2001～2006年海军飞行人员主要疾病分析及其对策（摘要）

目的分析2001～2006年海军飞行人员住院和医学停飞的主要疾病构成及其变迁特点,并对突出问题提出对策建议。方法对2001～2006年海军总医院收治的飞行人员全部病例和2001～2006年海军飞行人员医学停飞的全部资料进行统计分析,并同以往不同时期海军飞行人员主要疾病和医学停飞疾病资料进行对比研究。     

2010-2015年飞行不合格飞行人员疾病谱分析

目的 分析近5年飞行不合格飞行人员疾病谱特点和规律,为新时期进一步做好航卫保障工作提供参考资料.方法 收集我院2010年1月-2015年4月190例飞行不合格飞行人员病历资料,按疾病种类、涉及专业科室及年龄分布进行分类统计.结果 排在前20位的病症为头痛、高血压、腰椎间盘突出症、颈椎病、高脂血症、抑郁症、屈光不正、晕厥、神经性耳聋、心境不良等.前10位专业科室是神经内科、骨科、心血管内科、精神科、眼科、消化科、内分泌科、耳鼻喉科、全军临床航空医学中心及泌尿外科.31～40岁年龄段构成比最高,占51.05％.结论 飞行人员医学停飞疾病谱较广,涉及各专业科室,其中内科、骨科、眼科和耳鼻喉科疾病依然是医学停飞的常见原因,而精神性和代谢性疾病呈上升趋势,值得关注和重视.     

1993-2012年住院飞行人员传染病疾病谱及医学鉴定

目的 通过了解住院飞行人员传染病疾病谱和临床特点以及对飞行的影响,为飞行人员的传染病防治及医学鉴定提供依据. 方法 回顾性分析空军总医院1993年5月-2012年8月住院诊治的飞行人员传染病患者的临床病历资料. 结果 19年间传染病住院飞行人员共105例,占同期飞行人员住院人数的0.93％;近5年来下降至0.31％(15/4915),与其他时期比,差异有统计学意义(P＜0.05).飞行人员传染病发病人数呈逐年减少趋势(x2=53.354,P＜0.01).105例传染病疾病分类共12种,排在前3位的是病毒性肝炎(65例)、细菌性痢疾(11例)和感染性腹泻(8例).肝炎病毒感染最为常见,占本组传染病疾病构成比的61.90％;其中乙型肝炎病毒感染51例,占本组传染病疾病构成比的48.57％.105例中医学鉴定结论为飞行不合格52例,停飞率49.52％.65例肝炎病毒感染者中飞行不合格52例,停飞率80.00％;3例地面观察期,待做医学鉴定.其他40例患者中除2例尚在康复治疗外,均经临床治疗后康复痊愈,医学鉴定结论为飞行合格. 结论 飞行人员传染病的发病率及其在飞行人员疾病构成上的比例总体上呈逐年下降,疾病谱相对单一,主要以病毒性肝炎特别是乙型病毒性肝炎和肠道感染性疾病为主,乙型病毒性肝炎是飞行人员传染病中最常见的疾病,也是停飞的最主要原因.     

2015—2020年飞行人员医学停飞疾病谱分析

目的 分析近5年军事飞行人员医学停飞疾病谱的构成和特点,总结降低飞行人员医学停飞率的相关工作经验.方法 收集空军特色医学中心2015年1月—2020年3月医学停飞的204例飞行人员资料,按疾病种类、年龄分布、涉及专业科室、 飞行机种及飞行职务分类统计,进行描述性分析.结果 飞行人员医学停飞前20位的病症为头痛、高血压、颈椎病、腰椎间盘突出、抑郁障碍等.前10位专业科室是神经内科、骨科、心血管内科、耳鼻喉科、精神科等.患病年龄多集中在31～40岁(64.70％).不同飞行职务中,飞行员占比最高(72.06％).不同飞行机种中,运输机飞行人员占比最高(29.90％).结论 31～40岁飞行人员的健康维护是航卫保障工作的重点;骨科、神经内科、心血管内科和精神心理科疾病依然是医学停飞的最常见疾病;应从航空医学角度减少疾病的诱发因素,提高疾病的早期筛查率和诊疗水平,有效降低相关疾病的医学停飞率.     

