民航飞行员原发性自发性气胸的航空医学鉴定——附病例报告四例

目的 回顾性分析民航飞行员原发性自发性气胸病例及文献,以期强化对该病的认识,提高诊断和鉴定水平.方法 介绍4例民航飞行员原发性自发性气胸,分析并探讨该病的鉴定方法.鉴定标准依据〈民用航空人员体检鉴定和体检合格证管理程序〉：各级体检合格证申请人患有自发性气胸,治愈后无复发,可评定为合格;各级体检合格证申请人如接受胸腔手术,术后地面观察6～12个月,无功能障碍,可评定为合格.结果 本组病例发病时年龄22～29岁,均接受胸腔闭式引流术.1例地面观察3个月后评定为合格;2例残留肺大疱,行胸腔镜手术治疗,术后6个月评定为合格;1例气胸复发,行胸腔镜手术治疗,术后18个月,CT检查发现肺大疱,鉴定结论为不合格.结论 原发性自发性气胸一般认为是胸膜内大疱和胸膜下大疱破裂引起,飞行员的职业因素是否能成为原发性自发性气胸的危险因素还没有确切的依据.原发性自发性气胸对飞行安全构成威胁,气胸愈后进行双肺薄层CT扫描检查必不可少,如有肺大疱残留应建议手术治疗,防止气胸复发.航空医学鉴定时应综合考虑气胸的治疗方式、检查情况、地面观察时间等因素,鉴定合格后应随访观察.

Aviation medical assessment of primary spontaneous pneumothorax in civil pilots-4 cases attached

Objective To strengthen the understanding of primary spontaneous pneumothorax (PSP) and to improve the diagnosis and assessment level by retrospectively analyzing correlative literatures. Methods Clinical cases of PSP of 4 civil pilots were introduced. Medical assessment methods were analyzed and discussed. Assessment was in accordance with Administration Procedure of Medical Identification and Medical Certificate of Civil Aviation Personnel: "the applicant with spontaneous pneumothorax seeking for any class medical certificate can be assessed as fit in case of healing and without relapse;the applicant, who had thoracic surgery treatment, seeking for any class medical certificate can be assessed as fit if no dysfunction had been observed for 6-12 moths". ResultsThe onset age of pilots was 22-29 yr and they all received closed drainage of thoracic cavity. One case was assessed as fit after 3 months observation. Two cases received thoracoscope therapy due to residual bullae 18 months later and were assessed as fit 6 months later. One case pneumothorax relapsed and received thoracoscope therapy. CT scan showed bullae 18 months later and he was assessed as unfit. Conclusions It is generally consider that PSP is due to the rupture of subpleural bleb or bullae. There is no exact evidence showed that pilot′s vocation is one of the induced factors of PSP. PSP threatens flight safety. It is necessary to receive lamellar CT scan of lungs after recovery. It is suggested to operate if there are residual bullae in order to prevent relapse. It is necessary to comprehensively consider the treatment style, the examination condition, observation time and so on in aviation medical assessment, as well as close follow-up.