CAJ | 학술논문

目的通过分析民航飞行员1例机械瓣膜置换术后病例及文献回顾,以期加强对该病的认识,提高鉴定水平.方法介绍1例飞行员主动脉瓣机械瓣置换术后的临床资料,分析并探讨该病的医学鉴定方法.结果该飞行员2年前体检时发现血压脉压差大,超声心动图示左室明显增大,左房增大,主动脉瓣重度返流,左室收缩功能测量值在正常低限的52%.1个月后行主动脉机械瓣置换术.术后1年申请特许鉴定,考虑其血凝控制稳定,心功能良好,在自我认识充分、密切随访和严格的航医监控的前提下特许合格,但不担任机组必需成员,每月飞行不超过50 h.特许合格后安全飞行200 h,未见因医学原因出现的飞行事故或飞行事故征候.结论民航飞行员机械瓣膜置换术后的航空医学评定应遵循个别评定、风险评估和谨慎的原则,若心功能良好,血凝较为稳定,且控制在可接受范围内,无出血、栓塞的高危因素,预计发生出血、栓塞、卡瓣、瓣膜功能不良等总体风险水平在可接受范围内,在飞行员自我认识充分、密切航医监控、定期专科会诊的前提条件下可给予有限制的特许合格,但仍需密切随访.
목적 통과분석민항비행원1례궤계판막치환술후병례급문헌회고,이기가강대해병적인식,제고감정수평.방법 개소1례비행원주동맥판궤계판치환술후적림상자료,분석병탐토해병적의학감정방법.결과 해비행원2년전체검시발현혈압맥압차대,초성심동도시좌실명현증대,좌방증대,주동맥판중도반류,좌실수축공능측량치재정상저한적52%.1개월후행주동맥궤계판치환술.술후1년신청특허감정,고필기혈응공제은정,심공능량호,재자아인식충분、밀절수방화엄격적항의감공적전제하특허합격,단불담임궤조필수성원,매월비행불초과50 h.특허합격후안전비행200 h,미견인의학원인출현적비행사고혹비행사고정후.결론 민항비행원궤계판막치환술후적항공의학평정응준순개별평정、풍험평고화근신적원칙,약심공능량호,혈응교위은정,차공제재가접수범위내,무출혈、전새적고위인소,예계발생출혈、전새、잡판、판막공능불량등총체풍험수평재가접수범위내,재비행원자아인식충분、밀절항의감공、정기전과회진적전제조건하가급여유한제적특허합격,단잉수밀절수방.
Objective To strengthen the understanding of the effects of mechanical cardiac valve replacement and to improve assessment by analyzing civil pilot′s case and reviewing correlative literatures. Methods The clinical data of a civil pilot with mechanical aortic valve was introduced. Medical assessment method of the pilot with mechanical valve was analyzed and discussed. Results The pilot was found pulse gradient pressure enlargement in the physical examination 2 years ago. Echocardiography showed obvious left ventricle hypertrophy, left atrial enlargement and severe aortic valve backstreaming. Ejection factor was 52% of the lower limit of normal range. He received mechanical aortic valve replacement 1 month later and applied for special assessment 1 year after surgery. He was specially qualified with limited flight assignment and flying within 50 h per month on the base of his steady hemagglutination control and good heart function, as well as basic on his self-cognition, close follow-up and rigorous supervision by flight surgeon. He had flied for 200 h without any accident or incident due to medical reasons. Conclusions The aeromedical assessment for the civil pilot with mechanical cardiac valve should follow the principles of carrying individual evaluation, risk assessment and caution. Civil pilot would get limited flying qualification if his heart function and hemagglutination control are within the acceptable range, no such risks or potential risks as haemorrhage, embolism and valve dysfunction, as well as the sufficient self-cognition, close follow-up, scheduled consultation and rigorous supervision by flight surgeon.