联勤后飞行人员神经科住院及停飞疾病谱分析

目的 分析飞行人员神经系统疾病谱特点,为新时期航卫保障提供参考依据.方法 收集空军总医院2005年1月—2014年12月患神经系统疾病飞行人员病历资料243例次,按疾病、机种类别、年龄段以及飞行结论 进行分类统计.结果 ①神经科疾病住院及停飞前3位疾病均为头痛、晕厥、脑血管病;②多集中在36～40岁;③晕厥构成比最多的为歼、强击机,其次为直升机,其他疾病在不同机种间差异无统计学意义(P＞0.05).结论 重视飞行人员神经科疾病,招飞时详细调查有无家族史及脑创伤史,同时重视社会-心理因素对飞行员的影响.     

军事飞行学员医学停飞疾病谱分析

目的 总结分析空军某航空大学近年军事飞行学员医学停飞病征（疾病或体征）特点,为今后军事飞行学员医学选拔和医学鉴定提供客观依据. 方法 对近年空军航空大学医学停飞的614名飞行学员按照所患疾病或病征及病征所隶属体检科室（专业）进行分类统计. 结果 614名医学停飞学员共涉及病征90余种.飞行学员停飞病征排前10位的是视力不足超标、血压超标、频发心律失常、外伤（骨折）、腰椎间盘病变、鼻中隔偏曲、慢性鼻窦炎、胆囊息肉、晕厥及其他心电图异常.医学停飞病征所涉及体检科室（专业）排序依次为眼科、内科、外科、耳鼻喉科、神经内科、心电图检查、超声检查、放射科检查和检验科检查,其中以眼科和内科病征为主,分别占全部医学停飞病征的50.00％、14.86％. 结论 导致在校军事飞行学员医学停飞的主要病征是视力不足超标、血压超标.针对飞行人员职业特点,普及航空医学教育,加强卫生监督,加强可变的功能性病征的矫治、训练,采取积极保护性的干预和心理疏导等措施,对降低在校飞行学员的医学停飞率,提高军事飞行学员的成才率具有重要意义.     

飞行人员神经内科住院疾病谱分析

研究飞行人员住院疾病谱的变化规律对制定飞行人员疾病预防、诊治措施,降低停飞率都具有重要意义.神经内科疾病是飞行人员常见病和多发病,根据我院对1991～1995年270例医学停飞飞行员疾病分析表明,神经内科疾病居前位占46.3%,从疾病性质看,功能性疾病多于器质性疾病.近些年来飞行人员神经内科疾病谱有什么变化,还不甚清楚,笔者对近9年在我院住院飞行人员的神经内科疾病进行统计分析,为进一步搞好航空卫生保障工作提供参考.     

海军飞行人员改装体检疾病谱和不合格原因分析

目的 掌握改装体检的海军飞行人员的疾病谱和改装不合格原因,为海军飞行人员临床航卫保障提供理论依据.方法 收集2019年12月—2020年8月在海军特色医学中心改装体检的307例海军飞行人员的病例资料,对其年龄、飞行机种、体检发现所患疾病的种类及改装结论进行描述性统计分析,并计算其疾病构成比及系统疾病顺位.结果 307例海军飞行人员共检出62种疾病,降序排序依次为代谢综合征、甲状腺疾病、副鼻窦疾病、颈腰椎疾病、心脏疾病、肝胆疾病.而改装医学鉴定不合格的常见疾病依次为:心律异常、颈腰椎疾病、神经系统疾病、屈光不正、副鼻窦疾病、身高超标、泌尿系疾病、肿瘤、BMI异常.结论 针对海军飞行人员常见疾病的病因和发病机制尽早开展防治干预可减少停飞率,这有助于延长飞行人员的飞行生涯,维护和提升海军航空兵的战斗力.     

