飞行人员胆囊结石特点（4218名飞行人员临床调查）

为了了解飞行人员胆囊结石发病、诊治情况、临床特点以及对飞行安全影响等，我们于１９９５年５ 月至 １９９７ 年５ 月随机对４２１８ 名飞行人员进行了临床调查。结果：４２１８ 名中发现胆囊结石患者１８９例，患病率为 ４．５％ 。临床特点：男性多（１８５ 例占 ９７．８％ ）；４０ 岁以上者多（１４３ 例占７５．７％ ）；单纯胆囊结石多（１６８ 例占８８．８％ ）；胆囊多发结石多（１４４ 例占 ７６．２％ ）；有症状胆囊结石多（１１０ 例占 ５８．２％ ）；带石飞行多（１０４ 例占５５．０２％ ）；手术治疗少（７０ 例占３７．０３％ ）。临床调查证实：胆囊切除术是治疗飞行人员胆囊结石安全、可靠、有效的方法，术后能够达到飞行合格标准。结论：对空军飞行人员和民航驾驶员的胆囊结石不论有无症状，在恢复飞行之前必须施行航空医学性胆囊切除术以保障飞行安全     

飞行人员高血压病及危险因素调查分析

目的 调查飞行人员高血压发病情况,探讨引起飞行人员高血压病的危险因素. 方法 回顾分析1 070名飞行人员体检资料及同时进行的问卷调查资料.采用SPSS 13.0软件,组间计数资料比较进行x2检验,高血压与危险因素的关系采用多因素Logistic逐步回归分析. 结果 1 070名飞行人员中患高血压病者76人,患病率为7.10％;正常血压者401人,占37.48％;正常高值血压者593人,占55.42％.不同专业、不同飞行机种飞行人员间高血压发病率差异无统计学意义（P＞0.05）;高血压病的主要预测因子有年龄（OR=1.415,95％CI：1.069～1.874,P＜0.05）、体质指数（OR=2.501,95％CI：1.915～3.266,P＜0.01）、腹围（OR=2.235,95％CI：1.723～2.897,P＜0.01）和高胆固醇血症（OR=1.372,95％CI：1.043～1.804,P＜0.05）. 结论 本组飞行人员高血压患病率低于普通人群.年龄、超重或肥胖、高胆固醇血症是飞行人员高血压的主要危险因素.不同专业、不同机种的飞行人员高血压患病率差异无统计学意义.     

飞行员睡眠质量影响因素调查

目的：了解飞行人员睡眠状况并分析影响睡眠质量的因素。方法：采用匹兹堡睡眠质量指数（PSQI）量表和自制飞行人员睡眠质量影响因素调查表对来我院健康疗养的420名飞行人员进行调查分析。结果：飞行人员的PSQI总均分为（6．53±12．17）,以PSQI≥8分作为判断睡眠质量的标准,则睡眠差者96人,占22．86％;影响睡眠质量的因素主要有飞行环境、飞行压力、飞行时间、人际关系及再就业压力等。结论：约22．86％的飞行人员存在睡眠质量问题,发生率较高,应采取相应措施改善睡眠质量。     

飞行人员眩晕症156例分析

目的探讨飞行人员眩晕症的特点,为今后诊治和鉴定提供参考。方法根据１９５８～１９９７年４０年间与眩晕症有关的１５６例２５４人次病案资料进行分析。其中歼击机飞行员１０１例,轰炸机飞行员８例,运输机飞行员１４例（其中１例女性）,直升机飞行员２例,领航员１２例,空中通讯、机械和乘务员１９例（其中民航女乘务员１例）。结果①因眩晕症鉴定飞行不合格６２例,占３９．７％（６２／１５６）;②１５６例年龄分布：２１岁以下组５例,２１～２５岁组１９例,２６～３０岁组４７例,３１～３５岁组４１例,３６～４０岁组２５例,４１岁以上组１９例;③１５６例中,有明显前庭性眩晕症病的５１例,占３２．７％,因此而停飞的３２例,本组中梅尼埃病有８例,占５．１３％;④神经、心血管、内科等疾病引起的眩晕症４８例,占３０．８％,其中血管性和自主神经功能紊乱在发病中占有重要位置;⑤临床检查无异常发现者有５７例,占３６．５％。其中６例飞行不合格。结论正确的明确诊断是处理好眩晕症的关键问题。临床上应舍弃单一的检测方法,对前庭系统、心血管因素、自主神经系统反应等方面的检测手段更应重视,做好综合评定工作。     

