飛行員顱腦疾病譜分析以及處置措施的研究

1、1. 飛行員顱腦疾病譜分析以及處置措施的研究李松林,邱傳亞*,萬剛,李謙,王辰龍,張勇,楊劍,高敏,徐占明,薛彩霞,秦軍,張忠棟 民航醫(yī)學(xué)中心-民航總醫(yī)院【摘要】目的 了解國外民用航空飛行員的腦部健康情況，建立顱腦疾病發(fā)病譜，為保障民航飛行安全決策提供可靠的醫(yī)學(xué)數(shù)據(jù)依據(jù)。對(duì)象及方法 對(duì)民航現(xiàn)役 3950 例飛行員進(jìn)行顱腦MRI/MRA 掃描，分析其顱腦實(shí)質(zhì)及血管疾病分布情況。結(jié)果 3950 例飛行員中，共有 53 例飛行員具有

2、不符合《民用航空人員體檢合格證管理規(guī)則》（CCAR-67-R2）規(guī)定的顱腦疾患，其中 24例進(jìn)行了特許飛行許可申請(qǐng)，19 例予以特許合格，5 例予特許不合格。顱腦疾病譜涵蓋以下四大類疾?。猴B腦血管性病變 30 例；腦實(shí)質(zhì)非腫瘤性病變 7 例；腦實(shí)質(zhì)腫瘤病變 3 例； 顱內(nèi)腦外腫瘤或占位性病變 13 例。結(jié)論 磁共振檢查能夠檢出飛行員顱腦疾患分布，為民航飛行風(fēng)險(xiǎn)管控提供決策依據(jù)。關(guān)鍵詞：飛行員； 飛行失能； 磁共振成像； 磁共振

3、血管成像 [Abstract] Objective To determine the brain’s health status of foreign civil aviators, to establish the disease spectrum of brain, and to provide medical data for the safety determination of civil flying. Material

4、s Materials and and Methods Methods We scanned the brains of 3950 in-service aviators by MRI/MRA, and analyzed the brain parenchyma and cerebrovascular distribution. [Results]: Among the range of 3950 in-ser

5、vice pilots, 53 of them had brain diseases which were not included in the disease spectrum in the ‘civil aviators’ health check-up regulations’ (CCAR-67-R2). 24 cases applied for the special permission

6、 of aviation license. 19 cases succeeded, and 5 cases failed. The brain disease spectrum was comprised of the four types: 30 cases of cerebrovascular disease, 7 cases of brain parenchyma non-tumor

7、change, 3 cases of brain parenchyma tumor lesion, and 13 cases of intracranial non-original tumors or occupying lesions. [Conclusions]: Magnetic resonance imaging examination revealed the brain disease spectrum in pilots

8、, thus offering data to decision-making in risk management of civil flying.Key words: aviator; flying incompetence; MRI; MRA共振風(fēng)險(xiǎn)評(píng)估專家小組”。評(píng)估小組成員由磁共振影像、神經(jīng)內(nèi)外科學(xué)、航空醫(yī)學(xué)體檢鑒定等多學(xué)科專家組成。評(píng)估小組對(duì)磁共振診斷異常飛行員進(jìn)一步做出臨床、航空飛行安全綜合評(píng)估。The president

9、 of civil aviation medical center established “pilot cerebral magnetic resonance imaging group ” and “flight security and MRI risks evaluation expert group” with experts from MRI、neurology、 neurosurgeon 、aviation physica

10、l examination and identification. They will conduct further comprehensive assessment including clinical and flight safety. 2).民航醫(yī)學(xué)中心-航衛(wèi)辦統(tǒng)一協(xié)調(diào)、安排各航空公司飛行員具體檢查時(shí)間。civil aviation medical center---aviation sanitation office car

11、ried the responsibility of coordinate the exact date and arrangements of pilots from different airline companies.3).民航醫(yī)學(xué)中心-磁共振室具體負(fù)責(zé)磁共振掃描、圖像處理、初步影像學(xué)臨床診斷。civil aviation medical center---MRI center took the responsibility o

12、f scanning、 data processing and primary imaging diagnosis.4).對(duì)于評(píng)估不合格飛行員，由其個(gè)人申請(qǐng)，提交“民航醫(yī)學(xué)專家委員會(huì)”討論，做出最終評(píng)估。The pilot who Denied Accreditation will individually filled a petition to “flight security and MRI risks evaluation ex

13、pert group”for final assessment.2. 研究對(duì)象：民航系統(tǒng)現(xiàn)役飛行員 3950 人，全部受檢者均為男性，年齡 31-60 歲，平均年齡 49.55±3.91 歲，其中中國籍飛行員 3323 例、外籍飛行員 627 例。Research objects: in-service pilots 3950,all male, age between 31-60, average 49.55±3.

14、91, chinese 3323, foreigner 627.3. 檢查方法：采用 GE 公司 1.5T HDX 型磁共振儀，利用 8NVheand 線圈對(duì) 3950 位機(jī)長進(jìn)行顱腦 MRI 及 MRA 圖像采集。MRI 主要檢查序列為：軸位：FSE/T1WI、FLAIR/T2WI、DWI、GR/T2*WI、FSE/T1WI 及矢狀位:FLAIR/T1WI；MRA 掃描采用三維時(shí)間飛躍法（3D-time of flight,3D-TO

15、F）MR 血管成像技術(shù)，利用磁傳遞技術(shù)（Magnetization Transfer，MT）、流動(dòng)補(bǔ)償（Flow Compensation ,FC）、動(dòng)態(tài)擴(kuò)展(extend dynamic range,EDR)、并行采集(Asset),進(jìn)行 MRA 采集。具體 MRI 及 MRA 技術(shù)參數(shù)見表 1：Research methods: GE company 1.5T HDX MRI performed the acquisitions

16、of MRI AND MRA via 8NVheand coil. The examination sequences referred as follows: axial: FSE/T1WI、FLAIR/T2WI、DWI、GR/T2*WI、FSE/T1WI; sagittal: FLAIR/T1WI; MRA: 3D-time of flight,3D-TOF、Magnetization Transfer，MT、Flow