[7]《美国空军特许飞行指南2011》 介绍

2011年1月24日美国空军公开发布了重新修订的特许飞行指南(Air Force Waiver Guide),对飞行人员医学检查标准中规定的飞行不合格疾病允许放宽的情况进行了说明,包括160项疾病内容,每一项内容按概述、航空医学问题、特许飞行可能性、特许鉴定需要提交的材料以及参考文献等几部分进行表述,资料翔实,分析合理,对我军临床航空医学鉴定有较大的参考价值.     

《美国空军特许飞行指南2011》介绍

2011年1月24日美国空军公开发布了重新修订的特许飞行指南（AirForceWaiverGuide）,对飞行人员医学检查标准中规定的飞行不合格疾病允许放宽的情况进行了说明,包括160项疾病内容,每一项内容按概述、肮空医学问题、特许飞行可能性、特许鉴定需要提交的材料以及参考文献等几部分进行表述,资料翔实,分析合理,对我军临床航空医学鉴定有较大的参考价值。     

临近飞行最高年限海军飞行人员的疾病谱与鉴定

目的 对临近飞行最高年限的海军飞行人员的临床资料进行回顾性研究,分析其疾病谱和特许医学鉴定结论,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—2021年5月在海军特色医学中心体检的36例46岁以上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飞行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 36例海军飞行人员共检出40种疾病,降序排序依次为甲状腺疾病、高脂血症、冠状动脉硬化、胃炎、肺结节、结直肠息肉、胆囊息肉、心肌桥、高血压、Ⅰ度房室传导阻滞。而超龄特许医学鉴定不合格的常见疾病仍是心脑血管疾病。结论 影响临近飞行最高年龄人员飞行结论的最主要疾病是心脑血管疾病。如果能对其飞行能力更加科学的评估,就可以适当延长其飞行年限。     

飞行人员鼻腔结构异常的诊治和鉴定

目的 总结飞行人员鼻腔结构异常(鼻中隔偏曲和鼻甲肥大)的临床诊治和健康鉴定经验.方法 分析因鼻腔结构异常而住院诊治的飞行人员病历资料91份,对其进行分类和分型,总结鼻腔结构异常的分型与继发性气压伤之间的关系.结果 飞行人员鼻腔结构异常分类为Ⅰ类(地面有症状或体征)50例,Ⅱ类(地面无症状或体征、飞行中出现继发性气压伤,包括Ⅱa继发性鼻窦气压伤10例,Ⅱb继发性耳气压伤26例,Ⅱc继发性鼻窦气压伤+耳气压伤5例)41例.分型为鼻中隔偏曲型41例,下鼻甲肥大型29例,中鼻甲肥大型8例,鼻中隔偏曲复合鼻甲肥大型13例.鼻中隔偏曲24例次、下鼻甲肥大12例次、中鼻甲肥大14例次与继发性气压伤有关.85例飞行合格,1例由歼击机降为运输机飞行,2例暂时飞行不合格,3例永久停飞.结论 鼻腔结构异常在飞行人员中常见,根据对鼻窦和耳气压功能的影响进行分类和分型具有重要的临床航空医学意义,在飞行学员医学选拔、飞行人员疾病诊治和健康鉴定时统一操作规范,是提高招飞体检质量及疾病诊治和健康鉴定水平,保障航空兵部队战斗力的重要措施.     

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.     

美国空军飞行人员疾病特许管理

目的：了解美国空军飞行人员疾病特许的管理与操作模式。资料来源与选择该领域相关研究论文和综述。资料引用国外公开与内部发表的期刊论文及科技报告等特种文献17篇。资料综合疾病特许审核权限明确，特许评估程序与推荐流程、文档书写和数据库管理要求严格，依据飞行人员机种机型分级特许，强调无履职障碍、无突发失能、疾病和症状在飞行环境下无重现可能性、不伤害他人、可持续飞行等特许原则。结论疾病特许管理的客观性和科学性强，最大程度地维护了空军投资利益，保留了空中作战力量。     

美国空军无人机飞行员医学标准

《美国空军无人机飞行员医学标准》适用于遥控驾驶系统操作人员.所有成员必须满足空军飞行员保留标准的相应条件.曾经接受过另一种武器系统训练并暂时执行遥控飞行任务的空勤人员将使用低于长期执行遥控飞行任务人员的FC ⅡU标准.机组人员接受过非航空军医的处理后,还必须接受航空军医合理的航空医学处置和判定后才可以继续执行遥控飞行任务,如果没有经过航空军医处置,将从遥控飞行任务移除直到接受航空军医评审.具体不合格及相关标准翻译介绍如下.     

