先天性脊柱侧弯与特发性脊柱侧弯对肺功能影响的对比分析

Comparative analysis on influence of congenital scoliosis and idiopathic scoliosis in pulmonary function

目的:比较先天性脊柱侧弯(CS)与特发性脊柱侧弯(IS)患者肺功能参数的差异,阐明其对呼吸功能的影响。方法:选择拟行手术治疗的脊柱侧弯患者61例,根据病因分为CS患者组(25例)和IS患者组(36例),分析两类脊柱侧弯患者肺功能参数的改变及其异同。结果:2组患者年龄、体质量和Cobb角等基线情况相似。CS和IS组中分别有6例和12例存在通气功能障碍,15例和25例存在换气功能障碍。2组患者残气量(RV)、残气量/肺总量(RV/TLC)和残气量/肺总量占预计值百分比(RV/TLC%pred)3项肺功能均异常升高。CS组患者用力肺活量占预计值百分比(FVC%pred)和第1秒用力呼气容积/用力肺活量(FEV1/FVC)显著低于IS组(P<0.05);IS组患者肺活量占预计值百分比(VC%pred)、FVC%pred、第1秒用力呼气容积占预计值百分比(FEV1%pred)、最大呼气中段流量占预计值百分比(MMEF%pred)、最大分钟通气量占预计值百分比(MVV%pred)、肺总量占预计值百分比(TLC%pred)及肺一氧化碳弥散量占预计值百分比(DLCO%pred)与Cobb角均呈负相关关系(r=-0.54^-0.35,P<0.05);CS组患者TLC%pred与Cobb角呈负相关关系(r=-0.047,P<0.05)。结论:不同类型脊柱侧弯对患者的肺功能指标均产生影响,IS患者肺功能损害程度较CS患者更为严重,对生活质量影响更大,需要早期及时处理。

Objective： To compare the differences of lung function parameters of the patients with congenital scoliosis （CS） or idiopathic scoliosis （IS）, and to clarify their influence in respiratory function. Methods： Sixty-one patients of scoliosis undergoing operation were selected. According to the cause they were divided into 25 patients with CS and 36 patients with IS. The changes of lung function parameters and the differences in the patients with scoliosis were analyzed. Results： The ages, body weights, Cobb angles of the patients in two groups had no significant differences. There were 6 cases and 12 cases of ventilation disturbance in CS and 1S groups, and 15 cases and 25 cases of ventilation dysfunction. The levels of residual volume （RV）, ratio of residual volume to total lung capacity （RV/TLC）, RV/TLC percent predicted （RV/TLC% pred ） in two groups were higher than the normal. The percentage of forced vital capacity predicted （FVCG pred） and FEV~/FVC in CS group were both lower than those in IS group （P〈0.05）. Some pulmonary function parameters such as vital capacity （VCGpred）, FVCG pred, forced expiratory volume in one second （FEV1% pred）, maximal mid expiratory flow （MMEF% pred）, maximal voluntary ventilation （MVV%pred）, TLC%pred and diffusion capacity for carbon monoxide of the lung （DLCO%pred） were negtively correlated with Cobb angle （r= -0.54--0.35, P〈0.05） in IS group and the TLC%pred was negtively correlated with Cobb angle （r=-0. 047, P〈0.05） in CS group. Oonclusiom Different types of scoliosis have influence in the pulmonary function of the patients. The degree of pulmonary function injury of the patients with IS is worse than that of the CS patients. The IS patients need treatment in time.