CAJ | 학술논문

目的：初步探讨冠状动脉粥样硬化性心脏病(CHD)军事飞行人员支架术后医学鉴定的原则及方法。方法回顾分析7例低性能飞机军事飞行人员患CHD经支架术治疗后医学鉴定情况，随访观察恢复飞行情况，探讨其医学鉴定原则。结果7例飞行人员冠心病患者41～55岁，诊断为无症状性心肌缺血3例，不稳定性心绞痛2例，急性前壁心肌梗死1例，急性广泛前壁心肌梗死1例；冠脉造影证实冠脉1支病变4例（其中1例分叉病变），2支病变1例，3支病变2例。均分别行介入治疗，植入支架1～5枚，术后规律经他汀类药物降血脂、阿司匹林+氯吡格雷双联抗血小板聚集、β受体阻断剂等药物治疗，经1个月康复疗养及6个月地面观察，返院化验血脂、血糖、肝肾功、血尿酸，复查心电图、次极量平板运动试验、ECT负荷心肌扫描、Holter、冠脉造影等检查，对其中4例无明显冠脉狭窄、病情平稳无临床症状、无心肌缺血客观表现、心血管系统功能正常，且冠心病危险因素控制良好者予以有条件恢复飞行，随访22～48个月，平均年飞行120～400 h，飞行耐力良好。结论低性能飞机军事飞行人员CHD患者经冠脉支架术行完全血运重建，术后恢复良好，心血管功能正常，危险因素得到有效控制，再发心血管事件风险显著减低，可在严格医学监督下恢复飞行。
목적：초보탐토관상동맥죽양경화성심장병(CHD)군사비행인원지가술후의학감정적원칙급방법。방법회고분석7례저성능비궤군사비행인원환CHD경지가술치료후의학감정정황，수방관찰회복비행정황，탐토기의학감정원칙。결과7례비행인원관심병환자41～55세，진단위무증상성심기결혈3례，불은정성심교통2례，급성전벽심기경사1례，급성엄범전벽심기경사1례；관맥조영증실관맥1지병변4례（기중1례분차병변），2지병변1례，3지병변2례。균분별행개입치료，식입지가1～5매，술후규률경타정류약물강혈지、아사필림+록필격뢰쌍련항혈소판취집、β수체조단제등약물치료，경1개월강복요양급6개월지면관찰，반원화험혈지、혈당、간신공、혈뇨산，복사심전도、차겁량평판운동시험、ECT부하심기소묘、Holter、관맥조영등검사，대기중4례무명현관맥협착、병정평은무림상증상、무심기결혈객관표현、심혈관계통공능정상，차관심병위험인소공제량호자여이유조건회복비행，수방22～48개월，평균년비행120～400 h，비행내력량호。결론저성능비궤군사비행인원CHD환자경관맥지가술행완전혈운중건，술후회복량호，심혈관공능정상，위험인소득도유효공제，재발심혈관사건풍험현저감저，가재엄격의학감독하회복비행。
Objective We aimed to study the principles and methods of aero-medical assessment of military aviators with coronary heart disease (CHD) after percuteneous coronary artery stents. Methods Clinical data about 7 military aviators of low performance aircrafts with CHD diagnosed by coronary angiography and performed with percuteneous coronary artery stents was analyzed. These aviators were followed up to further establish the principles of aero-medical assessment for their re-flying.Results 7 aviators aged from 41 to 55 years old,including 3 cases with latent coronary heart disease,2 cases with unstable angina,1 case with anterior wall acute myocardial infarction and 1 case with extensive anterior wall acute myocardial infarction.There were 4 cases with single-vessel lesion (including 1 bifucationg leision),1 case with two-vessel lesion and 2 cases with three-vessel lesion.These aviators were all performed with percuteneous coronary artery stents and implanted 1-5 stents.After stent implantation,they were regularly treated with statins,aspirin,clopidgrel and beta-blocker after stents.After 1 month recovery and 6 month follow-up,ECG,treadmill exercise testing,ECT treadmil exercise testing,Holter and coronary angiography were done in these aviators.4 aviators with good cardiovascular function and well controlled risk factors return to flight under medical monitoring.With 22~48 months follow-up,they flew 120~400 hours per-year with good flying tolerances.Conclusion Military aviators of low performance aircrafts can return to flight under medical monitoring after complete revascularization by stents with good cardiovascular function,and well-controlled risk factors.