飞行人员急性缺血性卒中临床特点与航空医学鉴定的回顾性分析

Clinical characteristics and aeromedical evaluation of flying personnel with acute ischemic stroke: aretrospective analysis

目的回顾空军飞行人员急性缺血性卒中(acute ischemic stroke,AIS)的临床资料,为飞行人员AIS的诊治和航空医学鉴定提供借鉴。方法通过空军特色医学中心电子病历系统、中国知网和PubMed数据库检索飞行人员AIS病例,总结分析飞行人员AIS特点及航空医学鉴定情况。结果总共检索到9例飞行人员AIS病例,均为男性,年龄36~50岁,其中飞行员6例,领航员1例,空中通信员1例,空中机械师1例。所有患者的美国国立卫生研究院卒中量表(National Institute of Health Stroke Scale,NHISS)评分均≤3分。按急性卒中治疗Org10172试验(trial of org 10172 in acute stroke treatment,TOAST)分型,2例为小动脉闭塞型,2例为心源性栓塞型,1例为嗜酸性粒细胞增多症,4例因存在多种病因或检查不全面而归因为不明原因型。共8例飞行人员经过航空医学鉴定,4例随访后无复发和后遗症,结论为特许飞行合格;2例暂时飞行不合格仍在地面观察;2例鉴定结论为飞行不合格。结论飞行人员AIS多为轻型卒中,其预后航空医学鉴定应结合病情程度、病因、复发风险、治疗结果、飞行岗位、飞行机种和飞行意愿等多因素进行综合评定。

Objective To review the clinical data on acute ischemic stroke(AIS)in aircrews and to provide reference for diagnosis,treatment and aeromedical evaluation.Methods Related cases and reports were retrieved from the electronic medical record system of Air Force Medical Center and databases of CNKI and PubMed.The clinical characteristics and results of aeromedical evaluations of these aircrews were summarized.Results A total of nine cases with AIS were retrieved,all of whom were male and aged 36 to 50.There were six pilots,one correspondent,one mechanist and one aviator.The National Institute of Health Stroke Scale(NHISS)scores of all these aircrews were 3 at most.According to the Trial of Org 10172 in Acute Stroke Treatment(TOAST)classification,two cases were attributed to small-artery occlusion,two cases to cardiogenic embolism and one case to eosinophilia.Four cases were classified as stroke of undetermined etiology due to multiple possible causes or incomplete evaluation.A total of eight aircrews underwent aeromedical evaluation.Four of these aircrews had no recurrence or sequelae after follow-up and were identified as qualified for flying.Two cases were still under ground observation and another two were identified as disqualified for flying.Conclusion AIS among aircrews is mostly mild.The capability of aircrews after AIS should be assessed in combination with such factors as the severity of health conditions,etiology,recurrence risk,outcomes,jobs,aircraft types and intentions.