Nuss手术矫治漏斗胸患者肺功能的变化

Pulmonary function test in patients with pectus excavatum before and after Nuss procedure

目的 回顾性分析我院漏斗胸患者Nuss手术前后肺功能变化情况及年龄因素对肺功能变化的影响.方法 选择2007年3月至2008年1月我科收治能够配合肺功能检测的漏斗胸患者45例.术前3 d测量肺功能,采用非胸腔镜辅助Nuss手术,术后3个月复查肺功能.统计患者手术前后肺功能检测资料,并按年龄分层分别对〈12岁和≥12岁患者分析年龄对肺功能的影响.结果 肺容量指标中,术后肺活量（VC）（74%±17%）较术前（89%±25%）明显降低,残气容积（RV）、肺总量（TLC）术后较术前降低（135%比139%,93%比96%）,RV/TLC术后较术前升高（157%比148%）,差异均有统计学意义（均P〈0.05）;按年龄分层分析,大年龄组TLC术后较术前降低,小年龄组TLC术后与术前无明显改变.通气功能指标中,最大通气量（MVV）、最大呼气流量（PEF）、最大呼气中段流量（MMEF）、75%肺活量最大呼气流量（V75）、50%肺活量最大呼气流量（V50）、25%肺活量最大呼气流量（v25）术后较术前有改善,用力肺活量（FVC）术后较术前降低,差异均有统计学意义（均P〈0.05）,一秒钟用力呼气容积（FEV1）和通气储备百分比（BR）术后较术前则无明显改变;按年龄分层分析,PEF、MMEF、V50、V25等在小年龄组中术后较术前有改善,大年龄组术前术后无明显变化;FEV1在小年龄组中术后较术前无明显变化,大年龄组术后较术前有降低;MVV在小年龄组中术后较术前无改善,大年龄组术后较术前有升高.结论 接受非胸腔镜辅助Nuss手术的漏斗胸患者肺功能术后短期尚无明确改善;肺容量指标略有降低;多数通气功能指标相比术前有提高;小年龄患者手术后,肺容量降低的程度小于大年龄组,通气功能改善优于大年龄组,远期变化尚需进一步追踪观察.

Objective To evaluate the pulmonary function in patients with pectus excavatum before and after Nuss procedure and stratified according to age. Methods A total of 45 patients treated at our hospital from March 2007 to January 2008 were recruited retrospectively. Pulmonary function was assessed 3 days before and 3 months after surgery. Non-thoracoscopy-aided Nuss procedure was performed for correction. The data were analyzed and stratified according to age （ 〈 12 years and ≥12 years）. Results The post-operative value of VC （vital capacity,74% ± 17% ） significantly decreased compared to its preoperative value（89% ±25%）. RV （residual volume） and TLC （total lung capacity） also significantly decreased （ 135% vs 139% , 93% vs 96% ） while RV/TLC was elevated （157% vs 148% ） （ all P 〈0.05）. When stratified according to age, post-operative TLC value decreased in older group and no significance was noted in younger group. As to the indices of ventilation function, post-operative MVV （ maximal voluntary ventilation） , PEF （peak expiratory flow） , MMEF （maximal mid-expiratory flow） , V75,V50, and V25 improved, FVC （forced vital capacity） decreased （all P〈0.05） while FEV1 （forced expired volume in one second） and BR （ bronchial responsiveness） had no significant change. When stratified according to age, the post-operative values of PEF, MMEF, V50, V25 improved in younger group in contrast to those in older group. No significant post-operative change of FEV, was noted in younger group while a significant decrease was found in older group. No significant change of MVV was noted in younger group and significant post-operative improvement was present in the older group. Conclusions In general, the Nuss procedure brings no significant improvement of pulmonary function in short-term follow-up. Most of the indices pertaining to lung capacity decrease whereas most of those pertaining to ventilation function increase.A decrease of lung caacity is significantly lower in younger patients than in dlders .And the inprovement of ventilation function es better in younger patients than in elders.