飞行人员强直性脊柱炎治疗后特许飞行的临床研究

目的 探讨飞行人员强直性脊柱炎（ankylosing spondylitis,AS）治疗后特许飞行的可行性。方法 选取2010年1月—2019年8月空军特色医学中心（原空军总医院）确诊的飞行人员AS患者,根据航空医学鉴定结果分为飞行合格组及飞行不合格组（包括停飞及地面观察超过6个月）,比较2组在年龄、飞行时间、病程、炎性指标及治疗方案的差异。结果 共纳入飞行人员AS患者20例,飞行合格组14例,飞行不合格组6例,飞行不合格组C反应蛋白水平高于飞行合格组（t=-2.95,P<0.05）,差异具有统计学意义;飞行不合格组中5例（83.3%）应用生物制剂,飞行合格组中2例（14.3%）应用生物制剂,2组比较差异具有统计学意义（83.3%vs 14.3%,P<0.01）;2组在年龄、飞行时间及病程方面比较差异无统计学意义;飞行合格组在飞行期间未发生安全事故;1例患者特许飞行合格后21个月病情复发。结论 部分飞行人员AS患者治疗后给予特许飞行具有可行性,飞行期间应定期进行病情评估。     

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.     

飞行人员晕厥诊治特点与航空医学鉴定--附36例临床分析

目的：总结飞行人员晕厥诊治和航空医学鉴定特点,为其诊治及航空医学鉴定提供参考。方法回顾性分析1998年10月—2015年10月入住空军总医院空勤科的36例军事飞行人员晕厥临床资料并复习相关文献。结果30～39岁年龄组的飞行人员发生晕厥较多,共19例,占52.8%;36例中血管迷走性晕厥23例,占63.9%,发生率最高;19例飞行合格,7例暂时飞行不合格,10例飞行不合格;飞行人员晕厥在不同机种间发病率差异无统计学意义。结论飞行人员晕厥包括地面晕厥和空中晕厥,诊治有其特殊性;按照现行飞行人员体格检查标准,借鉴美国相关标准,结合诱因是否明确、飞行机种、飞行经验、职别、个人意向及部队需求予以医学鉴定。     

飞行人员变应性鼻炎的临床诊治和医学鉴定（摘要）

目的总结飞行人员变应性鼻炎的临床诊治和健康鉴定经验。方法分析飞行人员因变应性鼻炎而住院诊治的病历资料53份,对其进行分类、分型和分度,并总结与继发性气压伤之间的关系。结果飞行人员变应性鼻炎分为Ⅰ类（飞行中无继发性气压伤表现）30例,Ⅱ类（飞行中出现继发性气压伤表现,包括Ⅱa继发性鼻窦气压伤4例;Ⅱb继发性耳气压伤16例,Ⅱc继发性鼻窦气压伤＋耳气压伤3例）共23例。     

Medullary sponge kidney and urinary calculi: aeromedical concerns

Medullary sponge kidney (MSK) is a benign disorder associated with a lifetime risk of renal stones in 60% of patients. Patients frequently have episodic painless hematuria, but are often otherwise asymptomatic unless renal calculi or infections complicate the disease. Nephrolithiasis is a relative, but frequently enforced, contraindication to space or other high-performance flight. Two case reports of asymptomatic NASA flight crew with MSK and three cases of United States Air Force (USAF) military aviators diagnosed with MSK are reviewed. All cases resulted in waiver and return to flight status after treatment and a vigorous followup and prophylaxis protocol. MSK in aviation and spaceflight necessitates case-by-case evaluation and treatment to rule out other potential confounding factors that might also contribute to stone formation and in order to requalify the aviator for flight duties.     

Results of Holter monitoring U.S. Air Force aircrew with ectopy on 12-lead electrocardiograms.

