军事飞行人员梅尼埃病的医学鉴定

目的 对军事飞行人员梅尼埃病的医学鉴定进行综述. 资料来源与选择该领域的相关研究论文、综述与标准. 资料引用国内外公开发表的论文、综述及标准42篇. 资料综合主要对梅尼埃病的研究进展、梅尼埃病对军事飞行的影响、军事飞行员梅尼埃病的医学鉴定3个相关问题进行了介绍和讨论. 结论 对于军事飞行人员梅尼埃病的医学鉴定,应该对其眩晕与耳鸣症状的控制情况、听觉及前庭功能进行全面的评估,并权衡梅尼埃病对飞行安全的影响以及飞行人员培养的巨大花费,在风险评估的基础上,个别评定,做出最佳选择. Abstract： Objective To review the medical identification of Meniere's disease (MD) in military aircrews. Literature resource and selection Research papers, reviews and standards in this field. Literature quotation Forty-two papers, reviews and standards that published in China and abroad were cited. Literature synthesis Three major issues, including progress of MD, the impact of MD to military flying, medical identification of MD in military aircrews, were reviewed and discussed. Conclusion For medical identification of MD, it's suggested to comprehensively evaluate the success rate of controlling vertigo and tinnitus, hearing level and vestibular function. In balancing the effects of MD on flight safety and expensive training cost, the best choice would be a personal assessment on the basis of risk evaluation.     

飞行人员恶性肿瘤术后安全放飞指征的临床研究

目的 研究和探讨我国飞行人员恶性肿瘤手术后放飞的安全标准. 方法 回顾分析38年间,经病理检查确诊为恶性肿瘤并进行外科手术的飞行人员病例资料,全组25例飞行人员恶性肿瘤术后放飞13例. 结果 本组13例恶性肿瘤术后放飞的飞行人员中,甲状腺癌4例、结肠癌3例、膀胱癌2例,胃癌、胰腺囊腺瘤、乳腺癌和耻骨软骨肉瘤各1例.经手术治疗及术后辅助治疗,13例病人机体状况恢复良好,鉴定结论 :飞行合格.术后随访3～38年,飞行时间30～2000 h,飞行状态良好. 结论 部分患恶性肿瘤的飞行人员,通过仔细认真的手术、正规的术后辅助治疗和护理、循序渐进的体能锻炼、定期严格的健康体检,可以达到飞行合格.作者提出了适合我国飞行人员恶性肿瘤术后恢复飞行的基本标准. Abstract： Objective To study and discuss the safety standard of flying qualification for the postoperative flying personnel with malignant tumor. Methods Related case history in past 38 years was retrospectively reviewed and sought 13 flying qualified cases out of 25 postoperative flying personnel with malignant tumor. Results Among 13 qualified cases there were 4 cases of thyroid carcinoma, 3 cases of colon carcinoma, 2 cases of bladder carcinoma and 4 cases respectively were gastric cancer, cystadenoma of pancreas, breast carcinoma and pubis osteochondrosarcoma. Those 13 cases were cured by operation and other adjuvant treatments and were diagnosed as well recovered. Since they were qualified for flying, the 3-38 years follow-up showed that they had fitted in flying for 30-2000 h. Conclusions Some flying personnel with malignant tumor would be qualified for flying by operation, proper adjuvant treatments and regular nursing, as well as the progressive physical exercise and under regular rigorous physical examination. The paper also puts forward a basic standard that suited for Chinese military flying personnel with malignant tumor.     

飞行人员空晕病的诊治和医学鉴定

Objective To summarize the clinical features,diagnosis and treatment methods,prevention and control measures,and medical evaluation principles for airsickness in flying personnel. Methods Forty-nine cases of flying personnel with airsickness,who were hospitalized from September of 1976 to July of 2009,were retrospectively analyzed in respect of disease course,etiology or incentive,clinical diagnosis and medical evaluation of airsickness.The relationship between vestibular function status and medical evaluation was also statistically analyzed. Results ① Three of 49 picked cases were diagnosed as primary airsickness while the rest 46 were the secondary that were induced by different causes or incentives.Etiological treatment and vestibular habituation were the primarily treatments for such airsickness.② Among these cases,22 were normal in vestibular nystagmus electroretinogram (VNG) comparing to 27 abnormal cases.③ Sixteen and 33 cases were evaluated as normal and deficient Coriolis acceleration tolerance respectively.④ Eleven flying personnel Were finally qualified while 10 and 28 were temporarily and permanently grounded respectively.Flying personnel with abnormal VNG or with deficient Coriolis acceleration tolerance showed higher grounding rate than those with the normal (χ2=5.584,16.722,P<0.05). Conclusions Airsickness in active service flying personnel is mostly the secondary affection,which is caused by various primary disease or incentives.Such prevention and control measures as treating primary disease.eliminating incentives and implementing vestibular habituation are suggested.The effect of airsickness treatment and vestibular function should be emphasized in making medical evaluation.     

