术前肺功能检查在脊柱侧凸手术治疗中的作用

The correlation between preoperative pulmonary function and postoperative pulmonary complications in the surgical treatment of scoliosis

目的评价术前肺功能检查(PFTs)在预测脊柱侧凸患者术后肺部并发症中的作用。方法以1996年10月～1999年10月完成的298例脊柱侧凸患者为研究对象,对患者术前肺功能与术后肺部并发症的关系进行分析。结果术后肺部并发症的发生率为64%;开胸手术肺部并发症的发生率为152%,而未开胸手术肺部并发症发生率为32%,两者间差异具有显著性(P=00000);正常PFTs患者术前呼吸困难症状发生率为27%,异常PFTs患者术前呼吸困难症状发生率为77%,提示术前呼吸困难症状与异常PFTs相关(P=001),但与肺部并发症发生无关(P=052)。在60%<肺活量占预计值的比例(FVCR)<80%、40%<FVCR<60%和FVCR<40%的患者中,术后肺部并发症的发生率分别为27%、74%和316%,提示肺部并发症的发生率随PFTs的降低而增加。结论术前呼吸困难可提示有PFTs的异常,但与术后肺部并发症发生无关;术后肺部并发症的发生率随PFTs减低而增加;前路手术可显著增加术后肺部并发症的发生率。

Objectives To evaluate the incidence of immediate postoperative pulmonary complications and their correlation to preoperative pulmonary function tests (PFTs), preoperative pulmonary symptoms and surgical approaches Methods The case records of 298 patients, who underwent anterior or posterior fusion, were reviewed Preoperative PFTs were recorded and abnormal PFTs were defined as forced vital capacity (FVC) is less than 80% of FVC predicted Preoperative pulmonary symptoms (breathless on exertion) were noted, and postoperative pulmonary complications were defined when the presence of atelectasis, infiltrates, pneumothorax, hemothorax, pneumonia or requirement of postoperative ventilatory support was noted Results The mean age of this group was 16 4 years (range from 6-62 years) The average coronal Cobb angle was 73 26° (range from 45°-141°) Of all the patients, 115 patients had normal preoperative PFTs, the other 183 cases had abnormal PFTs Nineteen cases of all the patients were found with postoperative pulmonary complications including postoperative ventilatory support in 6 cases, atelectasis in 4 cases, infiltration in 2 cases, pneumothorax in 3 cases, pneumonia in 3 cases and hypoxemia in 1 case The incidence of postoperative pulmonary complication was 6 4% in all the patients, while 18 99% in the 79 patients with thoracetomy and 1 85% in the 216 patients without The correlation between postoperative pulmonary complications and the surgical approach was statistically significant ( P =0 0000) When the patients were classified into 3 groups: 60%<FVCR<80%, 40%<FVCR<60%, FVCR<40%, the incidence of postoperative pulmonary complications were 2 72% (3/110), 7 40% (4/54) and 31 6% (6/19) respectively, which showed an increasing complication incidence In the 115 patients with normal PFTs, 3 patients had preoperative pulmonary symptoms (2 68%), while 14 of the 183 patients with abnormal PFTs had preoperative pulmonary symptoms (7 65%) The correlation between presence of preoperative respiratory symptoms and abnormal results on PFTs was statistically significant ( P =0 01) No significant correlation was found between preoperative respiratory symptoms and postoperative pulmonary complications ( P =0 52) Conclusions The incidence of postoperative pulmonary complications increases with the deterioration of PFTs The posterior procedure has a very low incidence of postoperative pulmonary possibility of complications, but a transthoracic procedure increases the complications significantly Preoperative respiratory symptoms usually predict abnormal results of PFTs but have no correlation with postoperative pulmonary complication