PURPOSE: To evaluate the results of 24-h Holter monitoring performed on healthy U.S. Air Force aircrew with asymptomatic ectopy on resting electrocardiograms (ECG). METHODS: A historical review of the USAF Central ECG Library database was conducted on all Holter studies completed for evaluation of ECG ectopy between 1 Jan 86 and 31 Dec 97. Univariate and multivariate statistical analyses were performed to determine the association between ectopy and the aeromedical dispositions of aircrew evaluated for incidental ECG ectopy. RESULTS: During this period, 147,571 resting ECGs were submitted to the Aeromedical Consultation Service (ACS) for interpretation. The mean age of the subjects was 35 yr (range 19 to 57 yr). There were 480 24-h Holter studies performed for ECG ectopy. Of these, 49% had normal or normal variant findings; another 11% were found acceptable for flying after normal treadmill testing and echocardiography. ACS evaluation was required for the remaining 40% of subjects. Overall, 4% were permanently disqualified, and 17% were lost to follow-up. Excluding subjects lost to follow-up, 95% of aircrew were returned to flying status (with or without a waiver). CONCLUSIONS: When controlled for age, no significant difference of aeromedical outcome was seen when comparing supraventricular and ventricular ectopy. Of the subjects, 51% had abnormal Holter studies, but the vast majority were returned to flying. Results of this study provide information useful in further defining aircrew medical evaluation protocols for evaluation of asymptomatic ECG ectopy with Holter monitoring.     

Permanent flying disqualifications of USAF pilots and navigators (1995-1999)

BACKGROUND: The USAF devotes great financial and medical assets to the identification and evaluation of USAF aircrew who have been grounded from flying duties for medical conditions thought to be dangerous to the flying mission or personal safety. The purpose of this study is to update the literature and to demonstrate that USAF efforts during the past 19 yr have improved our ability to retain experienced aviators. METHODS: The USAF waiver file was reviewed to quantify the number of USAF pilots and navigators receiving permanent medical disqualifications from flying duties during 1995-1999. We identified 157 cases, which were stratified by age group and sex. RESULTS: The number of disqualifications increased incrementally by age group. The most common diagnoses resulting in permanent disqualification were coronary artery disease, hypertension, back pain and disk abnormalities, migraine headaches, diabetes mellitus, and substance/alcohol abuse. DISCUSSION: These results are very similar to those reported in a 1984 USAF study and other studies of aviation populations. The rate of permanent flying disqualifications in this study was equal to 0.18% per year compared to 4.1% per year in 1984. This decrease in the rate of disqualifications could be due to modification of USAF standards, utilization of clinical management groups, better screening of applicants, new technology or therapies, and effective preventive medicine efforts throughout the Air Force.     

Myocardial infarction occurring at the conclusion of centrifuge training in a 37-year-old aviator.

In September 1988, the U.S. Air Force instituted routine centrifuge training for aircrew involved in high performance, high G aircraft. As of June 1991, 6,078 aircrew members have been trained. This report documents an anterolateral myocardial infarction that occurred in a 37-year-old pilot immediately after his centrifuge training profile. The individual had a history of elevated lipids and smoking, and was on a waiver from the USAF for Flying Class II duties for hyperlipidemia treated with cholestyramine.     

老年心房颤动122例临床分析

目的分析老年心房颤动患者的病因和治疗等相关情况。方法对我院2002—2006年8月住院的122例65岁以上老年房颤患者的临床资料进行回顾分析。结果阵发性房颤、持续性房颤和持久性房颤分别为27.9%,18.3%,54.8%。93.44%的老年患者存在器质性心脏病,其中冠心病49.18%、高血压病18.85%、风心病17.21%、肺心病3.28%。心功能Ⅰ~Ⅱ级者50.82%,Ⅲ~Ⅳ级者49.18%。结论本组分析表明,冠心病、高血压病、风心病是老年人房颤的主要原因。心房颤动患者抗凝率低,抗凝治疗应得到重视。     

Military aviators with mitral valve prolapse: long-term follow-up and aeromedical endpoints

INTRODUCTION: Mitral valve prolapse (MVP) is a disqualifying condition for USAF aviators. Trained USAF aviators, and in recent years flying training applicants, may be granted waiver for initial or continued flying duties following extensive, periodic evaluation. This study examines the usefulness of the various tests performed in that evaluation process and provides long-term follow-up from 404 USAF flyers with MVP. METHODS: We retrospectively reviewed 2-dimensional echocardiography, Holter monitoring, treadmill exercise, thallium imaging, coronary fluoroscopy, cardiac catheterization, and centrifuge testing results from 404 military aviators evaluated at the Aeromedical Consultation Service between 1 January 1972 and 31 October 1993. Follow-up was achieved through questionnaires (91%) and death certificates, etc. RESULTS: Mean follow-up was 8.6 yr (range 1-21 yr). Age at study entry was 21 to 64 yr (mean = 36 yr). The occurrence rate for suddenly incapacitating events (sudden cardiac death, syncope, pre-syncope, and cerebral ischemic episodes) was 0.32%/yr. CONCLUSIONS: Echocardiographic MVP in military aviators is associated with a low but statistically increased prevalence of "incapacitating" aeromedical events. Univariate predictors of adverse outcome included study entry with an enlarged left ventricle or left atrium, cardiovascular symptoms or findings, or MVP with thickened leaflets. Evaluation of coronary artery disease (CAD) in this population, absent specific indicators of CAD risk, is not indicated.     