脉搏波传导速度和踝臂指数在飞行人员动脉硬化早期检测中的应用

目的 探讨脉搏波传导速度(pulse wave velocity,PWV)和踝臂指数(ankle brachial pressure index,ABI)在飞行人员动脉硬化早期检测中的应用价值.方法 应用动脉硬化检测仪,检测107例飞行人员的PWV和ABI,并与107例地方体检人员进行对比分析.结果 飞行人员组发现PWV异常10例(9.3%),对照组发现36例(33.6%);对照组发现1例ABI异常,而飞行人员组未见ABI异常;两组人群PWV均值随着年龄的增长而增大(F=3.314～13.819,P＜0.05),但飞行人员PWV均值显著低于同年龄组一般人群(t=2.187～4.208,P＜0.05).线性回归分析结果表明,飞行人员PWV与年龄、血压、腰围和体重指数显著相关(β=0.439～0.634,P＜0.01).结论 年龄、血压、腰围或体重指数的增加是飞行人员大动脉弹性降低的主要危险因素,PWV可以作为飞行人员血管早期病变检测与评价的功能指标. Abstract： Objective To explore the value of using pulse wave velocity (PWV) and ankle brachial pressure index (ABI) to detect the early arteriosclerosis in flying personnel. Methods PWV and ABI were detected in 107 cases of flying personnel by arteriosclerosis detector and 107 civil personnel were examined as control group. Results 10 cases (9.3%) of abnormal PWV were found in flying personnel group while 36 cases (33.6%) found in control group. Only one abnormal ABI case was in control group but in flying personnel group. The mean PWV of both groups' showed significant increase with the age growing (F= 3. 314-13. 819, P＜0. 05). The mean PWV of flying personnel group was significantly lower than that of the control group in same age segment (t= 2. 187-4. 208,P＜0.05). Linear regression analysis showed that PWV was closely related to the age, blood pressure, waist circumference (WC) and body mass index (BMI) in flying personnel group (β=0. 439-0. 634, P＜0. 05). Conclusions The increases of age, blood pressure and WC or BMI are the major risk factors of causing aorta elasticity decreased in flying personnel. It is suggested that the PWV would be an applicable functional index in early diagnosis of vascular pathological changes and in medical evaluation.     

飞行人员空晕病的诊治和医学鉴定

目的 总结飞行人员空晕病的临床特征、诊治方法、防治措施及医学鉴定原则. 方法 回顾性分析1976年9月-2009年7月间住我院的49例飞行人员空晕病患者的病历资料,包括患者病史、病因与诱因、诊断分类、检查及医学鉴定结论 .对前庭功能检查结果与医学鉴定结论之间的关系进行统计学分析. 结果 ①本组病例原发性空晕病3例,继发性空晕病46例;继发性空晕病有其原发病因或诱因,其治疗主要为病因治疗和前庭功能脱敏习服训练;②前庭眼震电图检查正常者22例,异常者27例;③科里奥利加速度耐力正常者16例,不良者33例;④飞行合格11例,暂时飞行不合格10例,飞行不合格28例.前庭眼震电图异常者和科里奥利加速度耐力不良者飞行不合格率分别高于前庭眼震电图正常者和科里奥利加速度耐力正常者(χ2=5.584、16.722,P<0.05).结论 现役飞行人员空晕病多为继发性,防治措施包括治疗原发病因、消除诱因和加强前庭功能脱敏习服训练.其医学鉴定要兼顾原发病治疗效果、前庭功能状况及飞行机种情况. Abstract： Objective To summarize the clinical features,diagnosis and treatment methods,prevention and control measures,and medical evaluation principles for airsickness in flying personnel. Methods Forty-nine cases of flying personnel with airsickness,who were hospitalized from September of 1976 to July of 2009,were retrospectively analyzed in respect of disease course,etiology or incentive,clinical diagnosis and medical evaluation of airsickness.The relationship between vestibular function status and medical evaluation was also statistically analyzed. Results ① Three of 49 picked cases were diagnosed as primary airsickness while the rest 46 were the secondary that were induced by different causes or incentives.Etiological treatment and vestibular habituation were the primarily treatments for such airsickness.② Among these cases,22 were normal in vestibular nystagmus electroretinogram (VNG) comparing to 27 abnormal cases.③ Sixteen and 33 cases were evaluated as normal and deficient Coriolis acceleration tolerance respectively.④ Eleven flying personnel Were finally qualified while 10 and 28 were temporarily and permanently grounded respectively.Flying personnel with abnormal VNG or with deficient Coriolis acceleration tolerance showed higher grounding rate than those with the normal (χ2=5.584,16.722,P<0.05). Conclusions Airsickness in active service flying personnel is mostly the secondary affection,which is caused by various primary disease or incentives.Such prevention and control measures as treating primary disease.eliminating incentives and implementing vestibular habituation are suggested.The effect of airsickness treatment and vestibular function should be emphasized in making medical evaluation.     

