军事飞行人员梅尼埃病的医学鉴定

目的 对军事飞行人员梅尼埃病的医学鉴定进行综述. 资料来源与选择该领域的相关研究论文、综述与标准. 资料引用国内外公开发表的论文、综述及标准42篇. 资料综合主要对梅尼埃病的研究进展、梅尼埃病对军事飞行的影响、军事飞行员梅尼埃病的医学鉴定3个相关问题进行了介绍和讨论. 结论 对于军事飞行人员梅尼埃病的医学鉴定,应该对其眩晕与耳鸣症状的控制情况、听觉及前庭功能进行全面的评估,并权衡梅尼埃病对飞行安全的影响以及飞行人员培养的巨大花费,在风险评估的基础上,个别评定,做出最佳选择. Abstract： Objective To review the medical identification of Meniere's disease (MD) in military aircrews. Literature resource and selection Research papers, reviews and standards in this field. Literature quotation Forty-two papers, reviews and standards that published in China and abroad were cited. Literature synthesis Three major issues, including progress of MD, the impact of MD to military flying, medical identification of MD in military aircrews, were reviewed and discussed. Conclusion For medical identification of MD, it's suggested to comprehensively evaluate the success rate of controlling vertigo and tinnitus, hearing level and vestibular function. In balancing the effects of MD on flight safety and expensive training cost, the best choice would be a personal assessment on the basis of risk evaluation.     

飞行人员鼓膜破裂的特点及对航空航天飞行的影响

目的探讨飞行人员鼓膜破裂的特点及对航空航天飞行的影响。方法分析20例23耳飞行人员鼓膜破裂的病例。结果气压损伤所致4例5耳、外伤致鼓膜破裂各4例4耳,化脓性中耳炎致鼓膜破裂12例14耳;1例永久停飞,2例飞行暂不合格,17例飞行合格。结论鼓膜破裂可影响航空航天飞行,而航空航天飞行也可引起鼓膜破裂。     

飞行人员变应性鼻炎的特点及对飞行的影响

目的 探讨变应性鼻炎和航空航天飞行的关系。方法 总结分析飞行人员变应性鼻炎资料３２份。结果 ３２例中常年性鼻炎２０人,季节性变应性鼻炎１２人。２６例继续飞行,６例永久停飞。结论 变应性鼻炎可影响航空航天飞行;航空航天飞行也可诱发或加重变应性鼻炎。     

感觉神经性耳聋及其与航空航天飞行的关系

目的探讨感觉神经性耳聋与航空航天飞行的关系。方法地分析３６名飞行人员感觉神经性耳聋病例。结果３６例中单侧耳聋１５例,双侧耳聋２１例;轻度聋９耳,中度聋３７耳,重度聋１１耳;１９例永久停飞,１７例飞行合格。结论感觉神经性耳聋因影响空中通讯而危及飞行安全;航空航天飞行也能引起或加重感觉神经性耳聋。     

航空性额窦炎与航空航天飞行

目的探讨航空性额窦炎与航空航天飞行的关系.方法分析飞行人员航空性额窦炎临床资料31份.结果左侧病变17例,右侧病变2例,双侧9例,病历中未记录侧别的3例.合并有航空性中耳炎者6例、筛窦炎和/或上颌窦炎者22例、鼻中隔偏曲者11例、鼻甲肥大者10例.24例飞行合格,4例飞行暂不合格,3例飞行不合格.结论航空性额窦炎可因疼痛、流泪和视物模糊而危及航空航天飞行安全;航空航天飞行也能诱发或加重航空性额窦炎.     

特发性一侧前庭功能异常与航空航天飞行

目的　探讨特发性一侧性前庭功能异常与航空航天飞行的关系。　方法　分析30例飞行人员特发性一侧前庭功能异常的病例。　结果　右前庭功能减弱者19例，左前庭功能减弱者9例，左前庭功能丧失者2例；11例飞行合格，19例永久停飞。　结论　一侧前庭功能异常可因飞行错觉和/或运动病反应而危及飞行安全；航空航天飞行也能诱发或加重前庭功能损害。     

飞行人员咽鼓管机能障碍对内耳功能的影响

目的　探讨飞行人员咽鼓管机能障碍对内耳听功能和前庭功能的影响。　方法　总结飞行人员咽鼓管机能障碍和内耳功能异常的临床资料 2 6份。　结果　 2 6例中感音神经性耳聋者 18人 ,梅尼埃病者 3人 ,神经性耳鸣者 3人 ,突发性耳聋和前庭功能障碍者各 1人。　结论　咽鼓管机能障碍不仅可引起航空性中耳炎 ,而且可引起或加重内耳功能的损害。     

