超声心动图检出飞行员先天性心脏病的医学鉴定价值

目的 探讨超声心动图检出现役飞行员先天性心脏病对招飞体检工作的意义. 方法 回顾性分析9年间在我院超声科行超声心动图检查的现役飞行员中,因行超声心动图检查首次诊断为先天性心脏病的患者的影像学资料. 结果 发现先天性心脏病患者10例,其中主动脉瓣畸形4例,均为二瓣畸形;房间隔缺损3例,均为继发孔型房间隔缺损;冠状动脉瘘1例;永存左上腔静脉伴冠状静脉窦扩张2例.10例患先天性心脏病的飞行员9例飞行结论 为飞行不合格,1例飞行结论 为暂时飞行不合格. 结论 超声心动图检查在诊断现役飞行员先天性心脏病的过程中具有准确、安全、快捷的特点,是明确诊断的首选方法.因此,如条件允许,超声心动图应列为招飞体检的常规检查项目.     

彩色多普勒超声心动图诊断飞行员左室假腱索及其临床意义

目的 探讨飞行员左室假腱索的彩色多普勒超声心动图诊断及其临床意义.方法 对我院近8年来进行彩色多普勒超声心动图检查的934例男性飞行员资料进行分析,按是否存在左室假腱索对飞行员进行分组,比较两组室性早搏、T波或ST-T改变的检出率及年龄.结果 934例飞行员发现有左室假腱索98例,检出率10.49%,无假腱索者836例(占89.51%).左室假腱索组与无假腱索组飞行员所出现的室性早搏阳性率和T波或ST-T改变阳性率组间比较,差异有统计学意义(x2=97.71、70.16,P＜0.01),两组年龄比较无显著差异(t=1.479,P＞0.05).结论 除外器质性心脏病,飞行员左室假腱索与临床出现的室性早搏和T波或ST-T改变有一定的关联性,左室假腱索的检出对飞行员的医学健康鉴定有一定的诊断价值和临床意义. Abstract： Objective To study the clinical significance of diagnosing pilot's left ventricular false tendons (LVFT) by color Doppler echocardiography.Methods The case history of 934 pilots who were examined by color Doppler echocardiography in recent 8 years was reviewed.Pilots were grouped by judging if the LVFT was diagnosed.The detection rate of premature ventricular contraction and the change of T wave or S-T, as well as age were compared between LVFT group and healthy group.Results There were 98 cases of LVFT picked out of 934 pilots; the detection rate was 10.49%.Masculine of premature ventricular contraction and the change of T wave or S-T in LVFT group showed significant difference (x2=97.71 and 70.16, P＜0.01) but for age (t=1.479, P＞0.05).Conclusions LVFT shows certain relationship with premature ventricular contraction and the change of T wave or S-T except the reason of organic heart disease.Even LEFT taken as a kind of normal anatomical variation but it has the possibility of evoking premature ventricular contraction after all.Caring LVFT is suggested in medical identification of pilot.     

招飞体检胸部X线检查对先天性心脏病的诊断价值

由于超声心动图非招飞体检常规检查项目,不能有效杜绝先天性心脏病的漏诊,目前我军现役飞行员中存在一定比例的先天性心脏病患者,严重影响飞行安全,而一旦发现,鲜有能继续飞行者[1].为确保飞行人员身体健康和飞行安全,尽可能在招飞体检这个源头防止先天性心脏病患者进入飞行学员队伍是最好的解决办法.笔者总结分析成年人先天性心脏病的特征性X线表现,探讨胸部X线检查在招飞体检中检出先天性心脏病的价值.关键词：体格检查（Physical examination）;心脏缺损,先天性（Heart defects,congenital）;放射摄影术,胸部（Radiography,thoracic）分类号：R851.3;R445.4     