飞行人员多系统萎缩二例并文献复习

目的 探讨2例飞行人员患罕见病多系统萎缩(multiple system atrophy,MSA)的临床特征、鉴别诊断、治疗、与飞行的关系及健康鉴定. 方法 分析2例飞行人员的临床资料及复习相关文献. 结果 2例起始表现均不典型,晚期1例表现较典型.因是罕见病,都有一定时期误诊.最终确诊主要根据临床表现,结合电生理及影像学检查.确诊后飞行结论 为飞行不合格. 结论 神经系统变性疾病起始表现隐袭,病程较长.飞行人员身体素质较好,发病后表现更加隐蔽.要求航空医生要更加仔细地观察临床表现及分析相关检查,尽早做出诊断,避免误诊.对此类神经系统变性疾病的飞行结论 要根据病情轻重、飞行机种及飞行任务综合评定. Abstract： Objective To investigate the clinical features by analyzing two flying personnel cases of multiple system atrophy (MSA) for the references to diagnosis, treatment, as well as the influence to flying and the criteria of individual aeromedical evaluation. Methods The clinical data of 2 cases of aircrew with MSA were analyzed and related literatures were reviewed. Results The clinical MSA features of both cases were not typical in their early stage but 1 case appeared typical features in late stage. These 2 cases were misdiagnosed in a certain time because of MSA's rare occurrence, but finally the definite diagnosis was made by judging clinical features, electrophysiology and imageology examinations. These 2 pilots were finally disqualified for flying. Conclusions The clinical features of degeneration diseases of neurologic system in early stage were obscure and had relative longer course of disease, especially for those physical fitness pilots. So it raised higher requirements to the aviation physician in early recognizing the features of MSA for preventing misdiagnosis. Aeromedical assessment of flying personnel with degeneration diseases of neurologic system should be synthetically evaluated according to clinical features, aircraft type and mission.     

载人航天飞行对认知能力影响的研究进展

目的 综述当前用于载人航天飞行认知能力研究的方法、工具、内容以及研究结果,并指出研究中存在的问题以及未来的研究方向.资料来源与选择国内外相关领域的学术论著和综述.资料引用引用文献31篇.资料综合载人航天飞行环境存在着失重、隔离、限制等许多应激源,这些应激源会对航天员的认知能力造成一定影响.航天飞行中航天员认知能力改变的研究对于确保航天任务成功和飞行乘组安全有重要意义.当前载人航天飞行认知能力研究主要采用计算机化的测验工具,对影响航天飞行安全和操作效率的能力进行研究.结论 载人航天飞行对航天员认知能力有损害,具体的机制需要通过生理心理学和神经科学的手段进行深入研究. Abstract： Objective To discuss the matters in space cognition study and foresee its development in future by reviewing the methods, tools and results of current space cognition study.Literature resource and selection Domestic and abroad published papers and reviews in the related field. Literature quotation Thirty-one related papers and reviews were citied. Literature synthesis There are many stressors, such as microgravity, isolation, confinement, etc. , in space flight and those would influence astronaut's cognition. The study of cognition in space has a significant meaning for ensuring the success of mission and crew's safety. The computerized testing tools have being used in current space cognition study for assessing the influence of space to flight safety and operation efficiency. Conclusion The stressors in spaceflight would harm astronaut's cognitive abilities. But the mechanism needs to be further explored by means of the studies on physiopsychology and neuroscience.     

