脊髓损伤患者的肺功能变化

Changes of the pulmonary function in patients with spinal cord injury(SCI)

目的探讨脊髓损伤患者肺功能变化的特点及影响因素。方法共分析86例脊髓损伤患者的肺功能指标,比较颈髓损伤(48例)及胸腰髓损伤(38例)患者的肺活量(VC)、用力呼气肺活量(FVC)、最大通气量(MVV)、1秒钟最大呼气量(FEV_(1.0))预测百分比(分别记作VC%,FVC%,MVV%,FEV_(1.0))间的差异;并应用多元逐步回归分析研究患者性别、年龄、病程、体重指数、损伤部位(颈髓或胸髓损伤)、ASIA感觉/运动评分以及残损分级与脊髓损伤患者VC,FVC,MVV及FEV_(1.0)间的相关性。结果颈髓和胸腰段脊髓损伤患者VC%,FVC%,MVV%及FEV_(1.0)%均有不同程度下降,以颈髓损伤患者各项肺功能指标的下降幅度较为显著(P<0.01);多元逐步回归分析显示,影响VC,FVC,MVV及FEV_(1.0)的主要因素包括损伤部位、运动评分和性别。结论脊髓损伤患者(特别是颈髓损伤患者)均存在不同程度通气功能障碍;ASIA运动评分是影响脊髓损伤患者肺功能的主要指标之一。

Objective To investigate the features and influencing factors associated with pulmonary function in subjects with spinal cord injury （SCI）. Methods The pulmonary function data of 86 patients obtained by spirometry, including 48 at cervical and 38 at thoracolumbar level were analyzed. The values of vital capacity（VC） , forced vital capacity （FVC） , maximal voluntary ventilation （MVV） , forced expiratory volume（ FEV1-0 ） expressed as percentage of those of the normal subjects （VC% , FVC% , MVV% ,FEVI.0% respectively） were obtained and compared between cervical and thoracolumbar spinal cord injuries by independent-samples t-tests,then the muhivariable stepwise regression analysis was performed to study the relationship between such factors as age, gender, duration of SCI, body weight index（BMI） ,the level of lesion （cervical or thoracolumbar injury）, motor/sensory index score and ASIA （American Spinal Injury Association） impairment scale and the pulmonary function parameters including VC, FVC, MVV and FEV1-0. Results VC% , FVC% , MVV% , FEVl-0% decreased in all the subjects with cervical and thoracolumbar spinal cord injuries, and were lower in patients with cervical injuries than those with thoracolumbar spinal cord injury significantly. The multivariable stepwise regression analysis showed that the common powerful influencing parameters to the VC, FVC, MVV, FEV1-0 were the level of lesion, gender and the motor index score. Conclusion The SCI patients demonstrated ventilation impairment, especially those with spinal cord injuries at the cervical level ,and the motor index score of ASIA was one of the main factors related to the pulmonary function of SCI patients.