外医学文献数据库检索飞行人员IAs的病例或临床研究报告,总结飞行人员IAs的临床特点和航空医学鉴定情况。结果共检索到6例IAs患者,包含7个IAs,患者年龄21~48岁;男性5例,女性1例。其中飞行员3例,空中通信员1例,空中机械师1例,空中乘务员1例。3例为无症状性,3例为症状性。6个IAs位于前循环动脉,1个位于后循环,均≤7 mm。2例无症状IAs患者被批准特许飞行;3例症状性IAs患者行动脉瘤夹闭手术或血管内栓塞治疗,其中1例术后被批准特许飞行。结论飞行人员中存在一定数量IAs患者,无症状IAs具有潜在的飞行风险,应注意筛查,破裂风险大及症状性的IAs需外科手术或血管内治疗。可根据临床症状、动脉瘤的特点(包括形态学和血流动力学)、飞行因素的影响、飞行人员职责、治疗效果、预后等情况综合评定飞行风险。

Objective To retrospect the clinical characters and medical evaluations of the aircrew with intracranial aneurysms(IAs)based on the hospitalized cases in Air Force Medical Center and published literatures.Methods The cases and clinical reports on the subject of aircrew IAs were searched through the electrical case system in our center and medical literature database.We summarized the the clinical characters and medical evaluations of these aircrews.Results Six cases with 7 IAs were found in this study,including 5 males and 1 female aged from 21 to 48 yrs.There were 3 pilots,1 correspondent,1 machinist and 1 attendant.Three cases were asymptomatic and 3 cases were symptomatic.Six IAs located in the cerebral anterior circulation system and one located in the cerebral posterior circulation system.All the IAs were the small aneurysms with diameter≤7 mm.Two asymptomatic cases were decided waiver by the aeromedical evaluation.Three symptomatic cases were treated by surgery clipping or endovascular coiling.One of them was given the waiver consideration.Conclusions There are certain population with IAs in aircrew.The screening of asymptomatic IAs should be cared because of their potential risk in flight.Symptomatic IAs and the IAs with high risk to rupture are needed to be treated by surgery or endovascular coiling.The flight risk should be comprehensively assessed in conjunction with the clinical symptoms,aneurysms characteristics(morphology and hemodynamics),flight factors,flight duty therapy outcome and prognosis.