飞行人员面肌痉挛临床特点与航空医学鉴定的回顾性分析

Clinical characteristics and aeromedical evaluations of fl ying personnel with hemifacial spasm:a retrospective analysis

目的 探讨飞行人员面肌痉挛(hemifacial spasm,HFS)的临床特点和航空医学鉴定情况,以期为飞行人员HFS的处理和航空医学鉴定提供思路和借鉴。方法 采用回顾性研究,通过检索2008年1月—2021年12月空军特色医学中心的电子病例检索系统和1970年1月—2021年12月的国内外医学文献数据库检索飞行人员HFS的病例或临床研究报告,对检索出的飞行人员HFS患者的一般状况、飞行特征、临床表现、治疗措施、预后及航空医学鉴定结果等资料进行分析。结果 共检索到8例HFS患者,年龄27~55岁,其中飞行员6例,空中通信员1例,空中机械师1例。3例无不适主诉,给予飞行合格结论;5例有不适主诉:3例卡马西平片治疗症状无缓解给予飞行不合格;1例微血管减压术治疗症状缓解给予特许飞行合格;1例未治疗症状缓解给予飞行合格。结论 飞行人员HFS引起的视觉干扰、眼睛刺激流泪、阅读和驾驶困难等会对飞行安全构成威胁,微血管减压术应该推荐作为磁共振显示面神经走行区有血管伴行的飞行人员HFS的最佳治疗方法。可根据临床症状、治疗方法、治疗效果等情况综合评定飞行风险。

Objective To retrospectively analyze the clinical features and aeromedical evaluations of aircrews with hemifacial spasm(HFS)based on hospitalized cases in Air Force Medical Center and related literature in order to provide references for the treatment and aviation medical identification of HFS in pilots.Methods Using a retrospective study,the electronic case retrieval system of the Air Force Medical Center in the space of 2008-2021 and medical literature databases(from 1970 to December 2021)were searched for cases or clinical research reports of HFS inflight personnel.The general condition,data onflight,clinical manifestations,treatments,prognosis,and aviation medical identification results of the retrieved HFS patients inflight personnel were analyzed and summarized.Results Eight cases with HFS were found in this study,including 6 pilots,1 correspondent,and 1 machinist ages 27 to 55.Three of these cases were asymptomatic and the rest were symptomatic.Three asymptomatic cases were assessed as qualified forflight by an aeromedical evaluation.One symptomatic case treated with microvascular decompression was given waiver consideration and three symptomatic cases treated with carbamazepine were givenflight disqualification due to persistent symptoms.The other one experienced symptom relief without treatment and was givenflying qualification.Conclusion Visual interference,eye irritation,tears,difficulties in reading and driving caused by HFS in pilots will pose a threat toflight safety.The HFS clinical scale can help to accurately evaluate theflight risk of HFS,and microvascular decompression surgery should be recommended as the optimal treatment for HFS in pilots with blood vessels accompanying facial nerves displayed on magnetic resonance imaging.Flight risks should be assessed in conjunction with the clinical symptoms,therapies and outcomes.