民航飞行员机械瓣膜置换术后的航空医学鉴定——附病例报告一例  

Aeromedical assessment for the civil pilot with mechanical cardiac valve-1 case attached

作　　者：季涌[1] 曹善云[1] 范玉坤[2] 徐林[1] 

机构地区：[1]中国民用航空总局民用航空医学中心,北京100123 [2]100621北京,中国国际航空公司

出　　处：《中华航空航天医学杂志》2011年第2期121-125,共5页Chinese Journal of Aerospace Medicine

摘　　要：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.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.

关 键 词：主动脉瓣 心脏瓣膜 人工 合格鉴定 

分 类 号：R654.2[医药卫生—外科学]