中美空军飞行学员医学选拔对照实证研究——心脏瓣膜病

目的 分析我军招飞体检时因心脏瓣膜病而不合格的学员参照美军招飞标准的判定结果 ,为我军招收飞行学员体检标准中心脏瓣膜病相关内容的修改提出合理建议.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,存在杂音者行超声心动图检查,对于不符合我军心脏瓣膜病相关标准而淘汰的学员,参照美军招飞体检标准判定其是否合格.结果 2012—2015年我军招飞体检定选的心脏瓣膜病不合格率具有显著性差异(P＜0.05);我军招飞体检中的心脏瓣膜病主要包括二尖瓣疾病、主动脉瓣疾病、三尖瓣和肺动脉瓣疾病,对比中美招飞标准后,我军因心脏瓣膜病不合格的学员参照美军标准有68%合格,20%可以特许飞行.结论 我军和美军招飞医学选拔标准中关于心脏瓣膜病的相关内容具有一定差异.     

Phobic fear of flying in aircrews: epidemiological aspects and comorbidity

BACKGROUND: Phobic fear of flying may affect aircrew members during any phase of their flying careers. Symptoms are beyond voluntary control and may lead patients to avoid flying and seek medical advice. METHODS: Of 1101 psychiatric files from our institute for 1985-2002, 150 represented cases of fliers who suffered from phobic fear of flying. Data collected from those files included assessment of fear-evoking situations, type of aircraft, class of aircrew duties, aircraft accident history, past medical history, age, and associated psychiatric comorbidity. RESULTS: We compared a group of 56 pilots with 94 other aircrew members. Results included 143 cases of flight phobia behavior and 7 cases of anxiety about parachuting. Flight phobia was less frequent among pilots (37.4%) than the other aircrew members (62.6%). We found a history of aircraft accident to the patient or an acquaintance in 25% of the cases. Observed comorbid psychiatric disorders (54%) consisted of depressive disorders (22%), anxiety disorders (16%), and personality disorders (7.4%). Fixed-wing pilots and aircrews members had a higher incidence of depression than did rotary-wing pilots and crewmembers (p < 0.05). Rotary-wing pilots and crewmembers had a higher rate of anxiety disorders (p < 0.05). DISCUSSION: Flight phobia encompasses a wide spectrum of clinical origins that may lead pilots or other aircrew members to refuse to fly. We recommend a careful psychiatric evaluation and close follow-up to adequately diagnose fliers with flight phobic reactions, as well as establishing adequate medical and/or psychological treatment.     

Aeromedical management of U.S. air force aviators who attempt suicide.

BACKGROUND: Little has been published about the aeromedical management and disposition of aviators who attempt suicide, and almost no such information about military aviators exists in the open literature. The few available data are scattered and frequently anecdotal. METHODS: The authors reviewed all case reports of fliers evaluated at the USAF School of Aerospace Medicine's Aeromedical Consultation Service (ACS) between 1981-96 for possible return to flying duties after a suicide attempt, and prepared a representative case report. RESULTS: Between 1981 and 1996, the ACS evaluated 14 trained aviators (pilots and other aircrew members, excluding flight surgeons) who had attempted suicide. Of these, 11 (79%) ultimately received a recommendation for return to flying duties. CONCLUSIONS: In most instances the underlying stressors included failed intimate interpersonal relationships, administrative or legal problems, psychiatric disorders, death of spouse, or job conflicts. Evidence of abuse of alcoholor other substances was found in 54% of an earlier, larger data set of attempters. Some data on aircrew suicide completion were available and are reported. The top medical priorities after such attempts should be to diagnose what is wrong, and to treat it. In spite of the common assumption that a suicide attempt inevitably ends a military flying career, some attempters can return to safe and effective flying duty after appropriate psychotherapy. If the flier regains physical and mental health and maintains them for at least 6 mo after treatment, then that flier may be evaluated by an outside aeromedical psychiatric consultant such as the ACS (to avoid transference issues between flier and therapist) for possible return to flying duties. Waiver action should be based on the underlying psychiatric diagnosis, not the suicidal attempt itself. Follow-up may be accomplished through periodic mental health evaluations in conjunction with routine physical examination procedures. Issues involving substance abuse and security clearances must be handled through the appropriate channels.