CAJ | 학술논문

目的通过回顾性分析民航飞行员颅脑损伤病例及社区病例相关文献,探讨不同程度的颅脑损伤后不同时间段癫痫的发病率和颅脑损伤后癫痫发作的高危因素,以期指导民用航空人员颅脑损伤的医学鉴定.方法获取并回顾相关颅脑损伤后癫痫发作的流行病学研究,获得社区颅脑损伤病例共9475例,其中重度605例,中度1955例,轻度6915例;民航飞行员重度颅脑损伤申请特许鉴定病例2例.分析并探讨颅脑损伤后癫痫发作的航空医学鉴定.结果 ①重度颅脑损伤后癫痫发病率高于中度,中度高于轻度.②颅脑损伤后随时间推移癫痫发作可能性逐步降低;轻度颅脑损伤1年后癫痫年发病率小于1%,中度颅脑损伤3年后癫痫年发病率小于1%,重度颅脑损伤8年后癫痫年发病率小于1%.③颅脑损伤后癫痫发作高危因素有:脑挫伤、硬膜下血肿、凹陷性骨折及意识丧失或损伤后遗忘大于24 h.④两名颅脑损伤飞行员经及时有效治疗后恢复良好,各项检查未见异常,密切随访期间未见癫痫发作.其中1名飞行员于伤后第4年特许合格,安全飞行2年(1800 h),未见癫痫发作;另1名于伤后第9年特许合格,安全飞行4年(1600 h),未见癫痫发作.结论根据1%法则,颅脑损伤治愈后,若各项检查未见异常,轻度颅脑损伤1年后可评定为合格,中度3年后可评定为合格,重度8年后可考虑有或无限制的合格鉴定.
목적 통과회고성분석민항비행원로뇌손상병례급사구병례상관문헌,탐토불동정도적로뇌손상후불동시간단전간적발병솔화로뇌손상후전간발작적고위인소,이기지도민용항공인원로뇌손상적의학감정.방법 획취병회고상관로뇌손상후전간발작적류행병학연구,획득사구로뇌손상병례공9475례,기중중도605례,중도1955례,경도6915례;민항비행원중도로뇌손상신청특허감정병례2례.분석병탐토로뇌손상후전간발작적항공의학감정.결과 ①중도로뇌손상후전간발병솔고우중도,중도고우경도.②로뇌손상후수시간추이전간발작가능성축보강저;경도로뇌손상1년후전간년발병솔소우1%,중도로뇌손상3년후전간년발병솔소우1%,중도로뇌손상8년후전간년발병솔소우1%.③로뇌손상후전간발작고위인소유:뇌좌상、경막하혈종、요함성골절급의식상실혹손상후유망대우24 h.④량명로뇌손상비행원경급시유효치료후회복량호,각항검사미견이상,밀절수방기간미견전간발작.기중1명비행원우상후제4년특허합격,안전비행2년(1800 h),미견전간발작;령1명우상후제9년특허합격,안전비행4년(1600 h),미견전간발작.결론 근거1%법칙,로뇌손상치유후,약각항검사미견이상,경도로뇌손상1년후가평정위합격,중도3년후가평정위합격,중도8년후가고필유혹무한제적합격감정.
Objective To investigate the incidence of various grade of posttraumatic epilepsy in different time and risk factors by analyzing cerebral trauma cases of civil pilots and correlative literatures.The conclusion is expected to contribute to the aviation medical assessment for the civil pilot with posttraumatic epilepsy. Methods For analyzing epidemiology studies of posttraumatic epilepsy 9475 cases of civilians' posttraumatic epilepsy (include 605 severe, 1955 moderate and 6915 mild traumatic brain injury cases) were reviewed. Besides, 2 epilepsy cases of civil pilots with severe traumatic brain injury, who were specially applied for assessment, were also analyzed to investigate the application in aeromedical assessment. Results ①The severer traumatic brain injury the higher incidence of posttraumatic epilepsy. ②The possibility of posttraumatic epilepsy seizure was gradully diminished with time. The incidence of posttraumatic epilepsy could reduce to lower than 1% after 1, 3 or 8 years corresponding to the mild,moderate and severe traumatic brain injury. ③ The high risk factors of posttraumatic epilepsy included brain contusion, subdural hematoma, depressed fracture, loss of consciousness or post traumatic amnesia more than 24 h and early seizure. The close follow-up showed that 2 pilots well recovered by timely treatment and no more abnormities and seizure happened. One pilot was permitted for co-piloting at the 4th year of injury and had no epilepsy seizure in his safe flying for 2 years (1800 h). Another pilot returned to his qualified flight at the 9th year and had safely flied as pilot instructor for 4 years ( 1600 h) without seizure.Conclusions By applying 1% rule in aeromedical assessment, the mild traumatic brain injured pilot would be suggested to fit for flying by 1-year recovery and 3-year recovery for the moderate if no more abnormities were diagnosed. For the severe injured pilot, the flying qualification could be considered with or without limitation by 8-year recovery.