军事飞行人员颅内未破裂动脉瘤航空医学鉴定

Aeromedical evaluation of unruptured intracranial aneurysms in military aircrews

目的探讨军事飞行人员颅内未破裂动脉瘤(unruptured intracranial aneurysms,UIA)的航空医学鉴定原则。方法回顾性分析2014年1月—2021年1月在空军特色医学中心就诊的疑似UIA的飞行人员9例,收集其临床诊疗、航空医学鉴定和随访情况,并复习国内外相关文献。结果由旋转三维数字血管造影检查共确诊5例飞行人员,年龄23~44岁,其中三代机飞行员3例,二代机飞行员1例,直升机飞行员1例。患有颈内动脉海绵窦段动脉瘤者3例,颈内动脉眼动脉段动脉瘤者2例;4例动脉瘤直径≤3 mm,1例直径为>3 mm且<5 mm;医学观察4例,介入手术1例。1例患有颈内动脉眼动脉段动脉瘤者,飞行不合格;3例颈内动脉海绵窦段动脉瘤者,特许飞行合格(限双座);1例颈内动脉眼动脉段动脉瘤者仍处于治疗观察期,暂时飞行不合格。结论对于偶然发现的颈内动脉海绵窦段单发动脉瘤,直径≤3 mm、形态规则,其发生自发破裂致蛛网膜下腔出血的风险极低,可予特许飞行;对于最大径>3 mm且≤5 mm的颈内动脉海绵窦段动脉瘤,可考虑限轰运直、无人机飞行;其他情况的动脉瘤者建议飞行不合格。

Objective To investigate the principles of aeromedical evaluation of unruptured intracranial aneurysms in military aircrews.Methods The medical records of nine Air Force pilots with suspected unruptured intracranial aneurysms admitted to Air Force Medical Center between January 2014 and January 2021 were retrospectively analyzed.Data on the diagnosis,treatment,aeromedical evaluation and follow-up were collected,and related literature was reviewed.Results Five pilots with an average age of 37(23-44 years old)were included,three of whom were pilots of the third-generation aircraft,one the second-generation aircraft and one of a helicopter.All aneurysms were diagnosed by 3D-DSA,including three cases of internal carotid artery cavernous segment aneurysms and two cases of ophthalmic artery aneurysms.The average diameter of the aneurysms was less than 3 mm in four cases and between 3 and 5 mm in one case.Four cases were under medical observation and one underwent an interventional operation.Flying disqualification was given to one case with an ophthalmic artery aneurysm,flight was permitted(limited to double-seater)in three cases of internal carotid cavernous segment aneurysms and temporary flying disqualification was mandated to one case with an internal carotid ophthalmic artery aneurysm who was still under clinical observation.Conclusion For a single aneurysm of the internal carotid cavernous segment,less than or equal to 3mm in diameter and of regular sharp,the risk of subarachnoid hemorrhage caused by spontaneous rupture is exceedingly low,so flight qualification is limited to double-seats.For pilots with aneurysms of the internal carotid cavernous segment,whose maximum diameter exceeds 3 mm but less than or equal to 5 mm,flight of bombers,transport aircraft,helicopters and UAV is recommended.Those with other types of aneurysms are recommended to discontinue flight.