飞行员血液同型半胱氨酸与心血管疾病的相关性研究

目的 研究飞行员血液同型半胱氨酸(homocysteine,Hcy)水平变化,预测飞行员心血管事件的发生. 方法 将163例飞行员和60例男性健康地面工作人员(对照组)按年龄分别设21～30岁、31～40岁和41～50岁组;同时按飞行时间将飞行员分别设≤1000 h、1001～2000 h、2001～3000 h和3001～4000 h组;采用全自动生化分析仪测定Hcy浓度. 结果 飞行员组血液Hcy浓度为(9.86±4.45)μmol/L,对照组为(7.10±1.77)μmol/L.两组比较显示飞行员组血液Hcy明显高于对照组(t=4.67,P＜0.01);在不同年龄组血液Hcy测定中,对照组21～30岁组与41～50岁组差异显著(P＜0.05),飞行员不同年龄组之间差异均显著(P＜0.05或P＜0.01);在不同飞行时间血液Hcy测定中,1001～2000 h组、2001～3000 h组均与≤1000 h组差异显著(P＜0.01).同一年龄组中,飞行员血液Hcy浓度均高于对照组(t=3.893、6.221、3.193,P＜0.01). 结论 测定血液Hcy可预测飞行员心血管事件发生的危险性,应针对飞行员血液Hcy升高采取强有力的干预措施,从而有效预防飞行员冠心病的发生. Abstract： Objective To study the change of homocysteine (Hcy) concerntration in pilot's blood and to predict the occurrence of cardiovascular events of pilots. Methods One hundred and sixty-three pilots and 60 male health ground service personnel were selected as pilot and control groups and respectively divided by age as 21-30, 31-40 and 41-50 yrs sub-groups. Pilots were also grouped into ≤ 1000 h, 1001-2000 h, 2001-3000 h and 3001-4000 h sub-groups by flying hours. The concentration of Hcy were detected by using automatic biochemical analyzer. Results The Hcy concentration in pilot group was (9.86±4.45) μmol/L comparing to (7.10±1.77) μmol/L in control group and the difference between groups was significant (t=4.67, P＜0.01). For the Hcy change by age, significant differences were between sub-group 21-30 yrs and 41-50 yrs in control group (P＜0.05), and between each two sub-groups in pilot group (P＜0. 05 or P＜0. 01). For the Hcy detection by flying hours, sub-group 1001-2000 h and 2001-3000 h respectively showed significant difference to ≤ 1000 h sub-group (P ＜ 0.01). Between the same age sub-groups, the Hcy concentration in pilots is higher than that in control groups (t=3. 893, 6. 221, 3. 193, P＜0.01).Conclusions Detecting the Hcy concentration in blood can be used to predict the risk of cardiovascular events of pilot. Taking powerful intervention measure to restrict the elevation of Hcy level can effectively prevent coronary heart disease of pilot.     

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.     

招飞体检中对视网膜出血标准掌握的探讨

目的 通过对1987-2006年20年间招飞体检中发现的视网膜出血受检者的出血部位、形态进行统计分类及分析,探讨招飞体检中视网膜出血标准掌握的原则. 方法 对参加招飞体检的37 446人按地区分组进行散瞳、检查眼底,对217例视网膜出血眼进行分析、追踪检查.并对其中34例进行了凝血象检查. 结果 37 446人视网膜出血217眼,发生率为0.29%,地区间比较差异无统计学意义.出血眼中单纯性圆点状视网膜出血和火焰状出血占73.27%.伴有视网膜血管改变及其他眼底病变占17.51%,形态不规则出血占9.22%,出血形态组间比较差异有统计学意义(χ2=10.553,P<0.05).出血部位在视网膜后极部占49.77%,视网膜周边及赤道部占31.80%;视乳头旁及黄斑区占18.43%,出血部位组间比较差异有统计学意义(χ2=11.858,P<0.05).217眼中结论 合格159眼,占73.27%;不合格58眼,占26.73%. 结论 招飞体检中单纯性视网膜出血能在较短时间内完全吸收,无后遗症.除伴有先天性血管变异、多发性及眼底有其他异常的视网膜出血者外,原则上视网膜出血予以保留. Abstract： Objective To investigate and discuss the evaluation criterion of retinal hemorrhage by analyzing its location and morphology those were collected in pilot recruiting from 1987 to 2006.Methods Ocular fundus of 37 446 candidates',who were grouped by area (Shandong and Northeast region).were examined after mydriasis and 217 eyes of retinal hemorrhage were picked and tracked for analysis.Among these cases 34 were tested by coagulogram examination. Results The incidence of retinaI hemorrhage was 0.29% for 37 446 candidates (74 892 eyes) and no regional difference was found.In morphologic statistic,73.27%retinal hemorrhages were dot-shaped or flame-shaped while 9.22% were irregular-shaped.17.51%retinal hemorrhages were found with retinal vascular changes or other ocular fundus affections.There was significant difference between groups in morphologic analysis (χ2=10.553,P<0.05).For hemorrhage location,49.77% were at posterior pole,31.80% were at peripheral or equatorial area of retina and 18.43%were beside papilla optica or at macular area.The location of hemorrhage also showed significant difference between groups (χ2=11.858,P<0.05).159 of 217 eyes (73.27%) were finally assessed as eligible. Conclusions Simple retinal hemorrhage.that were found in pilot recruiting,could be recovered and no sequela resulted.Qualification could be issued to those candidates with simple retinal hemorrhage but with innate vascular variation or multiple ocular fundus abnormality.     