2000～2006年东北地区军事飞行人员停飞疾病分布与特点

目的 分析本世纪初东北地区军事飞行人员停飞疾病分布,为新时期航卫保障工作的实施提供临床流行病学依据. 方法 统计分析东北地区2000～2006年因伤病停飞的病历资料,编制2000～2006年停飞疾病分布表和2000～2006年历年停飞疾病分布表.应用SPSS 10.0统计软件包,两个构成比的比较采用卡方检验. 结果 ①21世纪初东北地区军事飞行人员停飞疾病居前10位的是:腰椎间盘突出症、颈椎间盘突出症、头痛、耳聋、晕厥、耳气压机能不良、心律失常、胃十二指肠溃疡、颈椎病和高血压病,②因骨科和耳科疾病停飞的人数增多. 结论 ①7年的统计中,虽然因腰椎间盘突出症停飞的人数最多,但近2、3年呈下降趋势;②结果 显示:腰椎间盘突出症、颈椎间盘突出症、头痛、耳聋、心律失常、颈椎病和胃十二指肠溃疡是东北地区飞行人员最常见的住院和停飞疾病,应引起关注;③晕厥停飞人数呈上升趋势,严重威胁飞行安全,各级航卫保障机构要制定出相应的防范措施.     

歼击机飞行员神经精神类疾病谱分析

目的 探讨歼击机飞行员神经精神类疾病的分布规律. 方法 回顾性分析1965～2006年在我院住院诊治的436例歼击机飞行员的临床资料,统计不同疾病类型,不同年龄段的飞行结论 ,并进行比较. 结果 常见的神经精神类疾病分别为空中晕厥/加速度耐力不良、地面晕厥、血管性头痛、神经症等,发病年龄相对集中在30～35岁.癫痫、空中晕厥/加速度耐力不良和其他神经精神类疾病(主要是抑郁症、恶劣心境等)是停飞的重要原因. 结论 歼击机飞行员的神经精神类疾病大多数无器质性病变,但治愈合格率低,停飞率高,且心理和精神类疾病有上升趋势,对其原因进行分析有助于提高航卫保障质量.     

飞行人员甲状腺疾病的特点、诊治及医学鉴定

目的 总结飞行人员甲状腺疾病的诊治和医学鉴定经验. 方法 收集我院2000年12月-2009年12月间住院飞行人员67例甲状腺疾病资料,将其归为:①无症状的良性甲状腺结节;②慢性淋巴细胞性甲状腺炎;③甲状腺功能异常类疾病(包括甲状腺机能亢进症和甲状腺机能减退症);④甲状腺恶性肿瘤.分析4类疾病的特点及飞行结论 情况. 结果 ①良性甲状腺结节36例(占53.73%),4例手术治疗(腺瘤3例,结节性甲状腺肿1例),除5例因其他原因停飞外,其余31例均飞行合格,定期复查;②慢性淋巴细胞性甲状腺炎5例(占7.46%),甲状腺功能正常,均飞行合格,定期复查;③甲状腺功能异常类疾病20例(占29.85%,甲状腺机能亢进18例,甲状腺机能减退2例),均行药物治疗,6例飞行合格,3例暂时飞行不合格,11例停飞;④甲状腺恶性肿瘤6例(占8.96%,4例为乳头状癌,2例为滤泡状癌),1例飞行合格,5例停飞.经统计学分析,甲状腺功能异常类疾病和甲状腺恶性肿瘤的停飞率均高于良性甲状腺结节和慢性淋巴细胞性甲状腺炎,且差异有统计学意义(P<0.01或P<0.05). 结论 飞行人员甲状腺疾病以无症状的良性结节常见,要重视功能异常类疾病和恶性肿瘤的早期诊断和治疗. Abstract： Objective To summarize the experiences of diagnosis,treatment and medical evaluation of thyroid disease in flying personnel. Methods Sixty-seven cases of thyroid diseases,that were hospitalized from December 2000 to December 2009,were collected and analyzed.They were concluded such categories as:①asymptomatic benign thyroid nodules;②Hashimoto's disease;③diseases of abnormal thyroid functions (including hyperthyroidism and hypothyroidism);and ④thyroid cancer.Their characteristics and the relationship between different categories were analyzed correspondingly to the evaluations for flying. Results ①Among 36 cases of diagnosed asymptomatic benign thyroid nodules (53.73%),4 (3 were adenoma and 1 was nodular goiter) were surgically treated.31 Cases were evaluated as qualified for flying but should be with regular medical check-up while the other 5 were permanently grounded.②There were 5 cases of Hashimoto's disease with normal thyroid functions (7.46%).They were qualified for flying but should be with regular medical check-up.③Thyroid dysfunction took 20 cases (29.85%),among which 18 were hyperthyroidism and 2 were hypothyroidism.Drug treatment was applied.Six cases were finally qualified for flying while the other 3 and 11 were respectively assessed as temporary and permanent grounding.④Six cases were thyroid cancer (8.96%),included 4 papillary carcinoma cases and 2 follicular thyroid carcinoma cases.Only 1 case was finally qualified for flying while the others were permanently grounded.Statistical analysis showed that thyroid dysfunction diseases and thyroid cancer caused significant higher disqualification rate than benign thyroid nodules and Hashimoto's diseases (P<0.01 or P<0.05). Conclusions Benign thyroid nodules are the common thyroid diseases in flying personnel.But the diagnosis of thyroid dysfunction diseases and thyroid malignant tumors should be cared in order to win the chance of treatment and further to reduce the rate of flying disqualification.     

