飞行人员甲状腺疾病的特点、诊治及医学鉴定

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.     

飞行人员恶性肿瘤术后安全放飞指征的临床研究

目的 研究和探讨我国飞行人员恶性肿瘤手术后放飞的安全标准. 方法 回顾分析38年间,经病理检查确诊为恶性肿瘤并进行外科手术的飞行人员病例资料,全组25例飞行人员恶性肿瘤术后放飞13例. 结果 本组13例恶性肿瘤术后放飞的飞行人员中,甲状腺癌4例、结肠癌3例、膀胱癌2例,胃癌、胰腺囊腺瘤、乳腺癌和耻骨软骨肉瘤各1例.经手术治疗及术后辅助治疗,13例病人机体状况恢复良好,鉴定结论 :飞行合格.术后随访3～38年,飞行时间30～2000 h,飞行状态良好. 结论 部分患恶性肿瘤的飞行人员,通过仔细认真的手术、正规的术后辅助治疗和护理、循序渐进的体能锻炼、定期严格的健康体检,可以达到飞行合格.作者提出了适合我国飞行人员恶性肿瘤术后恢复飞行的基本标准. Abstract： Objective To study and discuss the safety standard of flying qualification for the postoperative flying personnel with malignant tumor. Methods Related case history in past 38 years was retrospectively reviewed and sought 13 flying qualified cases out of 25 postoperative flying personnel with malignant tumor. Results Among 13 qualified cases there were 4 cases of thyroid carcinoma, 3 cases of colon carcinoma, 2 cases of bladder carcinoma and 4 cases respectively were gastric cancer, cystadenoma of pancreas, breast carcinoma and pubis osteochondrosarcoma. Those 13 cases were cured by operation and other adjuvant treatments and were diagnosed as well recovered. Since they were qualified for flying, the 3-38 years follow-up showed that they had fitted in flying for 30-2000 h. Conclusions Some flying personnel with malignant tumor would be qualified for flying by operation, proper adjuvant treatments and regular nursing, as well as the progressive physical exercise and under regular rigorous physical examination. The paper also puts forward a basic standard that suited for Chinese military flying personnel with malignant tumor.     

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.     

彩色多普勒超声在诊断颈性眩晕飞行人员椎动脉异常中的临床应用价值

目的 探讨彩色多普勒超声在诊断颈性眩晕飞行人员椎动脉异常中的临床应用价值,分析飞行人员颈性眩晕与椎动脉异常的相关性.方法 对168例颈性眩晕飞行人员患者的椎动脉超声检查结果及相关影像学资料进行回顾性分析.结果 椎动脉发育异常78例,发育异常包括起源异常、行径异常和发育不良.其中起源异常9例,单侧或双侧行径异常11例,单侧或双侧发育不良32例,完全闭塞1例,行径异常伴发育不良25例;发育异常的椎动脉中血流动力学异常者48例.飞行不合格8例,暂时飞行不合格25例,临床诊治后飞行合格45例.结论 飞行人员颈性眩晕患者椎动脉先天异常所占比例较大,招飞工作是飞行工作的源头,提示我们应从源头把关,降低飞行人员的停飞率,建议将椎动脉超声检查纳人空军招收飞行学员体格检查标准. Abstract： Objective To study the correlation between cervical vertigo and vertebral artery abnormality by analyzing the clinical application of color Doppler ultrasonography on flying personnel.Methods The ultrasound imaging and related data of 168 flying personnel's with cervical vertigo were reviewed and analyzed.Results There were 78 cases of vertebral artery abnormalities,including 9 cases of anomalous origin, 11 cases of unilateral or bilateral behavior abnormalities, 33cases of dysplasia (32 cases of unilateral or bilateral dysplasia and 1 case of complete occlusion) and 25cases of behavior abnormality plus dysplasia.Vertebral artery hemodynamics abnormality was found in 48 cases.Among vertebral artery abnormalities, 8 and 25 cases were respectively assessed as permanently or temporally grounding while the rest 45 were qualified.Conclusions Congenital vertebral artery abnormalities take high proportion in the flying personnel with cervical vertigo.Vertebral artery ultrasound examination would be helpful for diagnosing vertebral artery abnormalities at recruiting stage and furthermore for reducing grounding rate.It is suggested that to include vertebral artery ultrasound examination in flying cadets physical examination.     

飞行人员空晕病的诊治和医学鉴定

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.     