飞行学员低常远视力变化趋势的动态追踪观察

目的 追踪观察低常远视力飞行学员远视力变化趋势,为现行招飞体检标准的修订提供客观依据.方法 选择招飞时0.8≤远视力＜1.0的飞行学员共137人为观察组;同期招飞时远视力≥1.0的飞行学员134人为对照组;分别复查双眼散瞳前后远视力,采用配对秩和检验、x2检验进行组内不同时间远视力的比较及组间比较.结果 ①1年后观察组远视力散瞳前后达标率分别为95.62%和98.18%,对照组为94.78%和97.76%;散瞳后最低远视力两组分别为0.6和0.7.⑦两组远视力在招飞时、散瞳前和散瞳后呈逐步提高趋势,差异有统计学意义(Z=230.72、12.76,P＜0.01).③复查时两组远视力均较招飞时提高,散瞳后尤为明显.④两组均存在不同程度的睫状肌调节痉挛,观察组更为显著.结论 两组远视力绝大多数都符合招飞体检标准;调查阶段两组远视力均以稳定和上升趋势为主. Abstract： Objective To figure out the change tendency of flying cadet's subnormal distant vision based on one year follow-up study and to provide objective reference to the standards of physical examination for pilot recruitment.Methods One hundred and thirty-seven flying cadets, who had the subnormal distant vision in the range from 0.8 to 1.0 (include 0.8) that determined in physical examination of recruitment, were chosen as study group while other 134 homo-session flying cadets with 1.0 or better distant vision were randomly selected as control group.The distant vision of both groups was respectively rechecked under ante- and post-mydriasis states 1 year after enrollment.Results were statistically compared between states and between groups by matched-pairs rank test.Results ① Most cadets of study group remained stable distant vision according to 1 year later recheck and respectively 95.62% and 98.18% cadets, corresponding to ante- and post-mydriasis states, kept up to standard, comparing to 94.78% and 97.76% in control group.There were only few cadets in 2groups had their distant vision declined after 1 year and there was no significant difference between groups.The worst case was the going down to 0.6 and 0.7 post mydriasis vision respectively in study and control group.② Comparing to 1 year ago, both groups showed gradually improved distant vision both for with and without mydriasis and significance was found between groups (Z= 230.72, 12.76,P＜0.01).③ The distant vision of 2 groups showed significant increase under both ante- and postmydriasis state comparing to that of one year before, especially for the post-mydriasis state.④ The episode of ciliary muscle cyclospasm was appeared in various degrees in both groups.Conclusions Most of flying cadets in two groups keep their distant vision in stable improvement and match exam standard according to 1 year follow-up.Since ciliary muscle cyclospasm is common in flying cadets the oriented education of eye protection should be strengthened.     

