- 期刊
肥厚性心肌症：航空醫學之考量與現行航醫教範之探討
Hypertrophic cardiomyopathy: aeromedical consideration and waiver guideline
摘要
空勤體檢時，部分人員的心電圖報告會顯示有心臟肥大。大部分為生理性的心臟肥大，然而必須排除掉病理性的心臟肥大，例如肥厚性心肌症。肥厚性心肌症是一種並不少見的遺傳性心臟病，它的表現相當多樣性，包括胸痛、心臟衰竭、心律不整、及猝死。此病雖可透過藥物、手術，或酒精燒灼等改善症狀，但其多變性、不可預測性，及症狀一旦在飛行時發生，造成的失能或死亡的風險仍是無法被接受的。如何鑑別生理性或病理性的心臟肥大以避免停飛掉不需停飛的人員是航醫的一大課題。現行美軍規定一旦確診HCM即判定不合格；美國民航局則是有限制的給予第三類飛行許可。相較於我國現行航醫教範規定：心臟肥厚人員若運動心電圖正常則可予以不計，此規定是否過於寬鬆，值得探討。
並列摘要
Hypertrophic cardiomyopathy (HCM) is not an uncommon genetic heart disease, and the consequence of this disease is quite diverse, including chest pain, heart failure, arrhythmias, and sudden death. Although treatment such as drug therapy, septal myectomy, alcohol septal ablation could alleviate symptoms, there may still exist a risk of fatal or sudden incapacitation once occur in flight. The electrocardiogram of HCM may be similar to benign cardiac hypertrophy. How to differentiate between physiological or pathological HCM in order to avoid grounding the aircrew who should not be grounded is a major issue in aviation medicine. In current US air force regulation, medical certification is not permitted once the military pilot is diagnosed of HCM. The pilots of commercial transport airline could be referred to the FAA for third- or limited second-class special issuance consideration. Compared to US, the military pilot with cardiac hypertrophy is qualified once treadmil-excise testing is normal in Taiwan. The current regulation might need further adjustment after thorough discussion over the issue.