飞行人员多系统萎缩二例并文献复习

目的 探讨2例飞行人员患罕见病多系统萎缩(multiple system atrophy,MSA)的临床特征、鉴别诊断、治疗、与飞行的关系及健康鉴定. 方法 分析2例飞行人员的临床资料及复习相关文献. 结果 2例起始表现均不典型,晚期1例表现较典型.因是罕见病,都有一定时期误诊.最终确诊主要根据临床表现,结合电生理及影像学检查.确诊后飞行结论 为飞行不合格. 结论 神经系统变性疾病起始表现隐袭,病程较长.飞行人员身体素质较好,发病后表现更加隐蔽.要求航空医生要更加仔细地观察临床表现及分析相关检查,尽早做出诊断,避免误诊.对此类神经系统变性疾病的飞行结论 要根据病情轻重、飞行机种及飞行任务综合评定. Abstract： Objective To investigate the clinical features by analyzing two flying personnel cases of multiple system atrophy (MSA) for the references to diagnosis, treatment, as well as the influence to flying and the criteria of individual aeromedical evaluation. Methods The clinical data of 2 cases of aircrew with MSA were analyzed and related literatures were reviewed. Results The clinical MSA features of both cases were not typical in their early stage but 1 case appeared typical features in late stage. These 2 cases were misdiagnosed in a certain time because of MSA's rare occurrence, but finally the definite diagnosis was made by judging clinical features, electrophysiology and imageology examinations. These 2 pilots were finally disqualified for flying. Conclusions The clinical features of degeneration diseases of neurologic system in early stage were obscure and had relative longer course of disease, especially for those physical fitness pilots. So it raised higher requirements to the aviation physician in early recognizing the features of MSA for preventing misdiagnosis. Aeromedical assessment of flying personnel with degeneration diseases of neurologic system should be synthetically evaluated according to clinical features, aircraft type and mission.     

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.     

Prevalence of unsuspected thyroid nodules in adults on contrast enhanced 16- and 64-MDCT of the chest

AIM: To determine the prevalence of unsuspected thyroid nodules on contrast enhanced 16and 64-modified discrete cosine transform (MDCT) of the chest, in a population of adult outpatients imaged for indications other than thyroid disease. METHODS: This retrospective study involved review of intravascular contrast-enhanced MDCT scans of the chest from 3077 consecutive adult outpatients, to identify unsuspected thyroid nodules. Exclusion criteria included history of thyroid cancer, known thyroid nodules or thyroid disease and risk factors for thyroid cancer, as evidenced by their medical records. One of 9 radiologists recorded number of nodules, location and bidirectional measurement of largest nodule, as well as amount of thyroid visualized on the chest computed tomography (CT). Presence of nodule was correlated with age, gender, race and percentage of thyroid imaged. RESULTS: A total of 2510 (2510/3077 or 81.6%) study subjects were included in the data analysis; among them,one or more nodules were identified in 629 subjects (629/2510 or 25.1%), with 242 (242/629 or 38.5%) having multiple nodules. Patients with nodule(s) were significantly older than those without (64 ± 13 years vs 58 ± 14 years, P < 0.0001), and female gender was associated with presence of nodule(s) (373/1222 or 30.5% vs 256/1288 or 19.9%, P < 0.0001). Women were also more likely having multiple nodules (167/373 or 44.8%) compared to men (75/256 or 29.3%, P < 0.0001). The majority of nodules (427/629 or 67.9%) were less than 1 cm. CONCLUSION: This retrospective review revealed a prevalence of 25.1% for unsuspected thyroid nodules on contrast-enhanced chest CT.     

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.     

正常高值血压飞行人员心血管危险因素调查分析

Objective To investigate the epidemic features of cardiovascular risk factors in the flying personnel with high normal blood pressure(BP). Methods Three hundred and ninety-one flying personnel were divided into normal BP group and high normal BP group by judging if the systolic and diastolic BP was higher than 120 and 80 mm Hg respectively.Body mass index(BMI),serum total cholesterol(TC),triglyceride(TG),high density lipoprotein(HDL),low density lipoprotein(LDL)and uric acid(UA)were compared.History of smoking and heredity of cardiovascular diseases were surveyed. Results Level of BMI,TG,LDL and prevalence rate of blood fat abnormality in high normal BP group were significantly higher than those in normal BP group (r=2.023,2.191,2.336,P＜0．05;χ2=7.535,P＜0.05),but no significant differences on UA,TC,HDL,smoking habit and familial inherited cardiovascular diseases were found between groups. Conclusions The flying personnel with high normal BP run higher risk of suffering cardiovascular diseases.Medical interventions for controllable risk factors are suggested.     