飞行人员健康疗养体检发现恶性病6例

前言早期发现严重影响飞行人员健康和飞行安全的潜在性疾病，有重要意义。方法抓住飞行人员健康疗养时机，进行仔细体检。结果发现了6例恶性病，包括急性白血病1例，胃癌2例，肺癌1例，肝癌1例和直肠癌1例。6例恶性病均为中青年飞行人员，临床表现多不典型或轻微，外观酷似健康，确诊前尚继续飞行。结论。     

大龄军队飞行员的眼部疾患

前言 所有军事飞行人员中约20％年龄超过40岁,超过这个年龄的民航飞行员的数量更大。在航空航天医学会的学术会议上几乎每年一度的事件是对60岁年龄规定的讨论。有关年长飞行员的视力状况的实际资料是很有帮助的。方法 调查ACS中年龄超过45岁的飞行人员的医疗记录,查看从1989年1月1日到1995年12月31日影响他们飞行状况的眼科情况。结果 这个时期中发现有149个新病例。对这些病     

飞行员病史及从飞行事故尸检生物样本中发现的用药情况

美国联邦航空局（FAA）的航空航天医学办公室（Office of Aerospace Medicine，OAM）负有监控飞行员身体情况的责任，以确定飞行员是否符合FAA飞行安全医学认证标准。飞行员根据8500—8表格（飞行人员医学证明或飞行人员和飞行学员医学证明申请表     

Permanent grounding and flying restrictions in Canadian Forces pilots: a 10-year review

The medical files were reviewed of all Canadian Forces pilots in whom a permanent change in flying category was recommended during the period 1 January 1978 through 31 December 1987. In an average pilot population of 2,697 pilots, 60 permanent groundings (2.2 per thousand) and 209 permanent operational flying restrictions (7.7 per thousand) were assigned among 258 pilots. Coronary heart disease was the most common cause for permanent grounding (25% of total), followed by neurologic disorders including migraine (22% of total), other cardiovascular disorders, including mitral valve prolapse and arrhythmias (17%), and psychiatric problems (12%). Refractive errors were the most common basis for an operational flying restriction (25%), followed by orthopedic disorders (17%), mainly low back pain. The relevance of these observations is discussed in terms of medical selection and surveillance procedures.     

Medical-psychological aspects of flying training of pilots for informal aviation structure]

The authors report the data of medical and psychological monitorized of in formal aviation pilots trained for flying motor-hang-planes. Monitoring was conducted in two categories of pilots: professionals (reserves, n = 6) and amateurs (n = 6). Psychophysiological profile and level of neuroemotional stress before and after training were in correlation with previous flying experience. These results point to the importance of differential approach to planning and preparation of training flights for different categories of pilots.     

Avian flight without visual reference: preflight spinning produces spatial disorientation

INTRODUCTION: Birds regularly fly in conditions of reduced visibility where they cannot see the horizon, whereas human pilots under similar conditions are subject to spatial disorientation (SD) and must, therefore, rely on instruments to maintain safe flight. We surmised that pigeons whose eyes were covered and that were rotated in a centrifuge before flight might show signs of SD. METHODS: We built a small centrifuge ("ornifuge") that allowed us to spin a bird around the vertical axis of its head at 1 cps for a specified number of turns and then release it instantly through a trap bottom to fly free. We studied 67 cull racing pigeons once each under four conditions: 1) static with normal vision (Static-See, n = 13); 2) static with eyes covered (Static-Cover, n = 17); 3) spin with normal vision (Spin-See, n = 15); and 4) spin with eyes covered (Spin-Cover, n = 22). Flight behavior immediately on release was observed by the investigators and photographed to document the occurrence of initial hovering, direction of spontaneous rotation if any, and staggering after landing. Birds released with eye-covers flicked them off within a few moments. RESULTS: Both Static-See and Static-Cover birds flew normally. For Spin-See, most flew normally, but 27% hovered momentarily before flying away. Among Spin-Cover birds, abnormal flight was seen in 50% and 72% staggered after landing. DISCUSSION: Spinning in the ornifuge produced abnormal flight behavior in the majority of blind-folded birds. This may provide a model for examining certain aspects of SD experienced by pilots under instrument meteorological conditions and studying the mechanisms that make birds relatively resistant to SD.     

General aviation crashes involving military personnel as pilots.

