目的 探讨冠心病军事飞行人员在支架植入术后的二级预防用药现状,特许飞行的鉴定及评估程序.方法 回顾性分析支架植入术后的16例军事飞行人员术后二级预防用药,出院后用药依从性以及随访和复查的结果,包括病史、一般情况和相关检查(平板运动试验、心肌核素扫描、冠状动脉CT、冠状动脉造影),探讨冠状动脉支架术后军事飞行人员特许飞行的程序和标准.结果 16例飞行人员,诊断无症状心肌缺血6例,急性心肌梗死5例,不稳定性心绞痛5例.其中9例经6~20个月地面随访,综合评估鉴定为飞行合格,7例结论为飞行暂不合格.9例飞行合格飞行人员中,心脏超声射血分数均正常,无室壁运动异常;2例平板运动试验阳性,其中1例复查冠状动脉CT无异常,1例冠状动脉CT示病变较前略发展.7例平板阴性的飞行人员中,其中3例复查冠状动脉CT,2例病变较前狭窄程度略发展.9例均复查造影,支架通畅,无异常.7例飞行人员,1例出现术后再狭窄,2例非侵入性检查提示存在心肌缺血,3例支架术后仍有其余部位冠状动脉病变,1例冠状动脉造影证实冠状动脉病变进展,再次植入支架.16例飞行人员在支架植入后均规律服用抗血小板、他汀类药物,用药依从性良好,无不适.结论 低性能飞机的飞行人员在支架植入后经平板运动试验、心肌核素扫描、冠状动脉CT、冠状动脉造影等检查后,综合评定无客观心肌缺血证据的,综合评估支架术后二级预防药物使用的合理性,可以特许飞行.非侵入性检查对冠状动脉血管评估存在较大误差,建议飞行人员在首次特许飞行时,完善冠状动脉造影检查.%Objective To study the medication for secondary prevention after percuteneous coronary artery stents in military aircrews with coronary heart disease (CHD), and principles and methods of aero-medical assessment.Methods Sixteen aircrews were selected as subjects. The types of medicine for secondary prevention, medication compliance,and results of testing including treadmill exercise test, myocardial perfusion imaging, computed tomography coronary angiography and coronary angiography in these aircrews were restrospectively analyzed. These aviators were followed up to establish the principles of aero-medical assessment.Results Among the sixteen aircrews, there were six cases of latent coronary heart disease, five cases of acute myocardial infarction and five cases with unstable angina. They were all treated with percuteneous coronary artery stents. After 6 to 20 months of follow-up, nine cases were permitted to resume flight. Their ventricular wall motion and systolic function were normal. Among them, there were two cases whose treadmill exercise test was positive, and one of them was diagnosed with lesion stenosis in computed tomography coronary angiography. The treadmill exercise test of seven cases was negative. Three of them received computed tomography coronary angiography, two of whom were diagnosed with lesion stenosis. All of them were normal with coronary angiography. The remaining seven aviators did not meet the criteria for waiver consideration, including one case with instent restenosis, two with noninvasive testing evidence of reversible ischemia, three with lesions stenosis, and one case who was treated percuteneous coronary artery stents a second time. After stent implantation, they were regularly treated with statins and antiplatelets, and all of them had good compliance.Conclusion After evaluation of medication for secondary prevention and invasive and noninvasive test which show good cardiovascular function, military aviators can return to flight with revascularization by stents. Military aviators for initial waiver consideration will complete noninvasive testing and follow-up coronary angiography.
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