未来战斗机飞行员供氧呼吸防护装备发展及其生理研究趋势

目的 简要概述国内外未来战斗机飞行员供氧呼吸防护装备及其生理研究的发展趋势.资料来源与选择该领域相关的论著、综述、专著及国军标.突出介绍了未来战斗机航空供氧与防护装备技术的发展动向.资料引用国内外公开发表的文章19篇,专著3部,标准文献2篇.资料综述根据国内外未来飞机供氧氧源、呼吸调节设备、供氧面罩、个体代偿防护服装的发展,提出了飞行员航空供氧装备、个体防护装备及其生理学问题的研究设想.结论 机载制氧是远航飞行必然的选择;电子变压调节无忧虑呼吸、飞行员个体装备核生化防护、离机落水应急呼吸防窒息生理要求是航空生理学研究的重点. Abstract： Objective To review the development of oxygen supply protective equipment for future fighter pilot in the world and foresee the tendency of related physiological study.Literature resource and selection References selected from publications and reports that emphatically introducing the technology development of aviation oxygen supply equipment and personal protective equipment for future fighter pilot.Literature quotation Nineteen papers, 3 monographs and 2 standard that were published in China and abroad were cited.Literature synthesis The developments of aviation oxygen supply and personal protective equipment as well as the related studies in future were foreseen by reviewing the progress of on board oxygen resource, respiratory regulator, oxygen mask, personal protective suit.Conclusion The on board oxygen generation system would be the certain choice for long-distance flight.The concerned studies of aviation physiology will mainly focus on electronic pressure regulating for carefree respiratory, pilot's protective equipment with the shield against nuclear, biological and chemical harm, and anti-suffocation for the escaped pilot in water.     

招飞体检中对视网膜出血标准掌握的探讨

Objective To investigate and discuss the evaluation criterion of retinal hemorrhage by analyzing its location and morphology those were collected in pilot recruiting from 1987 to 2006.Methods Ocular fundus of 37 446 candidates',who were grouped by area (Shandong and Northeast region).were examined after mydriasis and 217 eyes of retinal hemorrhage were picked and tracked for analysis.Among these cases 34 were tested by coagulogram examination. Results The incidence of retinaI hemorrhage was 0.29% for 37 446 candidates (74 892 eyes) and no regional difference was found.In morphologic statistic,73.27%retinal hemorrhages were dot-shaped or flame-shaped while 9.22% were irregular-shaped.17.51%retinal hemorrhages were found with retinal vascular changes or other ocular fundus affections.There was significant difference between groups in morphologic analysis (χ2=10.553,P<0.05).For hemorrhage location,49.77% were at posterior pole,31.80% were at peripheral or equatorial area of retina and 18.43%were beside papilla optica or at macular area.The location of hemorrhage also showed significant difference between groups (χ2=11.858,P<0.05).159 of 217 eyes (73.27%) were finally assessed as eligible. Conclusions Simple retinal hemorrhage.that were found in pilot recruiting,could be recovered and no sequela resulted.Qualification could be issued to those candidates with simple retinal hemorrhage but with innate vascular variation or multiple ocular fundus abnormality.     

中枢性眩晕飞行员全脑血管造影初步分析

目的 了解中枢性眩晕飞行员患者脑血管的形态结构.方法 利用数字减影血管造影技术对飞行员患者行主动脉弓及全脑血管造影,分析血管结构异常的类型.结果 7例患者中4例患者为一侧椎动脉纤细,其中2例发生了椎动脉闭塞,另有2例脑血管存在先天变异;1例患者有颈内动脉狭窄;2例患者造影未见异常.结论 飞行员中枢性眩晕的原因有可能是脑血管变异、脑血管闭塞和狭窄引起的. Abstract： Objective To investigate the morphological changes of cerebral blood vessels by digital subtraction angiography (DSA) in the hospitalized military pilots with central vertigo.Methods Seven pilots were examined by cerebral and aortic arch DSA through femoral artery puncture. Type and distribution of the cerebrovascular abnormalities were observed and analyzed.Results Four pilots out of 7 were thinner unilateral vertebral artery and 2 of them appeared vertebral artery occlusion and the rest 2 pilots showed congenital abnormalities of cerebral artery. One pilot was diagnosed as internal carotid artery stenosis. Only 2 pilots were not detected abnormalities by DSA.Conclusions Congenital abnormalities, stenosis and occlusion of cerebral artery would be the reasons of resulting in pilot's central vertigo.     

招飞学生阻塞性睡眠呼吸暂停低通气综合征相关危险因素的调查及分析

目的 调查招飞体检学生中存在的阻塞性睡眠呼吸暂停低通气综合征(OSAHS)相关危险因素及重要性,明确危险人群和主要危险因素,为主检综合评定取舍提供依据. 方法 采用整群抽样的方法,对2008年度参加招飞体检全面检测的318名学生进行问卷调查及相关专科体征检查,根据调查结果划分危险人群,并对各危险因素所占比例进行χ~2检验. 结果 在有效答卷的313名招飞学生中,根据调查结果我们建议划分出危险人群(4个以上危险因素者)32人(10.22%).同时在调查中发现鼻甲肥大及鼻道狭窄是招飞体检学生OSAHS相关危险因素中的主要危险因素,检出率分别为49.20%和39.30%. 结论 招飞体检学生中有部分学生已经存在OSAHS的相关危险因素,应当在招飞体检工作中引起重视,并根据危险因素的影响,建立OSAHS相关病史询问、检查程序及参考标准等.     

