662例飞行员活动平板运动试验的临床分析

目的 探讨活动平板运动试验(TET)对飞行员缺血性心脏病临床诊断价值和医学鉴定的意义. 方法 对我院近10年进行活动平板运动试验的662例男性飞行员资料进行分析,依据检查目的 不同分为改装体检组、年度大体检组及疾病组,对疾病组依据不同种类的疾病进行分组,比较不同组同TET阳性率的差别.结合超声心动图及冠状动脉造影检查分析不同年龄组的阳性检出率及最终停飞情况. 结果 662例飞行员活动平板运动试验阳性22例(占3.32%).可疑阳性32例(占4.83%),阴性608例(占91.85%).其中改装体检组、年度大体检组TET阳性率与疾病组存在显著差异(P<0.01),不同疾病组间阳性率存在显著差异.不同年龄组间TET阳性率存在显著差异(P<0.01).其中13例TET阳性结合临床分析不能排除冠状动脉疾病者进行了冠状动脉造影检查,结果 1例冠状动脉一肺动脉瘘先天异常,2例存在不同程度冠状动脉狭窄.经鉴定此3人飞行不合格. 结论 飞行员群体冠状动脉病变的发病率相对较低,活动平板运动试验对飞行员冠状动脉病变初步筛选有一定的协助诊断价值,但应结合临床症状及年龄选择TET检查以提高临床性价比.

Clinical evaluation of treadmill exercise test in 662 pilot cases

Objective To assess the clinical value of treadmill exercise test(TET) in diagnosis pilots' of ischemic heart disease, and to assess the value of TET in medical evaluation. Methods Pilots' TET results in the last 10 years were reviewed. Data were divided into retrofit group, annual physicat examination group and disease group by different examination purpose. According to different involved systems patients in each group were divided furthermore. The positive ratios of TET in different groups were compared. The positive ratio of TET and medical assessment together with uhrasonocardiogram and coronary angiography were analyzed in different age groups. Results There were 22 positive cases and 32 probable positive cases. There were significant differences of positive ratio of TET among retrofit group, annual physical examination group and disease group (P< 0. 01), also among different disease groups and among different age groups (P<0.01). Thirteen suspicious coronary artery disease cases were examined by coronary angiography. Among which one case was diagnosed as coronary artery-pulmonary artery fistula congenital anomaly while the other two were appeared coronary artery stenosis in various degree. All three were disqualified for flying. Conclusions The incidence rate of coronary artery disease of pilots is relatively lower. Although the TET has a certain clinical value in preliminary screening of coronary heart disease in pilots, but it should be undertaken together with the considerations of age and clinical symptoms in order to increase the clinical benefit-cost ratio.