飞行员卵圆孔未闭合并脑软化灶1例并文献分析  

A pilot case of patent foramen ovale complicated with encephalomalacia foci and literature review

作　　者：王军 郑军 刘红巾 付兆君 刘启明 王丽萍 王星 孙荣丽 汪东军 Wang Jun;Zheng Jun;Liu Hongjin;Fu Zhaojun;Liu Qiming;Wang Liping;Wang Xing;Sun Rongli;Wang Dongjun(Department of Medical Evaluation,Air Force Medical Center,Air Force Medical University,PLA,Beijing 100142,China)

机构地区：[1]空军军医大学空军特色医学中心医学鉴定科,北京100142

出　　处：《中华航空航天医学杂志》2023年第4期215-219,共5页Chinese Journal of Aerospace Medicine

摘　　要：目的分析飞行员卵圆孔未闭导致脑软化灶的诊治及航空医学鉴定结论,探讨航空医学鉴定结论应把握的原则。方法回顾性分析1例卵圆孔未闭合并脑软化灶飞行员的临床表现、头颅MRI、经胸心脏超声及经食道超声心动图等检查,并复习相关文献。结果本例患者为男性,28岁,歼击机飞行员,无临床症状及不适主诉,体检时头颅MRI示左颞极蛛网膜囊肿(2.18 cm×1.11 cm),左额叶脑软化灶(1.80 cm×3.50 cm×3.30 cm)。入院后行经食道超声心动图及发泡试验,检出卵圆孔未闭。局麻下行卵圆孔封堵术,术后恢复良好,无不适。复查心脏彩色超声示室间隔及左室壁心肌回声正常,室壁厚度、运动幅度未见异常,室壁运动协调。房间隔中部可见封堵器强回声,封堵器位置正常。航空医学鉴定结论:特许飞行合格。结论飞行员脑软化灶或脑梗死应注意卵圆孔未闭筛查,卵圆孔未闭经导管封堵术后应定期复查及随访;当其临床无症状、体征,动态心电图、次极量平板运动试验检查无心律失常,影像学检查无残余分流、瓣膜关闭不全和封堵器磨蚀且位置正常等,且心脏功能、储备功能、调节功能正常,离心机及加压呼吸检查正常且无心律失常,地面观察时间不短于6个月时,可予以特许飞行合格结论。Objective To investigate the diagnosis and treatment of pilots with patent foramen ovale resulting in encephalomalacia foci and discuss the aeromedical assessment principles.Methods The clinical manifestations,cranial MRI,cardiac ultrasound and transesophageal echocardiography of a pilot with patent foramen ovale and encephalomalacia foci were retrospectively analyzed,and the relevant literatures were reviewed.Results The patient was a male fighter pilot,28 years old,without clinical symptoms and complaints of discomfort.A left temporal pole arachnoid cyst(2.18 cm×1.11 cm)and a left frontal brain softening foci(1.80 cm×3.50 cm×3.30 cm)were detected by cranial MRI during physical examination,and patent foramen ovale was detected by transesophageal echocardiography and foam test after admission.The oval foramen was occluded under local anesthesia.The patient was well-recovered after surgery and without discomfort.The cardiac ultrasound recheck showed normal myocardial echoes in the septum and left ventricular wall,no abnormalities in wall thickness and motion amplitude,and coordinated ventricular wall motion.Strong echogenicity of the blocker was seen in the middle of the atrial septum,and the position of the blocker was normal.The aeromedical assessment conclusion of the patient was waiver to flight.Conclusions The patent foramen ovale should be screened when pilot is diagnosed as encephalomalacia foci or cerebral infarction.The regular reexamination and follow-up should be conducted for the transcatheter occlusion of patent foramen ovale.Pilots could be waivered when they have no clinical symptoms and signs,no arrhythmias and at proper position in dynamic electrocardiogram and submaximal treadmill exercise test,no residual shunt,valve regurgitation,or occluder erosion in imaging examination,and normal cardiac function,reserve function,and regulatory function,normal pressurized breathing and without arrhythmias in centrifuge run,and the grounding observation period is not less than 6 months.

关 键 词：脑疾病 房间隔缺损 体格检查 飞行员 

分 类 号：R856.74[医药卫生—航空、航天与航海医学]