民航飞行员先天性二叶式主动脉瓣畸形医学鉴定的探讨——附二例病例报告

摘要

Objective To analyze aviation medicine significance for the civil pilot with congenital bicuspid aortic valve malformations (BAVM) and discuss the assessment policies, standards, methods and measures of medical examination for promoting the level of medical identification. Methods Two cases of civil pilot with BAVM were reviewed and their invasive characteristics were analyzed. By taking the foreign policies and specified methods as reference, suggestions were raised for Chinese civil aviation medical assessment. Results These 2 final diagnosed BAVM cases didn't have any clinical symptoms, homodynamic changes and clinical indications that the medical intervention or operation was necessary. The 2 pilots would only apply for special permitted medical assessment, according to current physical examination standard for Chinese civil flying personnel, and were qualified for flying.They showed good endurance when they had recovered flying for 13 and 3 months respectively and no any medical causal flying accident or accident proneness occurred. Conclusions Medical assessment for the civil pilot with BAVM should follow the principles of individual evaluation, risk assessment and caution care. The overall risk will be in acceptable range if there are no clinical symptoms, no homodynamic changes and no indications that lead to medical intervention or operation. Special qualification would be issued on the base of pilot's self-awareness, flight surgeon's closed supervision and regular consultation. Physical examination doctor is suggested to be authorized for assisting the special permitted medical assessment.%目的 分析民航飞行员先天性二叶式主动脉瓣畸形的航空医学意义,探讨民用航空医学体检鉴定的政策、标准、方法和措施,提高体检鉴定水平.方法 报告2例民航飞行员先天性二叶式主动脉瓣畸形的临床资料,分析其发病特点;检索并借鉴国外航空医学的处置政策及具体方法,对我国民用航空医学的体检鉴定提出意见和建议.结果 确诊2例飞行员先天性二叶式主动脉瓣畸形,无任何临床症状,无明显血流动力学改变的临床证据,亦不具备介入和(或)手术治疗的临床指征.根据我国现行民航飞行人员体检鉴定标准,仅可按特许鉴定方案进行体检鉴定;两例飞行员特许鉴定合格后,分别恢复飞行3个月和13个月,飞行耐力良好,未见因医学原因出现的飞行事故或飞行事故征候.结论 民航飞行员先天性主动脉瓣畸形的航空医学评定应遵循个别评定、风险评估和谨慎的原则,若无症状、无血流动力学改变的临床证据、不具备介入治疗或手术治疗的指征等,总体风险水平在可接受范围内.在飞行员自我认识、密切航医监控、定期专科会诊的前提条件下可给予特许合格,或考虑授权航空体检医生进行协助特许体检鉴定.