甲状腺彩色超声检查在飞行员健康体检中的临床价值

目的 调查飞行员甲状腺彩色超声检查结果及鉴定情况,为航空卫生保障提供依据.方法 回顾分析在解放军第四五六医院因健康体检行甲状腺彩色超声检查的629名飞行员的超声检查结果、病理诊断以及医学鉴定情况,并进行统计学分析. 结果 ①629名飞行员中,检出甲状腺疾病139例,阳性率22.10％.②随年龄增长,飞行员甲状腺疾病发病率逐步增高（x2=35.564,P＜0.01）.③甲状腺疾病与飞行员所飞机种无关.④139例患甲状腺疾病的飞行员中飞行合格124例,其中桥本甲状腺炎6例,急性/亚急性甲状腺炎4例;暂时飞行不合格13例,其中原发性甲状腺功能亢进2例,桥本甲状腺炎合并甲状腺功能亢进3例,甲状腺腺瘤术后5例;飞行不合格（停飞）2例,均为甲状腺癌. 结论 结节性甲状腺肿在飞行人员中较常见,对飞行安全无明显影响.甲状腺癌及继发性甲状腺功能亢进患病率有增加趋势,且对飞行安全有着直接或间接影响,应加强预防和早期治疗.甲状腺彩色超声检查对甲状腺疾病的早发现、早诊断、早治疗具有重要意义.     

飞行人员甲状腺功能异常的诊治及医学鉴定

目的 总结甲状腺功能异常飞行人员的临床资料,为规范相关疾病的诊治与鉴定提供依据. 方法 回顾性分析2000年12月至2014年9月间在空军总医院住院的42例甲状腺功能异常的飞行人员病例资料,包括甲状腺功能亢进症和甲状腺功能减退症,总结其疾病特点、诊治过程、治疗效果、医学鉴定结论及随访情况. 结果 ①甲状腺功能亢进症30例（71.43％）,其中26例（86.67％）应用抗甲状腺药物治疗后,医学鉴定结论为飞行合格7例、暂时飞行不合格4例、飞行不合格15例,停飞率57.69％（15/26）.4例（13.33％）应用放射性131I治疗后3例出现甲状腺功能减退;医学鉴定结论为飞行合格2例、暂时飞行不合格2例.②甲状腺功能减退症12例（28.57％）,应用药物替代治疗后,医学鉴定结论为飞行合格9例、飞行不合格3例;3例停飞者中2例为合并心房颤动.结论 飞行人员甲状腺功能亢进症单病种飞行合格率低于甲状腺功能减退症.需要进一步优化飞行人员甲状腺功能亢进症的治疗路径,完善甲状腺功能异常飞行人员的医学鉴定,既最大限度地保存飞行力量又保证飞行安全.     

2003-2008年歼击机飞行员飞行不合格疾病谱分析

目的 分析2003-2008年近5年来歼击机飞行员飞行不合格疾病谱,并与我们曾报道的1965-2004年间歼击机飞行员飞行不合格的疾病谱比较,为联勤后航卫保障提供参考依据.方法 收集空军总医院2003年10月至2008年10月飞行不合格的180名歼击机飞行员病历资料,按疾病和机种类别、涉及专业及不同年龄段进行分类统计,并与既往资料比较.结果 ①飞行不合格的常见疾病为加速度耐力不良、颈腰椎病、头痛、高血压、神经症、地面晕厥、乙型肝炎、脑外伤和阻塞型睡眠呼吸暂停低通气综合征等.②飞行不合格机型分布以歼-7、歼-8最多.③与飞行不合格最相关的专科有神经科、骨科、耳鼻咽喉科和心血管内科等.④飞行不合格在35～39岁年龄段最多.⑤与既往资料比较,加速度耐力不良、飞行错觉和耳气压伤等所占比例下降;高血压等所占比例上升.结论 加速度耐力不良、颈腰椎病、头痛、神经症、胃肠功能紊乱、地面晕厥仍是飞行不合格的重要原因,高血压、糖尿病等占停飞比率有上升趋势,而航空病有下降趋势.     

海军飞行人员住院疾病谱及停飞疾病谱分析

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.结果 ①飞行人员颈椎腰椎疾病明显增多,其疾病构成比达19.1%,医学停飞构成比达140.0%,均位居第1位;②头痛、自主神经功能紊乱等功能性疾病仍然是飞行人员住院和医学停飞的主要原因之一,疾病构成比分别为18.3%与11.3%,医学停飞构成比分别为11.0%与10.0%;③晕厥(包括加速度耐力性晕厥),在住院疾病构成比仅为4.2%,但其医学停飞构成比达13.0%;④消化系统疾病和传染性疾病无论是住院还是医学停飞构成比均逐渐降低,排序亦逐渐靠后,但出现个别性传播性疾病值得重视.结论 飞行人员住院和医学停飞主要疾病与飞行职业因素密切相关,针对飞行人员的职业特点采取合理锻炼和有效装备防护,积极心理学干预和心血管疾病预防等措施,对降低飞行人员患病率和医学停飞率具有重要意义.     

