民航招飞体检中449例眼底三面镜检查结果分析  

Analysis of 449 fundus examination results detected by three-mirror lens during civil aviator recruitment′s physical examination

作　　者：王益蓉 刘欢 申芙蓉 齐亚娜 Wang Yirong;Liu Huan;Shen Furong;Qi Yana(Hospital of Civil Aviation Flight University of China,Guanghan,Sichuan 618307,China;West China Hospital,Sichuan University,Chengdu 610041,China)

机构地区：[1]中国民用航空飞行学院医院,四川省广汉618307 [2]四川大学华西医院,成都610041

出　　处：《中华航空航天医学杂志》2021年第3期134-141,共8页Chinese Journal of Aerospace Medicine

基　　金：中国民用航空飞行学院科研项目(J2020-150)。

摘　　要：目的分析民航招飞体检中疑似眼底病变学生的眼底三面镜检查结果, 探讨眼底三面镜检查在民航招飞体检中的必要性和实际意义。方法收集2017年11月—2019年12月参加民航招飞体检的1 808名学生中直接检眼镜检出疑似眼底病变的学生眼底三面镜检查数据, 统计描述各类眼底病变的频数与占比, 将直接检眼镜检查结果与三面镜的检查结果进行一致性检验并计算Kappa值。采用χ^(2)检验或Fisher确切概率法分析三面镜检出各类眼底病变的眼别、屈光度及病变部位(按象限划分为颞上、颞下、鼻上、鼻下, 按同心圆划分为后极部、赤道部、周边部)的分布特征。结果直接检眼镜检出疑似眼底病变的学生共449名(898眼), 其中三面镜检查检出有任何一种眼底病变的学生434名, 确诊率96.66%(434/449);疑似眼底疾病检出率24.83%(449/1 808), 眼底疾病检出率24.00%(434/1 808)。449名学生898只眼中, 霜样变性(233眼, 占比25.95%)、囊样变性(170眼, 占比18.93%)、铺路石样变性(234眼, 占比26.06%)较为常见;有70只眼(7.80%)检出视网膜裂孔, 13只眼(1.45%)检出视网膜脱离。直接检眼镜与三面镜检查在先天性色素上皮多灶性肥大(熊印)、视网膜脱离、视网膜裂孔的检出结果上一致性较差(Kappa值分别为0.164、0.349、0.535), 且直接检眼镜容易漏诊。眼底病变在右眼的检出比例高于左眼, 均是颞上部高发, 其次是颞下部, 多数眼底病变好发于周边部。结论三面镜检查可弥补民航招飞直接检眼镜筛查眼底病变中的不足, 能检出较为严重的视网膜脱离、视网膜裂孔等, 值得广泛推广并纳入航空体检医师眼科体检操作规范。建议先用直接检眼镜初检, 结合眼底病变的分布特征和好发部位进行判断, 若不能对眼底病变性质和定位进行准确判断, 必须行眼底三面镜检查进行确诊、分类和随访。Objective To investigate the necessity and practical significance of fundus examination by three-mirror lens by analyzing the fundus examination results of students with suspected fundus lesions in physical examination of civil aviation recruitment.Methods Data of fundus examination detected by three-mirror lens of students with suspected fundus lesions were collected among 1808 students in physical examination of civil aviation recruitment from November 2017 to December 2019.Descriptive analysis were used to present the frequency and proportion of various fundus lesions,and the consistency between the results of direct ophthalmoscope and three-mirror lens was tested and the Kappa value was calculated.Chi-square test or Fisher exact probability method were used to analyze the characteristics of fundus lesions distributed across eye types,diopters and lesion locations(divided into upper temporal,lower temporal,upper nasal,and lower nasal by quadrants,or posterior polar,equatorial and peripheral parts by concentric circle).Results A total of 449 students(898 eyes)with suspected fundus lesions detected by direct ophthalmoscope,of which 434 students were diagnosed with any kind of fundus lesions.The diagnosis rate was 96.66%(434/449);the detection rate of suspected fundus lesions was 24.83%(449/1808);the detection rate of fundus lesions was 24.00%(434/1808).Among 898 eyes of 449 suspected students,those with frost-like degeneration(233 eyes,25.95%),cystic degeneration(170 eyes,18.93%)and paving stone degeneration(234 eyes,26.06%)were common.There were 70 eyes and 13 eyes detected with retinal holes and retinal detachment,accounting for 7.80%and 1.45%of the total eyes,respectively.Congenital hypertrophy of retinal pigmented epithelium ophthalmoscope and three-mirror examination showed poor consistency in the detection results of congenital hypertrophy of retinal pigment epithelium,retinal detachment,and retinal hole(Kappa values were 0.164,0.349 and 0.535,respectively),and direct ophthalmoscope was inclined to miss di

关 键 词：检眼镜检查 诊断技术 眼科 眼底 视知觉 体格检查 人员选用 三面镜检查 

分 类 号：R851.3[医药卫生—航空、航天与航海医学]