【作者】 马进；

【导师】 张作明； 胡文东；

【作者基本信息】 第四军医大学 ， 航空航天与航海医学， 2008， 博士

【摘要】 长时间、不规律、夜航及其跨时区飞行等因素使飞行人员生物节律发生改变、睡眠不足,易于发生疲劳,严重影响工作能力,从而存在引发飞行安全的隐患,因此飞行脑力疲劳的预防和监控仍是当前航空航天医学研究的重要课题之一。飞行脑力疲劳是一个多维的构建,目前尚无统一的标准去测量。多种因素均可以引起脑力疲劳,其表现往往与诱发因素有关,常用的脑力疲劳研究模型包括睡眠剥夺、缺氧、饮酒等。上述研究模型中都存在自主神经功能的变化,因此自主神经功能变化是一个比较共性的指标。对操作者的认知活动进行生理测量是一个实时、客观的方式,生理测量的优势在于能在从低脑力负荷到脑力超负荷的较宽范围内提供敏感性较高的总体评价。本研究针对飞行员疲劳后的主要表现、飞行员职业的特殊要求等实际情况,挑选了相应的生理测验指标,要求对飞行疲劳的反应灵敏、测验时间短,准确度高,客观,无创,操作简单。我国在飞行脑力疲劳评价方面的研究起步较晚,经验较少,缺乏实际资料。本课题研究旨在通过饮酒方式对健康青年进行自主神经生理指标测试和认知功能检测,探讨飞行人员脑力疲劳的生理心理指标变化规律,了解其心率变异性、瞳孔孔径、立体视觉、眼底血管直径、视频眼震电图检查、隐斜、认知能力等指标的变化规律,重点是瞳孔孔径和心率变异性的相应变化曲线,对操作人员进行客观、科学、准确、系统的评价,进一步探讨飞行员生理状态适应性选拔标准,从而通过对飞行人员采用生理心理指标的变化来客观判断飞行员的身体及心理状况,以达到保障飞行安全,预防飞行事发生的目的。为探讨飞行员实际飞行过程中的脑力负荷水平的变化,本研究主要从生理测量方面对飞行员飞行前的实际情况进行了评定。通过视频眼震电图仪、瞳孔测量仪、免散瞳眼底照相仪、同视机等生理检测设备,采集记录了健康青年饮酒前后的多种生理参数的变化,同时采用三项认知能力测验进行心理学测试,分别是空间旋转测验（SCT）、数字、光点数相加测验（NPPPT）和速度估计测验（SET）,以正确率和反应时间作为测试指标,分析了不同条件下健康青年生理心理各项评价指标的变化规律和脑力负荷水平的变化。生理指标主要测验项目名称及主要指标如下:（1）心率变异性（HRV）:包括立位和平卧位两种姿势,时域指标包括Mean NN（NN间期平均值）、SDNN（NN间期的标准差）;频域指标包括LF（低频成分）、HF（高频成分）、TF（总频谱）和LF/HF（低频和高频之比）;（2）瞳孔孔径（PPD）:包括瞳孔灰度直方图和瞳孔面积;（3）视频眼震图（VNG）:包括OPTOKINETIC TESTS的左像和右像、TRACKING TESTS、SACCADE TESTS的速度和潜伏期;（4）同视机（CC）:包括立体视觉（分为双眼的鼻侧、中间部分和颞侧）、隐斜测试（分为垂直隐斜和水平隐斜两种）、双眼红绿、黄蓝色觉检查结果;（5）免散瞳眼底照相仪（FC）:包括眼底颞上动、静脉直径检查结果。心理测验的项目名称及主要目的如下:（1）空间旋转测验（SCT）:检测空间认知、判断以及推理能力;（2）数字、光点数相加测验（NPPPT）:检测短时记忆能力、计算能力以及注意的分配与选择能力;（3）速度估计测验（SET）:检测对距离的空间知觉以及作为驾驶人员的预判能力。主要结果如下:1、在生理测验中,其中HRV的平卧位的HF、LF、TF三项结果、瞳孔面积、颞上静脉直径、垂直隐斜结果、左眼黄蓝色觉结果在饮酒前后呈现显著性变化,而其余的结果无明显差异;2、以瞳孔直径作为因变量Y,以HRV的时域指标SDNN和频域指标LF/HF作为自变量,得出的线性回归方程为:Y=215.198-0.217X₁+0.177X₂,其中X₁为LF/HF（r=-0.143,p< 0.05）,X₂为SDNN（r=0.816,p< 0.01）。3、心理测验与生理检测结果指标间线性回归方程为:Y=2.688+1.19X₁+0.028X₂-27.83X₃+22.68X₄,其中:Y为心理测验结果,X₁为垂直隐斜（r = 0.810, p < 0.01）,X₂为立位LF（r = 0.341, p < 0.05）,X₃为左眼黄蓝色觉（r = - 0.535, p < 0.05）,X₄为瞳孔孔径（r =0.632,p < 0.05）。脑力疲劳生理心理指标评定的研究结论:1、生理指标测试能客观地反映疲劳前后生理功能的变化,通过相应的软件分析和数据技术处理,能够敏感地评定飞行人员脑力疲劳的状态;2、3项心理学测验在饮酒前后,反应时以及正确率存在着显著差异,表明酒精所造成的脑力疲劳很大程度上存在着认知能力方面的变化;3、部分生理心理指标存在明显的相关性,回归成相应方程,说明指标间能够共同反映脑力疲劳,只是权重不同,瞳孔孔径、心率变异性和垂直隐斜均能一定程度上评定生理心理状态;4、生理指标的实验室研究指标能否评定飞行员实际工作中的工作绩效和脑力负荷还有待进一步探讨,但是自主神经生理指标评定脑力疲劳是最新的研究方向之一,与认知能力相结合,准确度能够大大提高,也能够解决实际飞行任务对脑力疲劳测量客观化、快速化和无创化的需要;总之,本研究说明,脑力疲劳的评定不能用单一的指标进行,应选用多层次、多角度多项指标同时进行评定。由于条件限制,本研究仅涉及脑力疲劳的自主神经生理信号检测和认知注意特征。本研究的方法和指标的实用性和可靠性有待进一步验证和完善。更多还原

【Abstract】 It is one of the most important issues to monitor and prevent flight fatigue in the field of aerospace medicine. Fatigue, lack of sleep, and circadian disruption caused by long-haul, irregular, night and crossing time zone flight operations can degrade performance, alertness and safety. The aim of this study is to find the changing regulation of aircrew’s physiological indexes such as HRV、pupil pore diameter、stereoscopic vision、blood vessel diameter of eye ground、video-nystanography、heterophoria and cognitive ability with a focus on pupil aperture and heart rate variability of the corresponding curves of the operators to conduct an objective, scientific, accurate, systematic evaluation, and further study adaptive