民航飞行人员高血压病危险因素与心率变异性及压力反射敏感度的联系

目的：探讨民航飞行人员高血压病危险因素暴露与心率变异性（HRV）及压力反射敏感度（BRS）之间的联系。方法：在参加年度大体检的450名血压正常的民航飞行人员中,根据有无危险因素暴露将其分为年龄≥40岁组、体重超重组、血胎异常组、吸烟组、饮酒组及相应对照组。采用常规自回归谱分析方法对各组飞行人员的短时程HRV信号进行分析,同时采用序贯法计算其BRS。结果：与对照组相比,年龄≥40岁的飞行人员HRV明显降低,表现为总功率（TP）、低频功率（LF）、高频功率（HF）及归一化高频成分（HFn）显著降低（P＜0．01）,而归一化低频成分（LFn)与LF／HF则显著增加（P＜0．05）;其BRS亦显著降低（P＜0．01）。其他危险因素暴露时,HRV的TP、LF及HF均显著降低（P＜0．05）,而LFn、HFn及LF／HF则无明显变化,BRS亦显著降低（P＜0．05）。结论：民航飞行人员高血压病危险因素的暴露与HRV及BRS的降低密切联系;提示在高血压病发病之前,心血管自主神经调节功能即已发生异常。在对飞行人员进行高血压病的早期危险性预报时应重视对其自主神经调节功能的评价。     

飞行人员年度体检和特殊体检鼻窦炎和鼻窦囊肿的比较分析

目的比较飞行人员年度体检（又称大体检）和特殊体检（如航天员临床医学选拔）鼻窦炎和鼻窦囊肿的特点,为规范飞行人员鼻科体检方法提供依据。方法回顾分析9312名飞行人员疗养大体检（大体检组）、151名飞行员特殊体检（特殊体检组）的鼻科体检资料。大体检时依据病史行鼻镜检查,必要时行鼻窦数字化摄影（digital radiography,DR）检查;特殊体检鼻科体检时,全部行鼻窦CT扫描。对两组人员患鼻窦炎和鼻窦囊肿的资料进行对比分析。结果①大体检组飞行人员中,鼻窦炎170例,占1．8％（170／9312）;需要治疗者90例,占1．0％（90／9312）。特殊体检组飞行员中,鼻窦炎22例,占14．6％（22／151）;需要治疗者2例,占1．3％（2／151）。②大体检组飞行人员中,鼻窦囊肿112例,占1．2％（112／9312）;特殊体检组飞行员中,鼻窦囊肿18例,占11．9％（18／151）,囊肿均无需治疗。③大体检组鼻窦炎、鼻窦囊肿的检出率均低于特殊体检组（X^2-120．11、125．98,P〈0．01）;但鼻窦炎需要治疗者,两组所占比例没有显著差异。结论飞行人员疗养大体检鼻科检查时,依据病史行鼻镜和鼻内镜检查,必要时行鼻窦X线、CT等影像学检查可满足诊断需求;但特殊体检鼻科检查时,应全部行鼻窦CT扫描,才能满足诊断和医学鉴定需求。     

飞行人员血压水平与心血管危险因素流行病学调查

目的：调查我军飞行人员血压水平与心血管疾病危险因素流行病学的关系。方法选取全军飞行人员年度体检资料,分析比较各血压分组的血压、血脂、血尿酸、体质量指数（body mass index,BMI）、高血压及高脂血症患病率等指标。结果①1171名中资料完整有效者1135名。分为正常血压组386名,年龄（33.4±7.6）岁;正常高值血压组704名,年龄（35.0±8.3）岁;高血压组45名,年龄（44.6±7.3）岁;②飞行人员吸烟率为45.9%,超重肥胖率为58.5%,腹型肥胖率为25.9%,高血压、高胆固醇血症、高三酰甘油血症、糖尿病、高尿酸血症的患病率分别为3.97%、22.38%、25.99%、1.23%和17.71%;③各组间年龄、腰围和血糖水平比较差异有统计学意义（均P＜0.01）,高血压组腹型肥胖患病率明显高于正常血压组和正常高值血压组（P＜0.01,P＜0.05）,高血压组和正常高值血压组的BMI水平、超重肥胖率和吸烟率明显高于正常组（P＜0.01或P＜0.05）;④具有1个或1个以上心血管危险因素者占80.65%,各血压分组间心血管危险因素聚焦情况有显著差异（P＜0.01或P＜0.05）。结论我军飞行人员心血管危险因素存在率高,应加强对可控危险因素的干预。     