冠状动脉多层螺旋CT成像与常规冠脉造影对照研究

目的：探讨16层螺旋CT用于诊断冠状动脉粥样硬化性心脏病(冠心病)的价值。资料与方法：对230例临床可疑冠心病患者进行16层螺旋CT心电门控平扫及增强扫描。用平扫图像行钙化积分测定，用增强图像行二维及三维重建，其中40例患者有常规冠状动脉造影作对照。以常规造影为“金标准”，得出16层螺旋CT冠状动脉CT血管造影(CTA)诊断各类冠状动脉狭窄的敏感性、特异性和准确性。结果：16层螺旋CT冠状动脉CTA用于诊断冠状动脉轻度狭窄的敏感性为95.2％，特异性为90.2％；诊断中度以上狭窄的敏感性为100％，特异性为97.3％。结论：16层螺旋CT冠状动脉CTA是一种无创、简便、优良的冠状动脉成像方法，高质量的CTA图像可作为一种诊断冠心病的可靠手段用于临床。     

Past physical activity, current physical activity, and risk of coronary heart disease

PURPOSE: Middle-aged and older women who are physically active have decreased risk of coronary heart disease (CHD); however, little is known about how physical activity during young adulthood influences activity during middle age and older, and CHD risk. We examined the relationship between 1) physical activity during young adulthood and middle age, and 2) physical activity during each time period and CHD occurring in middle age or older. METHODS: Cohort study of 39,876 healthy U.S. female health professionals, age > or = 45 yr, in the Women's Health Study. Physical activity was reported at baseline. Additionally, physical activity in high school and age 18-22 yr was reported on the 24-month follow-up survey. Women were followed for an average of 9 yr, after the 24-month survey, for CHD occurrence (N = 477). RESULTS: Among 37,169 eligible participants at baseline, the most active women (vigorous physical activity 10-12 months x yr) during high school and age 18-22 yr were more than twice as likely to meet physical activity recommendations at baseline than the least active women (no vigorous activity) during high school and age 18-22 yr (multivariate-adjusted odds ratio = 2.43; 95% C.I. 2.24, 2.63). At baseline, the most active women (> or = 1500 kcal x wk(-1)) had a 39% lower risk of CHD during follow-up than the least active (<200 kcal x wk(-1)) (multivariate-adjusted relative risk = 0.61; 95% C.I. 0.46, 0.81). However, physical activity during young adulthood was not associated with risk of CHD occurring during middle age and older. CONCLUSION: Women who are physically active during young adulthood are more likely to be active when middle-aged and older, when rates of CHD increase, and physical activity during middle-age predicts lower risk of CHD.     

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.     

320排动态容积CT在冠心病筛查中的初步应用

目的探讨320排动态容积CT冠状动脉造影在冠状动脉粥样硬化性心脏病(冠心病)筛查中的应用。方法分析90例临床拟诊为冠心病患者的320排CT前瞻性心电门控全心容积扫描检查结果。对显示的冠状动脉主干及其主要分支进行分级评价,并对辐射剂量进行统计分析。结果本组90例,发现狭窄性病变70例,其中三支狭窄性病变10例,两支狭窄性病变25例,单支狭窄性病变35例;其中狭窄度≥50%35支(30.43%),<50%80支(69.57%)。90例冠状动脉成像质量1级80例(88.89%),2级9例(10%),3级1例(1.11%)。结论 320排CT冠状动脉成像速度快,图像质量高,辐射剂量低,是冠心病筛查的首选检查。     

