Butler William P, Steinkraus Lawrence W, Burlingame Esther E, Smith Danny E, Fouts Brittany L, Serres Jennifer L, Burch David S
Air Force School of Aerospace Medicine, 2510 5th Street, Building 840, Wright-Patterson AFB, OH 45433.
Division of Preventive, Occupational, and Aerospace Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.
Mil Med. 2018 Mar 1;183(suppl_1):193-202. doi: 10.1093/milmed/usx171.
Combat medical care relies on aeromedical evacuation (AE). Vital to AE is the validating flight surgeon (VFS) who warrants a patient is "fit to fly." To do this, the VFS considers clinical characteristics and inflight physiological stressors, often prescribing specific interventions such as a cabin altitude restriction (CAR). Unfortunately, limited information is available regarding the clinical consequences of a CAR. Consequently, a dual case-control study (CAR patients versus non-CAR patients and non-CAR patients flown with a CAR versus non-CAR patients) was executed. Data on 1,114 patients were obtained from TRANSCOM Regulating and Command and Control Evacuation System and Landstuhl Regional Medical Center trauma database (January 2007 to February 2008). Demographic and clinical factors essentially showed no difference between groups; however, CAR patients appeared more severely injured than non-CAR patients. Despite being sicker, CAR patients had similar clinical outcomes when compared with non-CAR patients. In contrast, despite an equivocal severity picture, the non-CAR patients flown with a CAR had superior clinical outcomes when compared with non-CAR patients. It appeared that the CAR prescription normalized severely injured to moderately injured and brought moderately injured into a less morbid state. These results suggest that CAR should be seriously considered when evacuating seriously ill/injured patients.
战斗医疗依赖于空中医疗后送（AE）。对空中医疗后送至关重要的是认证飞行外科医生（VFS），其负责确保患者“适合飞行”。为此，认证飞行外科医生会考虑临床特征和飞行中的生理应激因素，通常会开出特定的干预措施，如机舱高度限制（CAR）。不幸的是，关于机舱高度限制的临床后果的信息有限。因此，开展了一项双病例对照研究（接受机舱高度限制的患者与未接受机舱高度限制的患者，以及未接受机舱高度限制但飞行时采用了机舱高度限制的患者与未接受机舱高度限制的患者）。从运输司令部调控与指挥控制后送系统以及兰施图尔地区医疗中心创伤数据库（2007年1月至2008年2月）获取了1114名患者的数据。人口统计学和临床因素在各组之间基本没有差异；然而，接受机舱高度限制的患者似乎比未接受机舱高度限制的患者伤势更严重。尽管病情更重，但与未接受机舱高度限制的患者相比，接受机舱高度限制的患者临床结局相似。相比之下，尽管严重程度情况不明确，但飞行时采用了机舱高度限制的未接受机舱高度限制的患者与未接受机舱高度限制的患者相比，临床结局更好。似乎机舱高度限制的处方将重伤患者调整为中度受伤，并使中度受伤患者处于病情较轻的状态。这些结果表明，在撤离重病/重伤患者时应认真考虑采用机舱高度限制。
