Objective:To analyze the results of low-dose lung CT screening for military flying personnel, and to explore its influence on aeromedical identification.Methods:The imaging and aeromedical identification data of military flying personnel who underwent annual physical examination in Air Force Healthcare Center for Special Services Hangzhou were analyzed retrospectively. According to the imaging manifestations, the enrolled low-dose lung CT results were divided into the following 6 categories: no obvious abnormality, old lesions, pulmonary nodules, pulmonary bullae, pulmonary inflammatory lesions and extrapulmonary diseases. The detection rates of various examination results were statistically analyzed. The military flying personnel were divided into 20-29 years group, 30-39 years group, 40-49 years group and 50-59 years group, and they were divided into fighter pilots, bomb-trans-helicopter pilots, and bomb-trans-helicopter crew members according to the post. The differences in various examination results of flying personnel were compared among different age groups and post groups. The influence of examination results on the aeromedical identification results was analyzed in accordance with the 3-level conclusions as not affecting the conclusion of aeromedical identification, leading to the decline of health grade and leading to temporary grounding. The overall significance level α=0.05, and the pairwise comparison with P< α/statistical times was statistically significant. Results:A total of 2 274 flying personnel was enrolled. The detection rates of various examination results from high to low was no obvious abnormality (45.82%), old lesions (37.55%), pulmonary nodules (14.86%), pulmonary bullae (6.73%), pulmonary inflammatory lesions (2.59%) and extrapulmonary diseases (1.85%). There was significant difference among examination results of different age groups ( χ2=183.43, P<0.001). The detection rate of no obvious abnormality was the highest in 20-29 years group and 30-39 years group; the detection rate of old lesions was the highest in 40-49 years group and 50-59 years group. The detection rate of no obvious abnormality decreased with age, and the detection rate of old lesions increased with age (both P< α/6=0.008). The detection rate of pulmonary nodules in 40-49 years group was higher than that in 30-39 years group; the detection rate of pulmonary bullae in 50-59 years group was higher than that in the other age groups; the detection rates of pulmonary inflammatory lesions in 40-49 years group and 50-59 years groups were higher than those in the other age groups; the detection rate of extrapulmonary diseases in 50-59 years group was higher than that in 20-29 years group, and the differences were statistically significant (all P<0.008). There was significant difference in the results of flying personnel among different post groups ( χ2=33.78, P=0.001). The detection rate of no obvious abnormality in bomb-trans-helicopter crew members group was lower than that in bomb-trans-helicopter pilots group and fighter-trainer pilots group, but the detection rates of old lesions and pulmonary nodules were higher than those in the other groups, the differences were statistically significant (all P< α/3=0.017). The detection rate of pulmonary bullae in fighter-trainer pilots group was lower than that in bomb-trans-helicopter crew members group, and the difference was statistically significant ( P<0.017). Although majority of the detected results had no effect on the results of aeromedical identification, there was a significant difference in the proportion of health grade decline and temporary grounding caused by different detected diseases (Fisher exact test value was 82.81, P<0.001). Conclusions:Low-dose lung CT screening plays an important role in the physical examination and aeromedical identification for military flying personnel. It can be routinely used during the annual physical examination for flying personnel, and the aeromedical identification standards and strategies for lung related diseases should be updated synchronously.

1例运输机飞行员年度空勤疗养体检，头颅MRI检查示右侧侧脑室三角区见囊状异常信号影，T1加权像呈低信号、T2加权像呈高信号、液体衰减反转恢复序列呈稍高信号、扩散受限、扩散系数值低，大小约1.2 cm×0.8 cm，边界清楚，所在脑室三角区未见明显扩张。MRI增强扫描，病灶并无强化；脑电图检查结果提示：排除癫痫的可能性。诊断为右侧侧脑室三角区脉络丛黄色肉芽肿。航空医学鉴定结论：飞行合格，健康等级：乙类。

1例直升机飞行员年度空勤疗养体检颈椎MRI检查，舌根部软组织信号肿块影；甲状腺超声检查，双侧颈部甲状腺区未见明显甲状腺样回声。送空军特色医学中心行进一步检查，甲状腺核素显像示：口咽部放射性浓聚灶，正常甲状腺区未见放射性浓聚；电子鼻咽喉镜检查示：舌根、会厌上方半球形肿物，大小约3.0 cm×2.5 cm，表面血供丰富，局部可见白色伪膜，随吞咽及舌体活动度可，会厌光滑、抬举好；头颈侧位X线检查并气道测量示：舌根后部软组织肿块，后方气道变窄约0.2 cm；睡眠呼吸监测：轻度睡眠呼吸暂停；甲状腺功能7项中促甲状腺激素15.6 mlU/L，甲状腺激素水平正常（游离甲状腺素13.9 pmol/L，游离三碘甲状腺原氨酸5.2 pmol/L，甲状腺素75.5 nmol/L，三碘甲状腺原氨酸 1.6 nmol/L）。诊断为舌根部异位甲状腺、亚临床甲状腺功能减退。航空医学鉴定结论：飞行合格，健康等级：乙类。