民航861名飞行人员血压状况调查分析

目的了解飞行人员血压水平及引起飞行人员血压升高的危险因素，为防治高血压提供依据。方法采用整体抽样的方法，抽取861名民航飞行人员的体检资料，同时进行有关、因素的问卷调查。所有资料采用SPSS13．0软件，进行方差分析及t检验。结果本组飞行人员正常血压者403人，占46．81％；正常高值者425人，占49．36％；1级高血压32人，占3．71％，2级高血压1人，占0．12％，高血压患病率3．83％。根据危险因素与血压组对照分析发现，年龄、心率、体重指数、腹围及是否经常锻炼与血压水平之间有显著性差异（P〈0．01），血糖、血脂、饮酒及吸烟与飞行人员的血压水平无明显差异（P〉0．05）。结论飞行人员血压水平与年龄、心率增快、超重、腹型肥胖及缺乏体育锻炼密切相关，因此，对飞行人员尤其是血压处于正常高值者应加强健康教育，使他们改变生活习惯，从而减缓血压偏高的人群向高血压发展的趋势。     

正常高值血压飞行人员心血管危险因素调查分析

目的 探讨正常高值血压飞行人员心血管危险因素存在情况,为预防心血管疾病的发生提供参考依据.方法 根据血压水平,将391名飞行人员分为正常血压组及正常高值血压组,并将两组人员的体质指数（body mass index,BMI）、血清总胆固醇（total cholesterol,TC）、甘油三酯（triglyceride,TG）、高密度脂蛋白（high density lipoprotein,HDL）、低密度脂蛋白（low density lipoprotein,LDL）、血尿酸（uric acid,UA）等指标进行比较,且调查其吸烟情况及心血管疾病家族史.结果 常高值血压组飞行人员BMI、TG、LDL水平及血脂异常患病率均显著高于正常组（r=2．023、2．191、2．336,P＜0．05;χ2=7．535,P＜0．05）,两组间UA、TC、HDL水平、吸烟率及心血管疾病家族史阳性率无明显差异. 结论 正常高值血压组飞行人员较正常血压组存在更多的心血管危险因素,应注重对这部分人群可控危险因素的干预.     

无症状性脑梗死飞行人员头颈部动脉狭窄与停飞情况的研究CSCD

目的观察36例无症状脑梗死（silentbraininfarction,SBI）飞行人员头颈部动脉狭窄情况及飞行适应性。方法回顾空军总医院近10年收治的SBI飞行人员的临床资料,根据检查结果分为头颈部动脉狭窄组和非狭窄组,比较两组的脑血管危险因素。观察在检出SBI后2年内的飞行情况。结果共纳入36例SBI飞行人员,均为男性,其中头颈部动脉狭窄10例（动脉狭窄组）,非头颈部动脉狭窄26例（非狭窄组）。高血压病12例（33．33％）;糖尿病2例（5．56％）;血脂异常5例（13．89％）;吸烟史16例（44．44％）。两组飞行人员的年龄、飞行时间及高血压病患病情况差异有统计学意义（P〈0．05）。36例SBI飞行人员中在观察期内无一例发展为症状性卒中。有6名在观察期内复查MRI时发现SBI病灶增多,但均未出现神经系统功能缺损症状。停飞20例,其中动脉狭窄组停飞6人,非狭窄组停飞14人,停飞与否和头颈部动脉狭窄无明显相关性（P=1．00）。停飞的20名飞行人员中5名因SBI合并中重度血管狭窄（包括头颈部动脉和冠状动脉）,7名伴随反复头晕、头痛症状,2名在地面或飞行训练中出现晕厥,4名伴随焦虑抑郁状态,2名合并其他疾病;无一例因单独的SBI而停飞。结论头颈部血管狭窄的飞行人员2年内的停飞比率未显著高于非狭窄组,SBI不是停飞的直接原因。但由于SBI存在影响飞行安全的潜在风险,应定期进行复查评估。     

