飞行员先天性心脏病的航空医学鉴定

Aeromedical identification of congenital heart disease in pilots

目的探讨航空医学鉴定中飞行员先天性心脏病的若干问题,为日后飞行员医学鉴定提供借鉴。资料来源与选择国内外该领域的相关文献及专著。资料引用引用国内外文献47篇。资料综合现役飞行员先天性心脏病的航空医学鉴定,需要综合考虑疾病治疗的时间及方法,还要评估治疗后出现的隐源性脑卒中、心律失常、感染性心内膜炎或精神障碍等不良事件的风险以及导致空中失能的风险。尽管研究表明卵圆孔未闭与脑卒中相关,但目前航空医学认为这是一种正常的解剖变异,可以给予飞行合格结论。先天性心脏病可能会合并各种心律失常,是飞行员心血管疾病停飞的三大原因之一,严重影响飞行安全。感染性心内膜炎也是患者发病和死亡的主要原因,合并心内膜炎的心脏瓣膜可能会在短期内发生功能变化,导致心功能恶化,预后不良。此外,飞行员需要有更强的心理素质,及时有效地进行心理疏导或药物治疗会避免不必要的停飞。结论现役飞行员先天性心脏病的诊断治疗及航空医学鉴定需要心脏科医师与航空医学鉴定委员会共同协商制定,保障飞行安全和部队战斗力。

Objective To provide reference for the aeromedical identification of pilots in the future by discussing the problems in the aeromedical identification of congenital heart disease in pilots.Literature resource and selection Domestic and international papers and monographs in this field and related fields.Literature quotation Forty-seven published papers and reviews were cited.Literature synthesis The aeromedical identification of congenital heart disease in active pilots should require a comprehensive consideration of the time and methods of the treatment of the disease,as well as the risk of adverse events such as cryptogenic stroke,arrhythmia,infective endocarditis or mental disorders after treatment,as well as the risk of air incapacitation.Although studies have shown that patent foramen ovale is associated with stroke,but the asymptomatic patent foramen ovale can be regarded as normal anatomical variation and can be qualified for flight.Congenital heart disease may be associated with different types of arrhythmias,which is one of the three major cardiovascular diseases that cause pilots grounded,and seriously affect the flight safety.Infective endocarditis is also the main cause of morbidity and death of patients.Heart valves with endocarditis may have functional changes in a short period of time and those would result in deterioration of cardiac function and poor prognosis.In addition,pilots need to have better psychological quality.Timely and effective psychological counseling or drug treatment can avoid unnecessary grounding.Conclusions The diagnosis and treatment of congenital heart disease and aeromedical identification of pilots need to be worked out jointly by cardiologists and the Aeromedical Identification Committee to ensure flight safety and combat effectiveness of the armed forces.