飞行人员耳气压伤的诊治和医学鉴定

目的 通过对40年间住我院飞行人员耳气压伤资料分析,了解耳气压伤的发病情况,并进一步探讨其临床诊治和医学鉴定. 方法 对1967年8月-2007年7月住我院的235例(375耳)耳气压伤飞行人员的资料进行分析:①统计患病年龄、住院年代、飞行机种、飞行职务和飞行时间等与飞行结论 的关系;②按原发性耳气压伤(由咽鼓管周围鼻咽科疾病所致)和继发性耳气压伤(由咽鼓管本身疾病所致)进行分类,并统计其疗效和飞行结论 的关系. 结果 ①耳气压伤在35岁以下占77.0%;在1997年8月-2007年7月仅占14.0%;歼击机飞行员占43.0%,飞行员占70.6%;飞行时间少于1000 h的占51.3%.②继发性耳气压伤治愈率68.9%(164耳/238耳)、停飞率11.2%(18例/160例),原发性耳气压伤治愈率29.2%(40耳/137耳)、停飞率57.3%(43例/75例),差异均有统计学意义(x2=53.8、73.5,P＜0.01). 结论 飞行人员耳气压伤常见,近10年耳气压伤的发生率呈下降趋势,多发生于年轻的歼击机飞行员,且继发性耳气压伤治愈率高于原发性,停飞率低于原发性耳气压伤. Abstract： Objective To summarize the clinical diagnosis, treatment and medical evaluation of barotraumas of ear (BE) by analyzing the inpatients' medical data in past 40 years. Methods The BE cases of 375 ears from 235 aircrews who were hospitalized from August of 1967 to July of 2007,hospitalization, duty, as well as the served aircraft type and flying hours, was respectively analyzed.(induced by the diseases of Eustachian tube itself) were classified and their curative effects were also was younger than 35 yrs. Only 14.0% BE occurred during the period from August of 1997 to July of 2007. In all BE cases, pilots took 70. 6% and the pilots with the flying hours less than 1000 h accounted for 51.3%. 43.0% (101 out of 235) fighter pilots appeared BE and 32.7% of them were permanently grounded, and this percentage was significantly higher than that on other types of aircraft caused 11.2% grounding rate (18 cases out of 160). The primary BE caused 57.3% pilots grounded while its healing rate was 29.2%. The differences were significantly (P＜0. 01). Conclusions BE is common in aircrew, especially in young fighter pilots. It shows a decreased trend in recent 10 year.Secondary BE has higher healing rate than primary BE's and causes lower grounding rate.     

