| 纪彧程,姜鹏,劳立峰,等.重度青少年特发性脊柱侧凸术前肺功能与术后肺部并发症的相关性分析.骨科,2023,14(1): 40-45. |
| 重度青少年特发性脊柱侧凸术前肺功能与术后肺部并发症的相关性分析 |
| Correlations between Preoperative Pulmonary Function and Postoperative Pulmonary Complications in Severe Adolescent Idiopathic Scoliosis |
| 投稿时间：2022-10-17 |
| DOI：10.3969/j.issn.1674-8573.2023.01.009 |
| 中文关键词: 青少年特发性脊柱侧凸 肺功能 肺功能检查 肺部并发症 胸廓成形术 |
| 英文关键词: Adolescent idiopathic scoliosis Pulmonary function Pulmonary function test Pulmonary complications Thoracoplasty |
| 基金项目:国家自然科学基金（81972127、82272573） |
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| 中文摘要: |
| 目的 分析重度青少年特发性脊柱侧凸（adolescent idiopathic scoliosis，AIS）病人术前肺功能状态与术后肺部并发症的相关性。方法 回顾性分析2000年2月至2022年2月上海交通大学医学院附属仁济医院脊柱中心收治的AIS病人1 362例，其中重度AIS病人63例（主弯Cobb角≥100°）。比较重度AIS病人与轻中度AIS病人的第一秒用力呼气容积（forced expiratory volume in one second，FEV1）、1秒末用力呼气容积比率（FEV1R）、用力肺活量（forced vital capacity，FVC）、用力肺活量比率（FVCR）以及最高呼气峰流速变异率（PEFR）。比较重度肺功能受限（FVCR≤60%）、中度肺功能受限（60%＜FVCR＜80%）、正常或轻度肺功能受限（FVCR≥80%）这三组病人的围手术期主要参数。比较术前不同肺功能受限程度的重度AIS病人术后肺部并发症的发生率。探讨开胸手术、胸廓成形术是否影响术后肺部并发症的发生率。结果 重度AIS病人与轻中度AIS病人相比，FEV1、FEV1R、FVC、FVCR及PEFR的差异均有统计学意义（P＜0.05）。在1 362例AIS病人中，正常或轻度肺功能受限组774例，中度受限组450例，重度受限组138例，三组间比较，在Cobb角、输血量、肺部并发症发生率方面的差异均有统计学意义（P＜0.05）。术后肺部并发症包括胸腔积液、呼吸衰竭、肺不张、血胸、气胸、低氧血症、再次机械通气等。1 362例AIS病人的肺部并发症总发生率是3.38%，而63例重度AIS病人的肺部并发症发生率是14.29%，且术前肺功能正常或轻度受限组（1.68%）、中度受限组（3.33%）和重度受限组（13.07%）的肺部并发症发生率比较，差异有统计学意义（P＜0.05）。63例重度AIS病人中，重度肺功能受限的病人比正常或轻中度受限病人更容易出现术后肺部并发症。是否开胸手术与术后肺部并发症无明显相关性，但是胸廓成形术显著增加术后肺部并发症发生率（OR=20.1，P＜0.001）。结论 重度AIS病人的肺功能出现明显受限，同时术前肺功能重度受限的重度AIS病人术后则更容易出现各种肺部并发症，作为重要危险因素之一，行胸廓成形术的病人更易出现术后肺部并发症。 |
| 英文摘要: |
| Objective To evaluate the correlations between preoperative pulmonary function and postoperative pulmonary complications in severe adolescent idiopathic scoliosis (AIS). Methods A total of 1 362 cases of AIS registered in the Spinal Center of Renji Hospital, Shanghai Jiao Tong University School of Medicine between February 2000 and February 2022 were retrospectively studied, among which 63 cases had coronary main Cobb angle ≥100° on standing position. The factors including forced vital capacity (FVC), FVC ratio (FVCR), forced expiratory volume in one second (FEV1), FEV1 ratio (FEV1R), peak expiratory flow variation rate (PEFR) were compared between severe and mild or moderate AIS patients. Perioperative parameters were investigated among three groups: severely restricted (FVCR≤60%), moderately restricted (60%＜FVCR＜80%) and mildly restricted or normal (FVCR≥80%) groups of pulmonary function. The relationship between incidence of postoperative pulmonary complications in severe AIS and different severity of preoperative pulmonary function restriction was explored. Furthermore, whether transthoracic procedures and thoracoplasty affected the incidence of postoperative pulmonary complications was examined as well. Results There were significant differences in FVC, FVCR, FEV1, FEV1R and PEFR between mild-moderate scoliosis groups and severe scoliosis group (P＜0.05). Among 1 362 cases of AIS, there were 774 cases of normal or mildly restricted pulmonary function, 450 cases of moderately restricted pulmonary function and 138 cases of severely restricted pulmonary function. Differences in the Cobb angle, blood transfusion volume and incidence of pulmonary complications were significant among three groups (P＜0.05). Postoperative pulmonary complications included pleural effusion, respiratory failure, atelectasis, hemothorax, pneumothorax, hypoxemia and repeated mechanical ventilation. The incidence of pulmonary complications was 3.38% in 1 362 cases, while that reached 14.29% in the 63 cases of severe scoliosis. The incidence of pulmonary complications was also significantly different between normal or mildly (1.68%), moderately (3.33%) restricted pulmonary function groups and severely restricted pulmonary function group (13.07%), indicating that postoperative pulmonary complications were more common in patients with moderately to severely restricted pulmonary function than in normal or mildly group. Transthoracic procedure was not related to postoperative pulmonary complications, but thoracoplasty increased the incidence of postoperative pulmonary complications significantly (OR=20.1, P＜0.001). Conclusion Pulmonary function was impaired in severe AIS. Patients with severely restricted pulmonary function had higher incidence of postoperative pulmonary complications. In addition, thoracoplasty was an important risk factor in the prediction of postoperative pulmonary complications. |
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