physiological state pilot selection criteria. By means of dynamic monitoring of the aircrew’s physiological status, their psycho physiological conditions can be found, which will ensure flight safety and prevent accident.It is general agreement that in-flight mental workload is a multidimensional construct, and there is no uniform standard to measure at present. Many factors can cause mental fatigue, and its performance is often induced by factors related to the commonly used model of mental fatigue, including sleep deprivation, lack of oxygen, drinking et al. The indexes of autonomic nervous system are relatively common indicators. Psycho physiological measurements are of particular importance in the flight environment since they offer a non-intrusive method to collect objective data about the mental workload of pilots and other crew members. We select some corresponding test items based on airplane pilots’mostly behavior after their fatigue, their professional request and their practical circs. These tests must be sensitive to flight fatigue short time cost and with good reliability, validity and distinction, small studying effect, brief maneuverability. Research on mental fatigue in our country is just underway, most of which was experimental or flight simulator study, but little real flight assessments reported.In order to evaluated in-flight mental fatigue of pilots of various kinds of flight course and flight phase, in the present study psycho physiological measures were obtained. We collect to record the changes of multi-physiological parameters in the condition of drinking alcohol by NVG、ETC、FC、CC etc equipment of physical detection. At the same time,we also have three psych tests involving spatial circumgyrate test （SCT）、numeral plus photic point test（NPPPT） and speed estimates test （SET）,which is as the accuracy and response time as the test indexes. There is an exact correspondence between psycho physiological indexes and mental workload.The names and indexes of physiological tests were as follows:（1） Heart Rate Variability （HRV）: including two postures as erect position and prostration position. The indexes of time domain contains Mean NN and SDNN while indexes of frequency domain contains LF、HF、TF and LF/HF.（2） Pupil Pore Diameter （PPD）: including pupil gray scale histogram and pupil area.（3） Video-Nystanography （VNG）: including leftward and rightward of OPTOKINETIC TESTS、TRACKING TESTS、velocity and latency of SACCADE TESTS.（4） Clement Clarke （CC）: including stereoscopic vision of binocular nasal side、temple side and intermedius side,vertical and horizontal heterophoria and binocular chromatometry.（5） Fundus Camera （FC）: including diameter of artery and vein in eye ground.The names and main purposes were as follows:（1）The Spatial Circumgyrate Test （SCT）: To examine the ability of space cognition, judgment and inference.（2）The Numeral Plus Photic Point Test （NPPPT）: To examine the ability of short–term memory, calculation ability and attention distribution and choices.