脊柱后凸和后侧凸畸形与肺心病

Kyphosis and Kyphoscoliosis and Cor Pulmonale

年龄较轻是脊柱后凸和后侧凸畸形所致肺心病的特点。患者肺功能障碍和动脉血气异常程度与脊柱畸形类型和脊柱畸形角度显著相关。即脊往后凸或后侧凸≥90°者,动脉血氧分压(PaO_2)和用力肺活量(FVC)的降低较脊柱畸形<90°者显著(P<0.05),后侧凸畸形者PaO_2与FVC显著低于后凸畸形者(P<0.05)。脊柱后凸或后侧凸患者由于心脏、血管在胸腔位置的变化,使肺心病的X线片和心电图诊断率明显低于一般肺心病患者,故大部分脊柱畸形肺心病患者需靠病史、临床体征和其他检查综合判断明确诊断。脊柱后凸和后侧凸所致的肺心病预后差,对抗生素、支气管扩张剂、呼吸兴奋剂的治疗均不敏感。其并发症如低氧血症、呼吸衰竭和心力衰竭也比较难控制,病死率较高。

Patients with cor pulmonale resulting from kyphosis and kyphoscoliosis are usually young. The abnormalities in pulmonary function test and arterial blood gases correlate well with the form and degree of spina! deformity- Patients with kyphosis or kyphoscoliosis greater than 90 degrees have a more significant reduction in arterial prcssure of oxygen(PaO2)and forced veral capaeity(FVC)than ihose with kyphosis'or kyphoscoliosis less than 90°(P<0. 05). PaO2 and FVC in patients with kyphoscoliosis show a more significant decrease than in patients with kyphosis (P<0. 05). The chest roentgenogram and electrocardiographic changes are much less sensitive than general popula-tion in making diagnosis of cor pulmonale in patients with spinal deformity ,owing to the severe car-diovascular distortion. For most patients diagnosis is based on comprehensive evaluations such as history ,clinical mauifestations and other diagnostic procedures. The prognosis for patients with cor pulmonale resulting from spinal deformity is poor. Patients usually have a higher mortality rate and don't respond well to antibiotics, bronchodilators and respiratory stiinulants, with complications such as hypoxemia,respiratory and heart failure being refractory to be controlled.