用脉图方法观察2.5h头低位15°倾斜期间心血管系统的变化

为了解航天员航天初期心血管功能的动态变化，用脉图方法观察了１９名被试者在２．５ｈ头低位１５°倾斜期间的心血管功能。结果表明，ＨＤＴ期间心血管指标变化可分为现时期：急性反应期和反应期。     

歼击机与运输机飞行员某些心功能参数的脉图分析

为正确评定和早期发现飞行员心血管病变，应用ＣＦＤＣＳ－Ⅱ型心血管功能检诊仪检查１２９名现役男性飞行员，发现心血管功能有异常表现者１３名（１０．３％），歼击机飞行员３０～３４岁年龄组平均动脉压及中动脉弹性明显劣于２５～２９岁年龄组，而运输机飞行员无此改变。提示航空航天医生应加强对飞行员的医学保障工作，必要时可进行动态观察，以期提高他们的健康水平，延长飞行寿命。     

军事飞行人员冠状动脉心肌桥的航空医学鉴定

目的 探讨军事飞行人员冠状动脉心肌桥的航空医学鉴定方法.方法 回顾分析空军总医院近年通过冠状动脉造影或多层螺旋CT检查诊断的8例军事飞行人员冠状动脉心肌桥病例资料,结合文献复习,归纳提出航空医学鉴定主法.结果 ①军事飞行人员冠状动脉心肌桥多数程度较轻,无明显症状,常合并有心电图ST-T改变,但不影响心血管功能和飞行,结论飞行合格;②心肌桥造成冠状动脉狭窄程度较重,合并有胸闷、心绞痛、心律失常等临床表现时,飞行暂不合格,之后根据治疗效果进行个别评定.结论 军事飞行人员冠状动脉心肌桥的航空医学鉴定应根据是否影响心血管功能,是否合并有临床症状及心律失常等进行个别评定.     

Characteristics of the blood lipoprotein spectrum in commercial aviation pilots

The study of lipids of civil pilots, aged 30-59 years, showed that their average levels of cholesterol and triglycerides were higher than those in a random sample of the male population of Moscow. The average level of HDL cholesterol in pilots was lower than in the sample. The prevalence of dislipoproteinemias in pilots was significantly higher than in the sample. The above lipoprotein changes in pilots versus nonpilots and the prevalence of hyperlipidemias suggest that they are "aterogenic" and produced by the flying profession. These observations also indicate that civil pilots should be regarded as a risk group in terms of atherosclerosis and concomitant cardiovascular diseases.     

151例飞行员频域心电图分析

为正常人频域心电图（ＦＣＧ）的诊断标准是否适合飞行员。采用香港ＨＢＤ－ⅡＡ仪检测了１５１例男性飞行员的频域心电电图，年龄为２２－４７岁，平均３０±６岁。结果表明：下沉人ＦＣＧ各函数图形特征和飞行员一致，各谱峰幅值和比例也基本一致。说明正常ＦＣＧ的诊断标准适用飞行员，所得结果各项数值可用于飞行员的选拔和地面训练时实时医学监督。     

Stress and workload in pilots

Several studies have highlighted the increase in physiological activity which occurs in pilots during flight and especially during takeoffs and landings. For example, it has been clearly demonstrated that pilots' heart rates increase during the landing approach to reach a peak at or just before touchdown. These changes have been attributed to workload and to psychological or emotional stress. This paper examines a number of test pilots' heart rate responses recorded during various flight trials involving different types of aircraft. Examples include ramp takeoffs in a VTOL fighter, automatic landings in fog, supersonic flight through monsoon rain, and a sortie in which the pilot developed acute appendicitis. It is concluded that heart rate responses in experienced pilots are influenced almost entirely by workload-related factors and not by emotional stressors, such as risk and anxiety. Because of the emotional overtones of the word "stress," it is suggested that the term workload should be used when referring to the reason for increased cardiovascular activity of pilots.     