Objective:To explore the influential factors of lumbar inter-vertebral disc degeneration and provide the references on flying personnel′s recruitment, physical checkup for transformation and medical identification.Methods:Lumbar MRI images and relevant data of 458 flying personnel who underwent medical identification in the Second Area of Air Force Healthcare Center for Special Services Hangzhou from March 2018 to May 2019 were retrospectively analyzed. Two thousand two hundred and ninety lumbar inter-vertebral discs of 458 flying personnel were semi quantitatively scored according to the Pfirrmann standard. The sum of five inter-vertebral disc scores of each flying personnel was taken as the lumbar inter-vertebral disc degenerative factor (LIVDDF). This factor was taken as the dependent variable ( y), and the age ( x1), height ( x2), weight ( x3), and flying hours ( x4) of flying personnel were taken as independent variables for linear regression analysis. The subgroup analysis was carried out based on the grouping of aircraft type and flight post. Results:The range of LIVDDF was 5-18, with an average of 10.87±2.83. Total analysis showed that age and weight were the influential factors of lumbar inter-vertebral disc degeneration in flying personnel. The regression equation was y=1.029+0.182 x1+0.038 x3 ( r=0.68, P<0.01). Subgroup analysis on the different aircraft types showed that the influential factor was age in the fighter subgroup. The regression equation was y=2.569+0.225 x1 ( r=0.59, P<0.01). Age and height were the influential factors in the trans-bomber aircraft subgroup. The regression equation was y=-8.848+0.186 x1+7.160 x2( r=0.69, P<0.01). Flying hours was the influential factor in the helicopter subgroup. The regression equation was y=7.823+0.001 x4 ( r=0.65, P<0.01). Subgroup analysis on different flight post showed that the influential factors were age in flying personnel. The regression equation was y=3.176+0.207 x1 ( r=0.65, P<0.01). Age and weight were the influential factors in crew members. The regression equation was y=-0.113+0.171 x1+0.056 x3( r=0.74, P<0.01). Conclusions:Age and weight are the main influential factors of lumbar inter-vertebral disc degeneration in flying personnel, but these factors show different influence on aircraft type and flight post. Due to the small sample size in this study, aviation related factors are not fully included. So other influential factors of lumbar inter-vertebral disc degeneration of flying personnel may exist.

战斗力构成三要素为人、装备、人装合一,其中人是最重要的要素.对航空兵部队而言,因军事飞行这一特殊作业对飞行人员生理健康、心理健康的高标准,以及对高空缺氧、飞行错觉、加速度耐力不良等航空医学能力的高要求,军事飞行人员的身心素质对航空兵部队战斗力的重要性尤为突出[1].本研究旨在提出军事飞行人员强健促进的概想,并论证建立一个涵盖医学健康、航空医学能力和职业环境健康3个部分的军事飞行人员强健促进系统模型,以规范和标准军事飞行人员健康保护和能力促进的医学行为,为打造一支强健的军事飞行人员队伍提供技术支撑.

目的 通过探讨1例飞行员Dandy-Walker综合征的医学鉴定,提高航空医学实践中对Dandy-Walker综合征的认识,为招飞、改装体检及医学鉴定标准的更新提供依据.方法 分析1例战斗机飞行员变异型Dandy-Walker综合征的诊断过程;通过相关文献回顾,总结Dandy-Walker综合征的病理生理、临床表现特点及诊断、评估要点,并由此对该飞行员进行针对性系统评估;最终依据系统评估结果做出航空医学鉴定.结果 该例飞行员41岁,男,无症状,入院M R I颅脑血管筛查诊断为变异型Dandy-Walker综合征,经运动、神经、精神等系统检查,发育、认知、体能等全面评估,医学鉴定为飞行合格(限双座机).结论 虽然Dandy-Walker综合征在军事飞行员中罕见,但其潜在症状对飞行员职业生涯影响巨大;因此,需要将相关检查方法规范化应用于飞行员招募、改装体检及医学鉴定等环节.