CAJ | 학술논문

目的：评估重度脊柱侧凸患者术前肺功能检查及术后肺部并发症情况，分析相关影响因素。方法回顾分析2000年3月至2009年3月脊柱中心收治的脊柱侧凸患者908例，其中重度脊柱侧凸60例（主弯Cobb角≥100°）。根据侧凸严重度、肺功能受限程度及手术路径，对影响术后肺部并发症的相关因素进行分析。结果重度侧凸与轻中度脊柱侧凸相比较，两组在Cobb角、FVC、FVCR、FEV1、FEV1R方面存在显著统计学差异（ P＜0.01）。908例脊柱侧凸矫形术的肺部并发症发生率是5.07％，60例重度脊柱侧凸矫形术的肺部并发症发生率是15.0％。术后肺部并发症包括胸腔积液，呼吸衰竭，肺不张，血胸，气胸，低氧血症，再次机械通气等。肺部并发症发生率在术前肺功能受限轻度组（2.52％）、中度组（5.0％）和重度组（19.6％）之间存在统计学差异。是否开胸手术与术后肺部并发症无相关性，但是胸廓成形术显著增加术后肺部并发症（P＜0.001，OR＝20）。结论重度侧凸患者肺功能明显受限，重度肺功能受限的患者术后更易出现各种肺部并发症，胸廓成形术是引起术后肺部并发症的重要危险因素。
목적：평고중도척주측철환자술전폐공능검사급술후폐부병발증정황，분석상관영향인소。방법회고분석2000년3월지2009년3월척주중심수치적척주측철환자908례，기중중도척주측철60례（주만Cobb각≥100°）。근거측철엄중도、폐공능수한정도급수술로경，대영향술후폐부병발증적상관인소진행분석。결과중도측철여경중도척주측철상비교，량조재Cobb각、FVC、FVCR、FEV1、FEV1R방면존재현저통계학차이（ P＜0.01）。908례척주측철교형술적폐부병발증발생솔시5.07％，60례중도척주측철교형술적폐부병발증발생솔시15.0％。술후폐부병발증포괄흉강적액，호흡쇠갈，폐불장，혈흉，기흉，저양혈증，재차궤계통기등。폐부병발증발생솔재술전폐공능수한경도조（2.52％）、중도조（5.0％）화중도조（19.6％）지간존재통계학차이。시부개흉수술여술후폐부병발증무상관성，단시흉곽성형술현저증가술후폐부병발증（P＜0.001，OR＝20）。결론중도측철환자폐공능명현수한，중도폐공능수한적환자술후경역출현각충폐부병발증，흉곽성형술시인기술후폐부병발증적중요위험인소。
Objective To evaluate preoperative pulmonary function test and postoperative complication and explore the related factors .Methods A retrospective study of 908 cases with scoliosis registered in our spinal center between 2003.3 and 2009.3.Among them,60 cases had coronary main Cobb angle≥100°on standing position. According to the severity of scoliosis , pulmonary function and operative procedures , all the factors related to the postoperative complications were analyzed .Results Compared with mild and moderate scoliosis groups ,there were significant differences in Cobb,FVC,FVCR,FEV1,FEV1R in severe scoliosis group.The incidence of pulmonary complication was 5.07% in 908 cases,while the incidence of pulmonary complication was 15.0% in the 60 cases with severe scoliosis .There were various pulmonary complication including pleural effusion , respiratory failure , atelectasis,hemothorax,pneumothorax,hypoxemia,mechanical ventilation.The incidence of pulmonary complication was significant different between mild ( 2.52%) , moderate ( 5.0%) and severe ( 19.6%) groups of restrictive pulmonary function .Transthoracic procedure was not related to postoperative pulmonary complication , but thoracoplasty increased the incidence of postoperative pulmonary complication significantly ( P<0.001 , OR=20 ) . Conclusion Pulmonary function is impaired in severe scoliosis .Patients with severe pulmonary dysfunction have higher incidence of postoperative pulmonary complication .Thoracoplasty is an important risk factor in prediction of postoperative pulmonary complication .