摘要
目的探讨军事飞行员视神经炎的临床诊治及航空医学鉴定原则。方法回顾分析2003年1月-2018年12月空军特色医学中心诊疗的13例视神经炎军事飞行员的临床资料,并复习相关文献。结果13例飞行员中特发性视神经炎(idiopathic demyelinating optic neuritis,IDON)11例(84.62%),其他多发性硬化(multiple sclerosis,MS)1例、视神经脊髓炎(neuromyelitis optica,NMO)1例。全部病例中3例(23.08%)在疾病早期给予足量规范糖皮质激素冲击治疗,治疗末期最佳矫正视力为1.00±0.20、视野平均偏差(mean deviation,MD)值(-1.34±1.02)db,模式标准偏差(pattern standard deviation,PSD)值(1.55±0.65)db,飞行合格复飞2例(15.38%),全身治疗未结束眼科结论飞行合格1例(7.69%);另10例(76.92%)早期治疗不规范,治疗末期平均最佳矫正视力0.40±0.16,平均视野MD值(-12.45±7.23)db,平均PSD值(13.21±2.61)db,视功能永久受损,飞行鉴定结论不合格致停飞。结论军事飞行员视神经炎应早期诊断并及时规范治疗,医学鉴定中可根据病情轻重、是否合并MS/NMO、治疗后视力及视野的MD和PSD值恢复情况综合判定。
Objective To investigate the clinical diagnosis,treatment and aviation medical evaluation principles of optic neuritis(ON)in military pilots.Methods Clinical data and aviation medical evaluation results of 13 pilots with ON admitted to Air Force Medical Center from January 2003 to December 2018 were analyzed and related literatures were reviewed.Results Of the 13 cases,there were 10 cases(84.62%)of idiopathic demyelinating optic neuritis(IDON),1 case of multiple sclerosis(MS),1 case of neuromyelitis optica(NMO).Three cases(23.08%)received high-dose intravenous methylprednisolone sodium succinate(shock therapy)treatment,their mean best vision acuity was 1.0±0.2,vision field was(mean deviation[MD])1.34±1.02 db,and pattern standard deviation(PSD)was 1.55±0.65 db;Two of them were given flying qualification,one case was given flying qualification for ophthalmology but needed treatment of other diseases.The other 10 pilots(76.92%)who did not receive shock therapy timely,had poorer vision acuity(mean 0.4±0.16)and severer vision field damage(MD:-12.45±7.23 db;PSD:13.21±2.61 db),and were given flying disqualification.Conclusion Patients with ON should be diagnosed correctly and timely and receive high-dose methylprednisolone treatment early.Evaluation should be individually decided according to the severity,vision acuity,MD and PSD of vision field,complications,as well as the related standards.
作者
赵燕燕
杨庆红
陈威
王华
刘勇
姜彩辉
ZHAO Yanyan;YANG Qinghong;CHEN Wei;WANG Hua;LIU Yong;JIANG Caihui(Department of Ophthalmology,Air Force Medical Center,PLA,Beijing 100142,China)
出处
《解放军医学院学报》
CAS
2020年第7期670-674,共5页
Academic Journal of Chinese PLA Medical School
基金
全军“十三五”后勤科技重大课题资助项目(AKJ15J003)