彩色多普勒超声在诊断颈性眩晕飞行人员椎动脉异常中的临床应用价值

目的 探讨彩色多普勒超声在诊断颈性眩晕飞行人员椎动脉异常中的临床应用价值,分析飞行人员颈性眩晕与椎动脉异常的相关性.方法 对168例颈性眩晕飞行人员患者的椎动脉超声检查结果及相关影像学资料进行回顾性分析.结果 椎动脉发育异常78例,发育异常包括起源异常、行径异常和发育不良.其中起源异常9例,单侧或双侧行径异常11例,单侧或双侧发育不良32例,完全闭塞1例,行径异常伴发育不良25例;发育异常的椎动脉中血流动力学异常者48例.飞行不合格8例,暂时飞行不合格25例,临床诊治后飞行合格45例.结论 飞行人员颈性眩晕患者椎动脉先天异常所占比例较大,招飞工作是飞行工作的源头,提示我们应从源头把关,降低飞行人员的停飞率,建议将椎动脉超声检查纳人空军招收飞行学员体格检查标准. Abstract： Objective To study the correlation between cervical vertigo and vertebral artery abnormality by analyzing the clinical application of color Doppler ultrasonography on flying personnel.Methods The ultrasound imaging and related data of 168 flying personnel's with cervical vertigo were reviewed and analyzed.Results There were 78 cases of vertebral artery abnormalities,including 9 cases of anomalous origin, 11 cases of unilateral or bilateral behavior abnormalities, 33cases of dysplasia (32 cases of unilateral or bilateral dysplasia and 1 case of complete occlusion) and 25cases of behavior abnormality plus dysplasia.Vertebral artery hemodynamics abnormality was found in 48 cases.Among vertebral artery abnormalities, 8 and 25 cases were respectively assessed as permanently or temporally grounding while the rest 45 were qualified.Conclusions Congenital vertebral artery abnormalities take high proportion in the flying personnel with cervical vertigo.Vertebral artery ultrasound examination would be helpful for diagnosing vertebral artery abnormalities at recruiting stage and furthermore for reducing grounding rate.It is suggested that to include vertebral artery ultrasound examination in flying cadets physical examination.     

飞行人员甲状腺疾病的特点、诊治及医学鉴定

Objective To summarize the experiences of diagnosis,treatment and medical evaluation of thyroid disease in flying personnel. Methods Sixty-seven cases of thyroid diseases,that were hospitalized from December 2000 to December 2009,were collected and analyzed.They were concluded such categories as:①asymptomatic benign thyroid nodules;②Hashimoto's disease;③diseases of abnormal thyroid functions (including hyperthyroidism and hypothyroidism);and ④thyroid cancer.Their characteristics and the relationship between different categories were analyzed correspondingly to the evaluations for flying. Results ①Among 36 cases of diagnosed asymptomatic benign thyroid nodules (53.73%),4 (3 were adenoma and 1 was nodular goiter) were surgically treated.31 Cases were evaluated as qualified for flying but should be with regular medical check-up while the other 5 were permanently grounded.②There were 5 cases of Hashimoto's disease with normal thyroid functions (7.46%).They were qualified for flying but should be with regular medical check-up.③Thyroid dysfunction took 20 cases (29.85%),among which 18 were hyperthyroidism and 2 were hypothyroidism.Drug treatment was applied.Six cases were finally qualified for flying while the other 3 and 11 were respectively assessed as temporary and permanent grounding.④Six cases were thyroid cancer (8.96%),included 4 papillary carcinoma cases and 2 follicular thyroid carcinoma cases.Only 1 case was finally qualified for flying while the others were permanently grounded.Statistical analysis showed that thyroid dysfunction diseases and thyroid cancer caused significant higher disqualification rate than benign thyroid nodules and Hashimoto's diseases (P<0.01 or P<0.05). Conclusions Benign thyroid nodules are the common thyroid diseases in flying personnel.But the diagnosis of thyroid dysfunction diseases and thyroid malignant tumors should be cared in order to win the chance of treatment and further to reduce the rate of flying disqualification.     

屈光不正的矫正与飞行

目的综述屈光不正的矫正方法及其与飞行关系的研究进展。资料来源与选择该领域的相关研究论文、研究报告与专著。资料引用国内外公开发表的论文和著作56篇。资料综合阐述屈光不正的各种矫正方法在飞行人员中应用的优缺点,着重阐述了对飞行人员进行角膜屈光手术的应用可行性。结论相对于其他矫正方法,对飞行人员进行角膜屈光手术具有较好的应用前景。目前国外民航飞行人员以准分子激光原位角膜磨镶术（1aser in situ keratomileusis,LASIK）为主,而军航飞行人员则以准分子激光角膜切削术（photorefractive keratectorny,PRK）为主;美国军航飞行人员已被允许进行飞秒激光LASIK手术,对我军飞行人员有借鉴意义。     

飞行人员合理应用抗抑郁药的研究进展

目的 对飞行人员抗抑郁药的应用研究及发展趋势进行综述. 资料来源与选择该领域的相关论文、综述、专著及技术报告. 资料引用国内外公开发表的论文22篇、综述两篇、著作3部、技术报告6份. 资料综合主要对飞行人员抗抑郁药应用的研究背景,常用抗抑郁药的分类和药理作用,抗抑郁药对飞行工作能力影响的实验评价和实际观察,关于飞行人员使用抗抑郁药的有关管理规定及修订建议4个相关问题进行介绍和讨论. 结论 合理使用抗抑郁药有利于飞行人员身心健康和飞行安全.应在临床治疗、实验评估和实际飞行观察的基础上,逐渐放宽飞行人员使用抗抑郁药的相关鉴定标准.     