Flight safety and medical incapacitation risk of airline pilots

BACKGROUND: This paper examines the use of quantitative incapacitation risk assessment for aeromedical decision-making in determining the medical fitness of multicrew airline pilots, and estimates the effect on flight safety should medical standards be relaxed. The use of the "1% rule" for setting limits for aircrew incapacitation risk is re-examined. Human failure (medical incapacitation) is compared with acceptable failure rates in another safety-critical system, the aircraft engines. METHODS: The expected number of cardiovascular incapacitations occurring in flight was modeled by applying an age-related cardiovascular incapacitation risk to the pilot population. The effect on flight safety of relaxing the maximum acceptable incapacitation risk on estimated incapacitation rates in two-pilot operations was also modeled, taking into account a likely increase in the number of pilots who would be allowed to continue to fly with a known medical condition. RESULTS: The model overestimates cardiovascular incapacitation risk and, therefore, provides a cautious estimate. If the maximum acceptable cardiovascular risk is increased, the model predicts a disproportionately small increase in the number of such incapacitations in flight. CONCLUSIONS: The evidence suggests that the incapacitation risk limits used by some states, particularly for cardiovascular disease, may be too restrictive when compared with other aircraft systems, and may adversely affect flight safety if experienced pilots are retired on overly stringent medical grounds. States using the 1% rule should consider relaxing the maximum acceptable sudden incapacitation risk to 2% per year.     

Pilot medical history and medications found in post mortem specimens from aviation accidents

INTRODUCTION: Federal Aviation Administration (FAA) regulations require pilots to report all medications and medical conditions for review and consideration as to the overall suitability of the pilot for flight activities. METHODS: Specimens were collected by local pathologists from aviation accidents and sent to the Bioaeronautical Sciences Research Laboratory for analysis. The results of such tests were entered into the Forensic Case Management System. This database was searched to identify all pilots found positive for medications used to treat cardiovascular, psychological, or neurological conditions over the period January 1, 1993, through December 31, 2003. RESULTS: Toxicological evaluations were performed on 4143 pilots. Psychotropic drugs were found in 223 pilots. Cardiovascular medications were found in 149 pilots. Neurological medications were found in 15 pilots. Pilots reported psychological conditions in 14 of the 223 pilots found positive for psychotropic drugs. Only 1 of the 14 pilots reporting a psychological condition to the FAA reported the psychotropic medication found after the accident. Cardiovascular disease was reported by 69 of the pilots found with cardiovascular drugs in their system. Cardiovascular medications found in the pilots were reported by 29 of the 69 pilots reporting a cardiovascular condition. Only 1 of the 15 pilots reported having a neurological condition to the FAA; none of the pilots found with neurological medications reported the medication. CONCLUSIONS: Toxicology successfully identified 93% of the medications reported by the pilots. Pilots involved in fatal accidents taking psychotropic or neurological medications rarely reported the medication or their underlying medical condition to the FAA.     

Cardiovascular system function in mitral valve prolapse in fighter pilots]

Echocardiogram examination of 250 young fighter pilots has revealed that 15 aviators had mitral valve prolapse (MVP) without symptoms of pronounced regurgitation. Their functional indexes of cardiovascular system at rest or dosed physical load at veloergometer tests were normal. Only in 3 pilots were marked rare supraventricular or ventricular extrasystoles during ECG monitoring or veloergometria. Performance capability of all pilots was sufficient. 13 pilots with MVP in examination of their tolerance to +Gz hypergravity at the levels of 6 G or more for 15 s had frequent polytop or group ventricular extrasystole. There was an ordinary aggravation of extrasystole in aviators with more deep and bilateral MVP. The article makes a conclusion that on the basis of medical flight expertise a thorough selection must be made concerning possibility of every pilot with MVP to carry out flight at high manoeuvring aircraft of new generation taking into account the gravity of prolapse and tolerance to high +Gz hypergravity more than 5 G.     

飞行条件对飞行员血清中脂联素和瘦素含量的影响

目的探讨飞行条件对飞行员血清中脂联素、瘦素含量的影响及其与飞行员易患心血管疾病的关系。方法采用RIA(放射免疫法)测定72名飞行后、151名飞行前即刻飞行员及50名正常对照组血清中脂联素和瘦素的含量。结果脂联素和瘦素含量(μg/L)均显示:(1)飞行后组(10.10±7.03,3.12±2.17)较飞行前组(15.46±9.47,3.47±1.15)显著降低(P<0.01,P<0.05);(2)飞行后组与正常组(8.97±3.49,2.92±1.72)无显著性变化(P>0.05,P>0.05);(3)飞行前组则显著高于正常组(P<0.01,P<0.01)。结论(1)在飞行条件下产生的飞行应激,可刺激交感神经兴奋从而抑制飞行员瘦素和脂联素的合成分泌,造成其含量降低;(2)这两种脂肪激素变化可能是导致飞行员这一特殊人群易患冠心病的另一重要因素。