卵圆孔未闭飞行员经系统评估后飞行合格1例并文献复习  

A case of pilot with patent foramen ovale be finally qualified with flying after scientific evaluation and literature review

作　　者：孙津津[1] 张海涛[1] 孙健[1] 李利[2] 王海音[3] 王建昌[4] 

机构地区：[1]空军总医院心脏中心,北京100142 [2]空军总医院超声诊断科,北京100142 [3]空军总医院特诊科,北京100142 [4]空军总医院,北京100142

出　　处：《空军医学杂志》2015年第5期273-277,共5页Medical Journal of Air Force

摘　　要：目的探讨飞行员卵圆孔未闭(patent foramen ovale,PFO)的医学评估,提高航空医学实践中对PFO的认识,为医学鉴定和招飞体检标准的更新提供依据。方法分析1例军事飞行员发现PFO后的诊断过程和评估结果,并通过相关文献回顾,总结PFO的病理生理特点、诊断和各种评估方法。结果该例23岁男飞行员无症状,体检有心脏杂音,曾行经食管超声发现未闭合卵圆孔,有左向右分流信号。入院后查经胸心脏超声提示房间隔中部回声缺失;经食管超声未发现分流信号;经颅多普勒提示未发现微栓信号;右心声学造影提示左心腔内未见气泡回声;头颅MRI平扫无异常。建议飞行合格,随访1年,飞行正常。结论 PFO是中青年发生缺血性脑卒中的重要病因之一,易漏诊,飞行员中也有一定的发生率,飞行动作可能进一步增加反常性栓塞的风险。长期处于高载荷的飞行环境以及抗荷动作可能是未闭合卵圆孔逐渐扩大的机制。各种检查方法中优势互补,可以大大提高PFO的检出率。可以将这些检查方法规范化应用于飞行员招募、改装体检等环节,值得推广。Objective To investigate the medical assessments of patent foramen ovale （PFO）, to improve the understanding of aviation medicine practice, to provide the basis for medical evaluation and to update medical standards. Methods A case of military pilot suffering fromPFO was analyzed for diagnosis and assessment results. By referring to the literature review, the pathophysiological characteristics, diagnosis and various evaluation methods were examined. Results The 23-year-old male pilot was admitted to the hospital with no complaints, found a heart murmur in physical examination and diagnosed as PFO with a left-to-right-shunt signal in septal by transesophageal echocardiography （TEE）. After admission, some examinations were performed. Transthoracic echocardiography （TTE） revealed the echo of central atrial septal missing, but shunting signal was not found. Microsphere signal was not found by transcranial doppler. No bubble echoes in the left heart chamber was suggested by right heart angiography. The result of brain MRI scan was normal. The pilot was finally qualified for flying and the current normal flight was reported during 1 year follow-up. Conclusions PFO is one of important causes of ischemic stroke in young and middle-aged people and easily fails to be diagnosed. There was a certain incidence rate of PFO in pilots and the flight maneuver may further increase the risk of paradoxical embolism. Long-term flight at high load and anti-G maneuver may be the mechanism of unclosed foramen ovale gradually expanding. Various inspections realized mutual compensation of advantages, which would greatly improve the detection rate. These inspections should be used to follow the standards and promoted for pilot recruitment and physical examination of pilots and modified high performance fighters.

关 键 词：卵圆孔未闭 飞行员 飞行鉴定 

分 类 号：R541.1[医药卫生—心血管疾病]