民航飞行学员卵圆孔未闭2例航空医学鉴定分析

Aeromedical identification analysis of 2 cases of patent foramen ovale in civil aviation student pilots

目的探讨民航飞行学员卵圆孔未闭(patent foramen ovale,PFO)的医学评估,提高航空医学实践中对PFO的认识,为航空医学鉴定和招飞体检标准的更新提供依据。方法回顾性分析2例民航飞行学员PFO的诊断过程和航空医学鉴定结果,并结合文献,总结PFO的病理生理特点、诊断思路和对飞行安全的影响。结果2例飞行学员在招飞和入校复查时均未检出PFO,分别在首次办证和年度体检时检出PFO,经食道超声心动图检查明确诊断,航空医学鉴定结论:不合格。结论多数的轻度PFO无症状,且难以判断卵圆孔是否闭合,容易漏诊。航空医学鉴定应依据经胸超声心动图、经食道超声心动图、右心声学造影、经颅超声微泡试验及320层心脏CT动态成像的检查结果判断疾病的发生及严重程度。

Objective To improve the understanding of patent foramen ovale(PFO)in aeromedical identification and the physical examination standards for recruitment by investigating the medical evaluation of PFO in civil aviation student pilots.Methods The diagnostic process and aeromedical identification results of PFO in 2 cases of civil aviation student pilots were retrospectively analyzed.Combined with the literature review,the pathophysiological characteristics diagnostic ideas of PFO,and its impact on flight safety were summarized.Results These 2 PFO cases were not detected in the examinations of pilot selection and admission review until the diagnoses confirmed by esophageal echocardiography for the first certificate and the annual physical examination.The aeromedical identification was concluded as unqualified.Conclusions The PFO diagnosis could be easily missed due to its asymptomatic feature of mild case and the difficulty of judging whether the foramen ovale is closed.The aeromedical identification should depend on the results of transthoracic echocardiography,transesophageal echocardiography,right heart acoustic imaging,transcranial echocardiographic microbubble test,and 320-slice cardiac CT dynamic imaging to determine its onset and severity.