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.     

飞行员肾脏疾病九例的医学鉴定并文献复习

目的 探讨飞行员肾脏疾病的发病特点、诊疗经验以及医学鉴定原则,提出应对策略.方法回顾性分析2005年6月至2008年5月3年间我科收治的9例飞行员肾脏疾病患者的资料和在此期间收治的住院飞行员病历. 结果 ①9例飞行员均为青壮年男性,年龄25～40岁.飞行员肾脏疾病主要分3类:原发性肾小球疾病、先天性尿路畸形和肾结石.②3年问检出各类肾脏疾病占同期本科住院飞行人员总人次的14.9‰.其中,原发性肾小球疾病4例,先天性尿路畸形3例,肾结石4例,有2例飞行员同时患有2种肾脏疾病.③原发性肾小球疾病停飞率高;成人期诊断的先天性尿路畸形多不严重,不影响肾功能者飞行合格;肾结石排出后飞行合格,稳定的肾结石无症状者双座机飞行合格,活动性肾结石飞行不合格.9例飞行员肾脏疾病患者,飞行不合格2例,均为肾小球肾炎患者(其中1例合并肾结石);飞行暂时不合格2例,1例为肾病综合征患者,1例为单纯肾结石患者;其余5例飞行合格,其中2例肾结石患者限双座机飞行. 结论 原发性肾小球疾病、先天性尿路畸形及肾结石在飞行员中均多见,对飞行安全有一定影响,应引起重视并加强相关研究.     

军事飞行员原发性青光眼的医学鉴定分析

目的 探讨因原发性青光眼和可疑青光眼住院的军事飞行员的疾病特点、飞行结论 及放飞观察情况. 方法 对95例因青光眼或可疑青光眼住院的飞行员资料进行回顾性临床分析.结果 95例住院患者中56例诊断为原发性开角型青光眼(POAG),其中停飞15例,飞行暂不合格3例,飞行合格38例,放飞观察中延长飞行年限1～26年,平均6.36±1.43年.36例怀疑青光眼者进行青光眼排除检查,33例排除了青光眼,飞行合格;3例临床可疑,飞行暂不合格.3例诊断为高眼压症,飞行合格. 结论 飞行员最多见的青光眼类型是开角型青光眼;患POAG的飞行员若视功能稳定,在严密观察下能够继续飞行;早期发现和及时治疗是控制疾病的关键.     

胃良性肿瘤脱垂于十二指肠(球)的X线诊断(附8例报告)

目的提高对胃良性肿瘤脱垂于十二指肠(球)的X线表现、机制、脱垂分型和鉴别诊断的认识。方法回顾性分析和研究了采用钡餐胃肠道造影和胃镜检查,并经手术和病理证实的胃良性肿瘤脱垂十二指肠(球)8例。结果胃良性肿瘤脱入十二指肠(球)的X线表现有①十二指肠(球)的充盈缺损和十二指肠降段充盈缺损;②牵引粘膜桥征和幽门管增宽;③肿瘤表面粘膜显示光整和龛影－“牛眼征”;④胃整体形态的改变;⑤肿瘤脱垂与回纳现象;⑥原发肿瘤的部位分布胃窦部肿瘤6例,胃体部和胃底部肿瘤各1例。病理诊断－脱垂于十二指肠球内平滑肌瘤4例,脂肪瘤和神经鞘瘤各1例,脱垂于十二指肠降部平滑肌瘤2例。结论可靠的X线诊断征象有①十二指肠(球)的充盈缺损;②牵引粘膜桥征;③幽门管增宽;④胃整体形态的改变。     

中美空军飞行学员医学选拔对照实证研究--先天性心脏病

目的：分析我军招飞医学选拔时因先天性心脏病（先心病）而淘汰的学员参照美军招飞标准判定情况,为我军招收飞行学员体检标准中先心病的相关内容修改提出合理建议。方法对2012—2015年参加招飞医学选拔定选的学员进行心脏听诊,存在杂音的行超声心动图检查,分析学员因先心病而淘汰的情况,并参照美军招飞医学选拔标准判定其是否合格。结果2012—2015年先心病的淘汰率差异无统计学意义（P＞0.05）;我军招飞体检中先心病的亚型主要包括杂音超标、冠状动脉瘘和左心室假腱索。我军先心病不合格学员参照美军标准进行判定后,86.67%结果合格。结论我军和美军招飞医学选拔标准中关于先心病的相关内容具有较大差异,在修订我军标准时可以适当借鉴美军标准。