2012-2015年度招飞定选骨科病症分析

目的：分析2012—2015年招收飞行学员定选骨科病症淘汰与综合评定（综评）情况,为改进招飞体检工作提供参考。方法选取2012—2015年招飞定选体检资料,统计4年中合格人数、综评合格人数和不合格人数,并对因外科和骨科病症淘汰学员的病种进行统计。结果2012—2015年间外科淘汰人数占总淘汰人数比例变化较大,平均比例为13.9%。骨科病症淘汰人数占外科淘汰人数比例平均为32.0%,为外科体检淘汰人员中最常见病症;同时,骨科病症综评人数占外科病症综评人数的21.8%,外科体检综评人员中排名第2。骨科体检中淘汰人员最多的病症依次为扁平足、髂胫束发育不良与挛缩、四肢形态异常与缺损、骨关节损伤和脊柱畸形等;骨科体检中综评人员最多的病症依次为扁平足、骨关节损伤、膝内外翻等。结论2012—2015年招飞定选体检中骨科病症占外科体检中淘汰和综评的重要部分,扁平足等为重要的骨科淘汰和综评病症,骨科病症的研究与科学筛选,以及骨科标准的改革对我军新时期招飞具有重要意义。     

64层螺旋CT在川崎病冠状动脉病变中的应用价值

目的探讨64层螺旋CT在川崎病冠状动脉病变中的应用价值。方法回顾性分析川崎病20例,所有患者均行64层螺旋CT冠状动脉造影和彩色多普勒超声检查,并对伴有冠状动脉病变患儿进行随访。结果典型川崎病患者15例,其中9例CT和彩色多普勒超声冠状动脉检查均未见异常,5例显示相同(2例左、右冠状动脉扩张,2例冠状动脉瘤形成,1例巨大动脉瘤伴附壁血栓),1例CT示左、右冠状动脉中远段多发瘤样扩张,B超未见明显异常。非典型川崎病患者5例,其中3例CT和B超冠状动脉检查均显示相同(2例冠状动脉瘤,1例双侧冠状动脉增粗迂曲),2例B超未见异常,CT示冠状动脉均有病变(1例冠状动脉瘤,1例冠状动脉狭窄)。结论64层螺旋CT冠状动脉造影对川崎病冠状动脉病变的诊断和随访很有价值。     

复杂先心病EBT与心脏超声和心血管数字造影的对比研究

目的　评价经胸心脏超声 (TTE)、心脏数字造影 (CVDI)和电子束CT(EBT)在诊断复杂性先天性心脏病 (先心病 )中的作用。方法　资料完整的复杂性先心病患者 2 1例 ,其中男 12例 ,女 9例 ,年龄 1～ 2 1岁 ,平均 8岁 4个月 ,行外科手术治疗 14例。 2 1例患者均行TTE、彩色多普勒血流显像和EBT检查 ,其中实施CVDI 11例。结果　EBT检查先心病与CVDI的符合率为 93 .3 % (2 8/3 0 ) ;TTE对复杂先心病的诊断准确率为 77.8% (3 5 / 45 ) ,EBT的诊断准确率为 93 .3 % (4 2 / 45 )。结论　把EBT显示心外结构的优势与TTE显示心内结构的优势结合起来 ,可以部分取代有创伤性的CVDI。     

民航飞行人员冠心病19例临床特点分析

目的 通过回顾分析19例民航飞行人员冠心病的临床特点和医学鉴定情况,为飞行人员冠心病医学鉴定和航卫保障工作提供参考. 方法回顾分析我国南方航空公司2002～2006年5年间19例新发冠心病飞行人员的临床和医学鉴定资料,总结其特点. 结果对象均为男性,发病年龄40～57(52.9±3.9)岁,平均飞行时间18 210 h,其中驾驶员12例,机械师7例;2002～2006年年均发病率为2.64‰,各年之间发病率比较无显著差异(x2=1.251,P>0.05);深圳分公司发病例数最多,为9例,年均发病率为9.50‰,与广州、武汉和郑州分公司比较,深圳分公司飞行人员冠心病的发病率明显偏高(P<0.05),其他地区之间冠心病发病率比较无显著差异(P>0.05);冠状动脉造影显示病变血管以中重度狭窄为主,其中单支病变8例,双支病变10例,3支病变1例.4例获特许飞行合格,至今最长安全飞行时间>2000 h. 结论加强心血管病危险因素干预是预防冠心病的根本,冠心病介入治疗为飞行人员冠心病后重获飞行资格创造了条件.