BACKGROUND: Injuries sustained in off-duty activities are a major cause of mortality and morbidity among military personnel. Reducing these off-duty fatalities is a continuing priority of the military. METHODS: General aviation crashes recorded by the National Transportation Safety Board between 1983 and 1998 were analyzed for military pilots (n = 205) and other military personnel (n = 185), and compared with all other general aviation crashes (n = 32,807) to identify differences in the crash circumstances and sustained injury severities. RESULTS: During the 16-yr study period, a total of 45 military pilots and 52 other military personnel were fatally injured while flying general aviation flights. Military pilots who were involved in general aviation crashes were more likely to have advanced licenses and higher total flight times when compared with other military personnel and civilian pilots (p < 0.05). Among the three groups of pilots, other military personnel had the least flying time and the largest percentage of student/private licenses. Military personnel had significantly less time in type in the 90-d and 30-d periods preceding the crash compared with civilians (p < 0.05). Shoulder restraint usage was associated with less severe injuries for all groups. We estimate that general aviation deaths have cost the military at least $405 million since 1983. CONCLUSIONS: General aviation crashes are a costly source of mortality and morbidity for military personnel, particularly military pilots. Interventions aimed at improving safety of military personnel in the general aviation setting warrant special consideration.     

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.     

军事飞行员原发性青光眼的医学鉴定分析

目的 探讨因原发性青光眼和可疑青光眼住院的军事飞行员的疾病特点、飞行结论 及放飞观察情况. 方法 对95例因青光眼或可疑青光眼住院的飞行员资料进行回顾性临床分析.结果 95例住院患者中56例诊断为原发性开角型青光眼(POAG),其中停飞15例,飞行暂不合格3例,飞行合格38例,放飞观察中延长飞行年限1～26年,平均6.36±1.43年.36例怀疑青光眼者进行青光眼排除检查,33例排除了青光眼,飞行合格;3例临床可疑,飞行暂不合格.3例诊断为高眼压症,飞行合格. 结论 飞行员最多见的青光眼类型是开角型青光眼;患POAG的飞行员若视功能稳定,在严密观察下能够继续飞行;早期发现和及时治疗是控制疾病的关键.     

阻塞性睡眠呼吸暂停低通气综合征对飞行员认知功能的影响

目的 探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)对飞行员认知功能的影响.方法 对13名经多导睡眠图(PSG)确诊的中重度OSAHS患者及10名正常体检健康飞行员进行Epworth嗜睡程度问卷(ESS)评分,以及进行闪光融合频率、多项反应时、空间位置记忆广度、注意力集中能力、警戒性等认知功能测试,并对OSAHS组进行ESS评分、睡眠呼吸紊乱指数(AHI)、最低血氧饱和度与各项认知功能测试结果间进行相关性分析.结果 OSAHS组ESS评分明显高于对照组(P＜0.01),闪光融合频率、空间位置记忆广度分值、注意力集中能力时间明显低于对照组(P＜0.05或P＜0.01),对黄、绿色的选择反应时明显慢于对照组(P＜0.05),对红色的选择反应时与对照组相比无显著差异.OSAHS组警戒性作业总错误率明显高于对照组(P＜0.01).OSAHS组ESS评分与警戒性作业的总错误率呈显著正相关(r=0.789 0,＜0.01).结论 中重度OSAHS患者有不同程度的认知功能减退,可能损害飞行操作能力,造成飞行安全隐患.临床未进行有效治疗的患者应暂时或永久取消飞行资格.     

军事飞行学员医学停飞疾病谱分析

目的 总结分析空军某航空大学近年军事飞行学员医学停飞病征（疾病或体征）特点,为今后军事飞行学员医学选拔和医学鉴定提供客观依据. 方法 对近年空军航空大学医学停飞的614名飞行学员按照所患疾病或病征及病征所隶属体检科室（专业）进行分类统计. 结果 614名医学停飞学员共涉及病征90余种.飞行学员停飞病征排前10位的是视力不足超标、血压超标、频发心律失常、外伤（骨折）、腰椎间盘病变、鼻中隔偏曲、慢性鼻窦炎、胆囊息肉、晕厥及其他心电图异常.医学停飞病征所涉及体检科室（专业）排序依次为眼科、内科、外科、耳鼻喉科、神经内科、心电图检查、超声检查、放射科检查和检验科检查,其中以眼科和内科病征为主,分别占全部医学停飞病征的50.00％、14.86％. 结论 导致在校军事飞行学员医学停飞的主要病征是视力不足超标、血压超标.针对飞行人员职业特点,普及航空医学教育,加强卫生监督,加强可变的功能性病征的矫治、训练,采取积极保护性的干预和心理疏导等措施,对降低在校飞行学员的医学停飞率,提高军事飞行学员的成才率具有重要意义.