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.

Clinic treatment and medical assessment of the flying personnel with congenital heart disease

Objective To study the diagnosis and treatment of congenital heart disease (CHD) in flying personnel as well as the medical assessment to them. Methods The disease characteristics, prognosis and medical assessment for the 12 flying personnel with CHD, who were hospitalized in Air Force General Hospital from 1993 to 2010, were reviewed. Results Diagnosis and medical assessments showed that: ① There were 3 ventricular septal defect (VSD) cases, 2 bicuspid aortic valve deformity cases and 1 coronary artery fistula case. All of them did not receive any special surgical treatment and were disqualified for flying eventually. ② A aerial engineer was diagnosed as foramen ovale open (PFO) and he was eventually qualified. One bicuspid aortic valve deformity case was assessed as qualified for the flying for his original aircraft type. ③ There was 1 atrial septal defect (ASD) case. Even he received surgical repair successfully, but was still disqualified eventually. ④ There were 1 patent ductus arteriosus (PDA) case and 2 ASD cases that received medical interventional closure. In 6 to 14 months period of temporary grounding period, the pilot with PDA and one pilot with ASD were closely followed-up and passed strict medical examinations. They were qualified for flying eventually. But another ASD pilot was still in observation and temporary grounded. Conclusions Once flying personnel is diagnosed as CHD, doctors should give individual assessment upon clinical symptom, type of aircraft and prognosis. Occluder interventional therapy for CHD is safe and effective. The recovered flying personnel by successful treatment could be considered to return flying.