（3）The Speed Estimates Test （SET）: To examine space cognition ability of distance and prejudgment of pilot.The main results were as follows:（1） Among physiological tests, the results from these tests involving HF、LF、TF、pupil area、diameter of superior temporal vein、vertical heterophoria and left eye chromatometry have shown that under the different condition, these indexes are significantly different. However, other results are not highly satisfactory.（2） The linear regression equation between pupil diameter as dependent variable Y and SDNN、LF/HF as independent variable was: Y=215.198-0.217X₁+0.177X₂, LF/HF as X₁, which the coefficient of correlation was -0.143 （p< 0.05）, SDNN as X₂,which the coefficient of correlation was 0.816 （p< 0.01）.（3） The linear regression equation between dependent variable Y and independent variable X was: Y=2.688+1.19X₁+0.00028X₂-27.83X₃+22.68X₄ vertical heterophoria as X₁ and the coefficient of correlation was 0.810 （p<0.01）, LF of erect position as X2 and the coefficient of correlation was 0.341 （p<0.05）, left eye chromatometry as X3 and the coefficient of correlation was -0.535（p<0.05）, pupil diameter as X4 and the coefficient of correlation was 0.632（p<0.05）.The research conclusion of psycho physiological indexes to assessment on mental fatigue:1. There are obviously expressed that these physical tests are sensitive to the special ability request of mental fatigue. These tests can evaluate pilots’mental status sensitively by the corresponding software analyses and technique disposal.2. The reaction time and right rate of 3 psychological tests are significantly different under the condition of mental fatigue,which indicates that alcohol can cause the changes of cognitive ability on mental fatigue.3. Some psycho physiological indexes are significantly correlative and can regress the corresponding equations, which indicates that these indexes can reflect mental fatigue,but different power, the pupil aperture, the heart rate changeability and vertical heterophoria can evaluate the physiological psychology to a certain extent.4 .Whether the laboratory research physiological indexes could evaluate the work achievements and mental ability workload of pilot remains to be further probed, but the autonomic nervous physiological indexes evaluate the mental fatigue is one of latest research directions, with the cognition ability union, the accuracy is able to be improved greatly and the measure of the mental fatigue which caused by actual flight mission can be objectively, rapidly and atraumatically.In brief, this research shows that mental fatigue should not use the sole index to carry on the evaluation, which should do with multi-level and multiple perspective indexes simultaneously. As a result of the condition limit, this research only involves autonomic nerve physiology signal examination and the cognition ability characteristic of mental fatigue. The practically and reliability of the research methods and indexes depend on further verification and consummation.更多还原