中华航空航天医学杂志
中華航空航天醫學雜誌
중화항공항천의학잡지
CHINESE JOURNAL OF AEROSPACE MEDICINE
2012年
1期
45-48
,共4页
冠状血管痉挛%心肌梗死%冠状血管造影术%合格鉴定
冠狀血管痙攣%心肌梗死%冠狀血管造影術%閤格鑒定
관상혈관경련%심기경사%관상혈관조영술%합격감정
Coronary vasospasm%Myocardial infarction%Coronary angiography%Eligibility determination
目的 探讨飞行员冠状动脉痉挛(coronary artery spasm,CAS)致急性心肌梗死(acute myocardial infarction,AMI)的临床特征、诱发因素、诊断、治疗及医学鉴定. 方法 分析1例直升机飞行员冠状动脉痉挛致急性心肌梗死的病史、临床诊断、治疗过程及医学鉴定结论,并进行相关文献复习. 结果 本例飞行员有大量饮酒、吸烟、高血脂、疲劳等多种诱发因素；临床表现为心前区疼痛,胸闷,左肩及左臂发麻,出汗；心电图及心肌酶谱符合急性心肌梗死演变过程；冠状动脉造影未见粥样硬化狭窄,造影过程中发生左冠状动脉全程僵硬,左前降支中段95％狭窄,右冠状动脉僵硬；左、右冠状动脉内推注硝酸甘油后僵硬及狭窄缓解,考虑为冠状动脉痉挛,痉挛血管与心肌梗死部位吻合,证实心肌梗死由CAS所致.该飞行员病后无明显并发症,心电图大致正常,超声心动图正常.经积极控制诱发因素,其病情稳定,未再出现心前区不适等症状,能正常参加体能训练,地面观察半年后复查心电图正常,心功能等指标良好,最后结论:飞行合格.安全飞行1年余无任何不适. 结论 CAS可发生于冠状动脉无粥样硬化狭窄基础上,可引起心绞痛、心律失常、急性心肌梗北等；CAS与冠状动脉内皮功能受损有关,其发作往往有饮酒、吸烟、疲劳等诱因,对高危人群应采取积极预防措施.
目的 探討飛行員冠狀動脈痙攣(coronary artery spasm,CAS)緻急性心肌梗死(acute myocardial infarction,AMI)的臨床特徵、誘髮因素、診斷、治療及醫學鑒定. 方法 分析1例直升機飛行員冠狀動脈痙攣緻急性心肌梗死的病史、臨床診斷、治療過程及醫學鑒定結論,併進行相關文獻複習. 結果 本例飛行員有大量飲酒、吸煙、高血脂、疲勞等多種誘髮因素；臨床錶現為心前區疼痛,胸悶,左肩及左臂髮痳,齣汗；心電圖及心肌酶譜符閤急性心肌梗死縯變過程；冠狀動脈造影未見粥樣硬化狹窄,造影過程中髮生左冠狀動脈全程僵硬,左前降支中段95％狹窄,右冠狀動脈僵硬；左、右冠狀動脈內推註硝痠甘油後僵硬及狹窄緩解,攷慮為冠狀動脈痙攣,痙攣血管與心肌梗死部位吻閤,證實心肌梗死由CAS所緻.該飛行員病後無明顯併髮癥,心電圖大緻正常,超聲心動圖正常.經積極控製誘髮因素,其病情穩定,未再齣現心前區不適等癥狀,能正常參加體能訓練,地麵觀察半年後複查心電圖正常,心功能等指標良好,最後結論:飛行閤格.安全飛行1年餘無任何不適. 結論 CAS可髮生于冠狀動脈無粥樣硬化狹窄基礎上,可引起心絞痛、心律失常、急性心肌梗北等；CAS與冠狀動脈內皮功能受損有關,其髮作往往有飲酒、吸煙、疲勞等誘因,對高危人群應採取積極預防措施.
목적 탐토비행원관상동맥경련(coronary artery spasm,CAS)치급성심기경사(acute myocardial infarction,AMI)적림상특정、유발인소、진단、치료급의학감정. 방법 분석1례직승궤비행원관상동맥경련치급성심기경사적병사、림상진단、치료과정급의학감정결론,병진행상관문헌복습. 결과 본례비행원유대량음주、흡연、고혈지、피로등다충유발인소；림상표현위심전구동통,흉민,좌견급좌비발마,출한；심전도급심기매보부합급성심기경사연변과정；관상동맥조영미견죽양경화협착,조영과정중발생좌관상동맥전정강경,좌전강지중단95％협착,우관상동맥강경；좌、우관상동맥내추주초산감유후강경급협착완해,고필위관상동맥경련,경련혈관여심기경사부위문합,증실심기경사유CAS소치.해비행원병후무명현병발증,심전도대치정상,초성심동도정상.경적겁공제유발인소,기병정은정,미재출현심전구불괄등증상,능정상삼가체능훈련,지면관찰반년후복사심전도정상,심공능등지표량호,최후결론:비행합격.안전비행1년여무임하불괄. 결론 CAS가발생우관상동맥무죽양경화협착기출상,가인기심교통、심률실상、급성심기경북등；CAS여관상동맥내피공능수손유관,기발작왕왕유음주、흡연、피로등유인,대고위인군응채취적겁예방조시.
Objective To investigate the clinical characteristic and causative factors by analyzing a pilot case of acute myocardial infarction (AMI) resulted from coronary artery spasn (CAS) and reviewing literatures,to conclude corresponding diagnosis and treatment and then to provide reference to the individual criteria of aeromedical assessment. Methods A case of pilot with CAS induced AMI was analyzed. The disease history, clinical diagnosis, treatment process and aeromedical assessment were the emphases in analysis. The related literatures were reviewed. Results Analysis showed that many inducements led to AMI presenting, such as drinking, smoking,hyperlipemia,fatigue,mental stress,etc..The pilot had such clinical symptoms as angina pectoris,chest distress,left arm and shoulder tingle and sweating. The changes of ECG and myocardial enzymes indicated the succession of AMI.Coronary arteriongraphy showed left and right coronary artery (LCA & RCA) stiff,and left anterior descending artery (LAD) stenosis,but no obvious arteriosclerosis observed.Arteriospasm was diagnosed since the stiffness and stenosis at LCA & RCA were eased as glonoin ejected into artery.Where the spasm broke out was the position of AMI so CAS was confirmed the cause.The pilot had no complication since AMI striking was diagnosed normal or roughly normal in echocardiogram and ECG examinations.As the causative factors were controlled he has no more precordia discomfort and could bear normal physical training.The six-month follow-up indicated his normal cardiac function and he was qualified for flying.The pilot had recovered flying for more than 1 year and no any unwell reported. Conclusions CAS may break out even no obvious arteriosclerosis and may bring angina,arrhythmia and AMI.CAS may result from the damage of endodermis function of coronary artery and the causative factors,such as drinking,smoking,fatigue,etc.,would result in CAS.The active protection is suggested to the high-risk group.