飞行人员合理用药飞行安全性评价方法和指标体系

目的 回顾与分析国内外有关飞行人员合理用药飞行安全性评价的研究资料,提出相关的评价方法和指标体系.资料来源与选择 国内外相关研究论文、综述和专著.资料引用论文及综述66篇,专著6部.资料综合 基于飞行人员合理用药对飞行工作能力影响评价的研究文献作者所采用的方法和指标,对资料进行分析、综合.结论 提出了军事飞行人员合理用药飞行安全性评价的主要方法和指标体系,对制定飞行人员合理用药方案、确保飞行安全具有重要意义.     

Soft hydrophilic contact lenses in civil and military aviation.

This study was undertaken to evaluate that possible acceptability of the hydrophilic contact lenses, both in military and civil aviation. Twelve volunteers, senior pilots of both military and civilian aircraft, were accepted for the first phase of this study. Hydrophilic contact lenses were evaluated in different flights conditions, including different altitudes, pressures and humidities, as well as the effects of light and glare and the special tasks of military flight. Although the series investigated is small, the results obtained indicate that hydrophilic contact lenses may favorably replace regular spectacles worn by pilots of military or civilian aircraft.     

飞行人员疲劳问题研究进展

目的 综述国内外关于飞行人员疲劳问题的研究进展,为对该问题的进一步研究提供思路和参考.资料来源与选择国内外该领域的相关研究论文和专著.资料引用公开发表的相关文献25篇.资料综合 飞行人员疲劳直接影响飞行安全和工作效率.影响飞行安全和诱发飞行人员疲劳的因素,监测技术,以及预防和缓解疲劳的方法,是近年研究广泛关注的问题.结论 抗疲劳依然是保证飞行安全、提高工作效率的热点问题.有效措施是要解决来自工作任务、环境和飞行人员自身因素造成的综合影响问题,采用包括宣传教育、强化训练、环境调整和装备改进的综合管理措施,将是解决这一问题的有效方法.     

持续军事飞行任务时睡眠剥夺和疲劳对工作能力的影响及其综合对策

目的：分析和综述持续军事飞行任务时睡眠剥夺和疲劳对工作能力的影响及其对策。资料来源与选择：该领域的研究论文、综述、研究报告和论著。资料引用：论文、综述和研究报告41篇，专著3本。资料综合：分析持续军事飞行任务时睡眠与工作负荷的基本特点，简介持续军事飞行任务时睡眠剥夺和疲劳对工作能力的影响及其对策。结论：持续军事飞行任务时睡眠剥夺和疲劳在所难免。综合性对抗措施中强调工作安排和睡眠管理，必要时合理使用中枢兴奋和抑制药物。     

俄罗斯航空医学发展概况

目的 介绍俄国航空医学发展概况。资料来源与选择 俄罗斯公开发表的论文及综述。资料引用 引用了文献12篇。资科综合 从航空医学经验的总结和理论发展，飞行人员卫生保障的科学同题，高机动飞行的卫生保障，高空飞行安全的卫生保障等4个方面作了介绍。     

Optical correction and quality of vision of the French soldiers stationed in the Republic of Djibouti in 2009

To ensure vision readiness on the battlefield, the French military has been providing its soldiers with eyewear since World War I. A military refractive surgery program was initiated in 2008. A prospective questionnaire-based investigation on optical correction and quality of vision among active duty members with visual deficiencies stationed in Djibouti, Africa, was conducted in 2009. It revealed that 59.3% of the soldiers were wearing spectacles, 21.2% were wearing contact lenses--despite official recommendations--and 8.5% had undergone refractive surgery. Satisfaction rates were high with refractive surgery and contact lenses; 33.6% of eyeglass wearers were planning to have surgery. Eye dryness and night vision disturbances were the most reported symptoms following surgery. Military optical devices were under-prescribed before deployment. This suggests that additional and more effective studies on the use of military optical devices should be performed and policy supporting refractive surgery in military populations should be strengthened.