飞行人员鼻窦气压伤的临床诊治和医学鉴定

目的 总结飞行人员鼻窦气压伤的临床诊治和医学鉴定经验. 方法 整理、分析73例飞行人员鼻窦气压伤临床资料. 结果 ①Ⅱ_a类56例(仅有鼻窦气压伤),Ⅱ_c类17例(鼻窦气压伤+耳气压伤).②发生于额窦54例,上颌窦10例,筛窦3例,蝶窦2例,额窦+上颌窦和额窦+筛窦各2例.③原发性气压伤24例(由窦口本身病变所致),继发性气压伤49例(由窦口周围病变所致).④继发性鼻窦气压伤Ⅰ型(鼻腔结构异常型)15例、Ⅱ型(炎症型)25例、Ⅲ型(变态反应型)8例和Ⅳ型(肿瘤型)10例;其中7例两型并存,1例3型并存;窦内型7例、窦外型42例.⑤轻度34例(46.6%),重度39例(53.4%).⑥62例飞行合格,2例飞行暂时不合格,9例飞行不合格. 结论 额窦气压伤发生比例最高.对鼻窦气压伤进行分类、分型和分度具有重要的临床航空医学意义.继发性病变所占比例较高,炎症型是窦口周围病变的重要原因,重度鼻窦气压伤需要手术治疗,Ⅱ_c类气压伤是最易导致医学停飞的疾病.

Clinical diagnosis, treatment and medical evaluation of barosinusitis in aircrew

Objective To sum up the experiences of clinical diagnosis, treatment and suggest medical evaluation of barosinusitis in physical examination of aircrew.Methods Case studies of barosinusitis were made in 73 aircrew (3 female and 70 males aged from 21-51 years). Such items as location, classification, type and graduate of barosinusitis, as well as treatment and final evaluation were statistically analyzed by means of SPSS 11.0 software.Results ① There were 56 cases of class Ⅱ_a (barosinusitis only)and 17 cases of class Ⅱ_c (barosinusitis and barotrauma of ear)based on diagnosis. ② For location, 54 cases of were in frontal sinus, 10 in maxillary sinus, 3 in ethmoid sinus, 2 in sphenoid sinus, 2 in frontal sinus and maxillary sinus, and 2 in frontal sinus and ethmoid sinus. ③ Twenty-four cases were classified as primary barotraumas that resulted from abnormal of sinus ostium while other 49 cases were the secondary barotraumas that resulted from the pathological change around sinus ostium. ④ In type statistics, 15 cases were the type Ⅰ (the type of anatomical abnormalities in nasal cavity), 25 for type Ⅱ (the type of inflammation), 8 for type Ⅲ (the type of allergy), and 10 for type Ⅳ (the type of tumor). Among them, 7 cases were simultaneously diagnosed as 2 types of barotraumas and 1 case had 3. There were 7 cases of in-sinus type and 42 outsinus type. ⑤ For graduate analysis, 34 cases (46.6%) were mild and 39 cases (53.4%) were severe. ⑥ For final evaluation, 62 cases were qualified while the other 2 and 9 cases were respectively decided as temporary and permanent grounding.Conclusions The incidence ratio of barosinusitis in frontal sinus is the highest.Classifying, typing and graduating barotraumas indicate important significance to clinical aviation medicine. The incidence ratio of secondary barosinusitis is higher than that of primary and the type Ⅱ is the main reason that causes the pathological changes around sinus ostium. Operation is suggested for severe barosinusitis. The class Ⅱ_c barotraumas would mostly result in aircrew grounded.