军事飞行人员升主动脉扩张病变临床资料分析及航空医学鉴定

Clinical features and aeromedical evaluation of 6 cases of ascending aortic dilatation among aircrews

目的 初步探讨军事飞行人员升主动脉扩张病变的临床特征、治疗方式及医学鉴定原则。方法 回顾分析空军特色医学中心2019年12月—2022年5月收治的6例升主动脉扩张军事飞行人员临床诊治和航空医学鉴定资料,结合国内外相关文献提出意见和建议。结果 本组病例均为男性,中位年龄44.5岁,中位飞行时间3 950 h,首次诊断时均无明显临床症状,无显著血流动力学异常。2例合并二叶式主动脉瓣畸形,体检发现心脏杂音,动脉病变直径>45 mm,存在手术指征,其中1例手术后恢复良好给予飞行合格,另1例暂要求保守治疗,给予暂时飞行不合格。其余4例依据实际情况分别给予限制条件下飞行合格。结论 升主动脉扩张病变发展到一定程度将严重威胁飞行安全,无手术指征飞行人员可视情况给予飞行合格,术后需综合评估后谨慎给予特许飞行合格。

Objective To explore the clinical characteristics,treatment methods and medical identification principles of ascending aortic dilatation in military aircrews.Methods The clinical data of six aircrews with ascending aortic dilatation admitted to the Air Force Medical Center between December 2019 and May 2022 was analyzed respectively and related literature was reviewed.Results All cases in this group are male.The average age of these aircrews was 44.5 years and the average flight time of these aircrews was 3950 h.There were no obvious clinical symptoms or hemodynamic abnormalities detected during the first diagnosis.Among the two cases of bicuspid aortic valves,cardiac murmur was found during physical examination.The diameter of arterial lesions exceeded 45 mm,and cardiac surgery was recommended.One case recovered uneventfully and was qualified as a waiver while the other case refused surgical treatment provisionally and was temporarily disqualified.The other four cases were qualified for fight under restricted conditions.Conclusion Ascending aorta dilatation can pose a serious threat to flight safety.Pilots can be qualified for flight if cardiac surgery is not needed.Pilots after operation can be qualified as waivers after comprehensive evaluation.