民航飞行员T波倒置随访10年一例并文献复习  

A 10-year follow-up case of civil pilot with T wave inversion and literature review

作　　者：向妍[1] 杨志勤[1] 李杏[1] 胡杨[1] 张莹[1] 胡冰[1] 王海峰[1] 冯菲[1] 

机构地区：[1]中国南方航空股份有限公司航空卫生管理部,广州510406

出　　处：《中华航空航天医学杂志》2016年第3期205-211,共7页Chinese Journal of Aerospace Medicine

摘　　要：目的：探讨体检中ECG出现T波倒置的飞行员的航空健康管理和航空医学鉴定。方法回顾性分析1例民航飞行员10年的T波倒置ECG变化、临床诊断及医学鉴定情况，复习相关文献。结果本例飞行员ECG有心尖肥厚型心肌病ECG改变，胸导联电压逐年升高，ST 段压低逐年显著，T波倒置程度逐年加深，间断进行冠状动脉造影和心脏彩色超声无明显异常。2013年踏板运动试验提示ECG ST‐T改变明显，运动恢复期出现频发房性早搏。考虑其ECG变化进展明显，临时停飞查明原因。心脏彩色超声检查诊断为心尖肥厚型心肌病，心脏核磁共振诊断：心尖部心肌广泛增厚，考虑心尖肥厚型心肌病。未行治疗。考虑飞行员存在肥厚性非梗阻性心肌病，无其他明显的心脑血管疾病，现特许飞行。结论 ECG警示心尖部肥厚型心肌病比心脏彩色超声早；当ECG出现倒置T波，排除冠状动脉病变时，应考虑肥厚性心肌病可能；每年鉴定应行心脏彩色超声检查，再次行冠状动脉造影检查时应加做左室造影和心脏核磁共振检查，以尽早发现疾病。Objective To discuss health management and medical determination of the civil pilot with T wave inversion . Methods The ECG ,diagnoses and medical determinations of a pilot with T wave inversion were retrospectively analyzed from 2004 to 2014 . Results The pilot′s ECG showed the change indicated apical hypertrophic cardiomyopathy （AHCM ） .The left ventricular voltage was rising and T wave inversion was deepening year‐by‐year .But intermittent coronary angiography and echocardiography showed no abnormality . His ECG showed obvious ST‐T change in the treadmill exercise test in 2013 . Frequent atrial premature beat occurred in convalescent period . Due to the progress of his ECG changed obviously ,the pilot was temporarily grounded for further examination . AHCM was determined by echocardiography and the thicker apical hypertrophy by CMRI also indicated the possibility of AHCM .Treatment was not conducted .Considering the pilot who was with AHCM had no obvious cardiovascular and cerebrovascular diseases ,we now decided his continued flight . Conclusions ECG would warn AHCM earlier than echocardiography . When T wave inversion occurs and the possibility of hypertrophic cardiomyopathy could be excluded ,we should consider the possibility of hypertrophic cardiomyopathy . The diagnosis by echocardiography and coronary angiography would be done in annual physical examination .Then the coronary artery contrast examination is suggested to additionally check left ventricle imagine and cardiac magnetic resonance imaging for early determination .

关 键 词：心肌病  肥厚性 心电描记术 合格鉴定 T波倒置 

分 类 号：R856.5[医药卫生—航空、航天与航海医学] R540.41[医药卫生—临床医学]