飞行人员良性阵发性位置性眩晕的特点及航空医学鉴定

摘要：目的分析飞行人员良性阵发性位置性眩晕（benignparoxysmalpositionalvertigo，BPPV）的临床特点，总结其航空医学鉴定原则。方法收集我院2000—2012年因BPPV住院的7例飞行人员临床资料，分析其临床特点、诊疗经过及航空医学鉴定情况。结果7例均为原发性BPPV，其中后半规管BPPV5例，外半规管BPPV2例，病程最短者1周，最长者反复发作1年以上。均为在地面发作，没有飞行中发病情况。7例变位试验均为阳性，听力检查均正常。前庭双温试验6例正常，1例提示右侧半规管功能下降。3例在发病后2周内自愈，4例经过耳石复位治疗。短期（1周）疗效评价为：痊愈5例，有效1例，无效1例。长期（3个月）疗效评价为：痊愈6例，有效1例。所有患者均在治疗后给予3。6个月的地面观察，5例飞行合格，1例因心理原因停飞，1例因长期前庭功能异常停飞。结论因空中失能的风险及复发风险均较小，BPPV是周围性眩晕中可以完全康复并有望恢复飞行的疾病，但恢复飞行之前必须进行全面的前庭评价，根据病情特点、前庭功能恢复情况并结合飞行机种、飞行职务等进行医学鉴定。恢复飞行后需密切复查，了解疾病动态发展情况。

Characteristics of benign paroxysmal positional vertigo in pilots and its medical identification

Objective To analyze the clinical characteristics of benign paroxysmal positional vertigo （BPPV） in pilots and summarize its aeromedical identification principles. Methods Clinical data including diagnosis, treatment, and aeromedical identification of 7 BPPV pilots admitted to our hospital from 2000 to 2012 were analyzed. Results Of the 7 pilots with primary BPPV, 5 were diagnosed with posterior semicircular canal BPPV and 2 with lateral semicircular canal BPPV. The shortest and longest course of BPPV was 1 week and over 1 year, respectively. BPPV occurred when the pilots were grounded and did not occur when they were flying. The 7 pilots were positive in postural test and normal in hearing test. Of the 7 pilots who underwent Hallpike caloric test, 6 were normal and 1 abnormal in the fight semicircular canal function. The disease was spontaneously recovered in 3 pilots two weeks after its onset and cured in 4 patients after canalith reposition. The short-term （1 week） curative effect assessment showed that the treatment was very effective in 5 pilots, effective in 1 pilot and ineffective in 1 pilot. The long-term （3 months） curative effect assessment showed that the treatment was very effective in 6 pilots and effective in 1 pilot. Of the 7 pilots who were observed for 3-6 months on ground after treatment, 5 were flight qualified, 1 was permanent grounded because of psychological reasons and 1 was permanent grounded due to long-term abnormal vestibular function. Conclusion BPPV is a peripheral vertigo disease which can be completely cured and pilots with it can return to flight as the risk of it-induced disability and its recurrence are relatively small. However, the pilots must undergo an overall assessment of vestibular function before they return to flight. The medical identification of vestibular function should be decided according to the clinical characteristics of the disease in combination with the aircraft species and flight duty. The progress of the disease in pilots should be closely monitored after they are allowed to fly.