空勤人员鼻科疾病谱研究

目的 通过分析空勤人员鼻科疾病谱提出飞行人员鼻科疾病的防治建议.方法 对1966-2007年间住院的320名空勤人员的373例次鼻科疾病谱进行对比分析.结果 排在鼻科疾病谱前位的为慢性鼻窦炎鼻息肉、鼻窦气压伤、鼻中隔偏曲、变应性鼻炎、慢性鼻炎、鼻窦囊肿、急性鼻窦炎、鼻腔鼻窦肿瘤和鼻外伤等.飞行合格283人,暂时飞行不合格12人,飞行不合格25人.结论 飞行人员鼻科疾病较常见,且与气压伤的关系密切,应积极治疗Ⅰ类鼻腔鼻窦疾病(地面生活有症状),阻止其向地面生活无症状、飞行中出现鼻窦气压伤和(或)耳气压伤症状的Ⅱ类疾病转化.有效治疗Ⅱ类疾病是降低停飞率的重要措施. Abstract： Objective To suggest the protection of aircrews on the base of analyzing disease spectrum of nasal cavity and sinus. Methods The disease spectrum of nasal cavity and sinus was made by analyzing 373 cases of 320 aircrews who were hospitalized from 1966 to 2007. The medical evaluation was reviewed. Results The top diseases in spectrum were chronic sinusitis and nasal polyp, sinus barosinusitis, deviation of nasal septum, allergic rhinitis, chronic rhinitis, cyst in nasal sinus, acute sinusitis, tumor in nasal cavity and sinus, and nasal injuries. In medical evaluation, 283 aircrews were qualified for flying compared to 12 were temporarily grounded and 25 were permanently grounded. Conclusions The nasal cavity and sinus diseases are common in aircrews and usually character barosinusitis and (or) aural barotrauma. The type Ⅰ nasal cavity and sinus diseases (with symptoms on ground) should be treated in time to prevent their transition to type Ⅱ (no obvious symptoms on ground but with symptoms of sinus barosinusitis and (or) aural barotrauma in flight).Duly treating type Ⅱ nasal cavity and sinus diseases would be the effective measure for reducing aircrew's grounding rate.     

飞行人员先天性心脏病的临床诊治与医学鉴定

目的 探讨飞行人员先天性心脏病的诊断治疗及医学鉴定.方法 回顾性分析1993年1月-2010年10月在我院住院的12例飞行人员先天性心脏病病例的临床特点、预后及其医学鉴定结论.结果 12例中：①3例室间隔缺损,2例主动脉二瓣畸形,1例冠状动脉-肺动脉瘘,均未作特殊处理,鉴定结论：飞行不合格.②1例卵圆孔未闭,空中机械师,未作特殊处理,鉴定结论：飞行合格;1例主动脉瓣二瓣畸形,未作特殊处理,鉴定结论：原机种合格.③1例房间隔缺损,外科修补后,鉴定结论：飞行不合格.④1例动脉导管未闭及2例房间隔缺损,均给予介入封堵治疗.其中1例动脉导管未闭及1例房间隔缺损患者经过6～14月地面观察及严格体检后,鉴定结论：飞行合格;另1例房间隔缺损患者尚处于地面观察期,鉴定结论：暂时飞行不合格.结论 飞行人员确诊先天性心脏病后,应结合临床分型、飞行机种及预后处理,进行个体化医学鉴定;封堵介入方法治疗先天性心脏病,创伤小,成功率高,治愈患者可考虑重新放飞.     

海军飞行员脂肪肝患病率及危险因素分析

目的 为了解海军飞行员脂肪肝患病率及危险因素，以便制定预防措施。方法 对人院保健疗养的458名男性飞行员进行肝脏B超检查，测身高、体重和清晨空腹血脂。按事先设计好的表格，以询问的形式对受试者进行有关因素的调查登记。危险因素的确定采用单因素和多因素Logistic回归分析方法。结果 本组海军飞行员脂肪肝患病率为14．8％。根据多因素Logistic回归分析，脂肪肝的危险因素为：饮酒、体重指数、高甘油三酯血症、飞行总时间、年龄，其优势化(0R)值以饮酒为最高(11．99)。结论 鉴于海军飞行人员脂肪肝患病率明显高于一般人群和民航飞行人员，应加强对可控危险因素的干预。     

飞行人员空晕病的诊治和医学鉴定

目的 总结飞行人员空晕病的临床特征、诊治方法、防治措施及医学鉴定原则. 方法 回顾性分析1976年9月-2009年7月间住我院的49例飞行人员空晕病患者的病历资料,包括患者病史、病因与诱因、诊断分类、检查及医学鉴定结论 .对前庭功能检查结果与医学鉴定结论之间的关系进行统计学分析. 结果 ①本组病例原发性空晕病3例,继发性空晕病46例;继发性空晕病有其原发病因或诱因,其治疗主要为病因治疗和前庭功能脱敏习服训练;②前庭眼震电图检查正常者22例,异常者27例;③科里奥利加速度耐力正常者16例,不良者33例;④飞行合格11例,暂时飞行不合格10例,飞行不合格28例.前庭眼震电图异常者和科里奥利加速度耐力不良者飞行不合格率分别高于前庭眼震电图正常者和科里奥利加速度耐力正常者(χ2=5.584、16.722,P<0.05).结论 现役飞行人员空晕病多为继发性,防治措施包括治疗原发病因、消除诱因和加强前庭功能脱敏习服训练.其医学鉴定要兼顾原发病治疗效果、前庭功能状况及飞行机种情况. Abstract： Objective To summarize the clinical features,diagnosis and treatment methods,prevention and control measures,and medical evaluation principles for airsickness in flying personnel. Methods Forty-nine cases of flying personnel with airsickness,who were hospitalized from September of 1976 to July of 2009,were retrospectively analyzed in respect of disease course,etiology or incentive,clinical diagnosis and medical evaluation of airsickness.The relationship between vestibular function status and medical evaluation was also statistically analyzed. Results ① Three of 49 picked cases were diagnosed as primary airsickness while the rest 46 were the secondary that were induced by different causes or incentives.Etiological treatment and vestibular habituation were the primarily treatments for such airsickness.② Among these cases,22 were normal in vestibular nystagmus electroretinogram (VNG) comparing to 27 abnormal cases.③ Sixteen and 33 cases were evaluated as normal and deficient Coriolis acceleration tolerance respectively.④ Eleven flying personnel Were finally qualified while 10 and 28 were temporarily and permanently grounded respectively.Flying personnel with abnormal VNG or with deficient Coriolis acceleration tolerance showed higher grounding rate than those with the normal (χ2=5.584,16.722,P<0.05). Conclusions Airsickness in active service flying personnel is mostly the secondary affection,which is caused by various primary disease or incentives.Such prevention and control measures as treating primary disease.eliminating incentives and implementing vestibular habituation are suggested.The effect of airsickness treatment and vestibular function should be emphasized in making medical evaluation.     

飞行人员尿石症临床特点和医学鉴定

目的研究飞行人员尿石症的临床特点，提高对飞行人员尿石症的防治和医学鉴定水平。方法对48例飞行人员尿石症患者（35例恢复飞行患者）随访资料进行回顾性分析。结果飞行人员尿石症的临床特点是大多起病急、症状典型、结石小、并发症少和治疗效果佳。35例（72．9％）一次住院治愈。2例（4．2％）病情反复发作伴其他疾病，予以停飞。随访的35例资料中1例患者次年复发门诊治愈；4例准予带石飞行者，均无空中肾绞痛发作。结论飞行人员尿石症必须及时送院、积极治疗，以缩短住院和地面观察时间，恢复飞行。带石飞行的标准应严格控制，以确保飞行安全。     

Will they fly again? The probability of wounded military aviators returning to flying duty: a study of 70 cases

In this study, 70 Israeli Air Force aviators, most of them suffering from severe or moderately-severe injuries, were evaluated as to their potential to return to active flying duty. Of these, 59 (84%) were able to return to flying and 11 (16%) were permanently grounded. While 44 of 51 fighter aviators (86%) returned to flying, only 30 of them (59%) returned to fly fighters, and the rest were transferred to another type of aircraft. The roles of age and severity of injury were studied in detail and it was concluded that higher age and severe injuries prolong the convalescence period but do not prevent the aviator from returning to flying. Nine aviators were permanently grounded because of medical reasons. In each case a single injury could be demonstrated as the direct cause of their permanent grounding. All aviators were followed-up for 3 years after having returned to flying. It was concluded that an evaluation period of 2 years is sufficient to determine the long-term success of military aviators returning to flying.