先天性脊柱畸形患者心脏异常因素分析  

Prevalence of cardiac abnormalities in patients with congenital spinal deformity

作　　者：李永宁[1,2] 刘立岷[1] 宋跃明[1] 杨光辉[1] 

机构地区：[1]四川大学华西医院骨科,四川成都610041 [2]川北医学院第二临床医学院.南充市中心医院骨科,四川南充637000

出　　处：《西部医学》2015年第11期1723-1727,共5页Medical Journal of West China

摘　　要：目的探讨先天性脊柱畸形患者中心脏异常的因素,提高对先天性脊柱畸形患者合并心脏异常的认识,以减少患者围手术期风险。方法对治疗的127例经全脊柱x线片、CT三维重建、MRI检查及术中确诊的先天性脊柱畸形患者的临床资料、心电图和超声心动图检查结果进行分析,统计其心脏异常发生率,将心脏异常病例分成心脏结构性异常组和功能性异常组、心脏异常组和心脏正常组进行各自组间差异比较;探讨年龄、冠状面Cobb角度、畸形类型对心脏异常发生率及心功能的影响。结果 127例患者中有56(44.09%)例合并心脏异常,心脏异常患者中有16例有心电图异常改变,5例体检异常结果。心脏结构性异常组和功能性异常组、心脏异常组和正常组相比,各组间性别构成比、年龄、Cobb角、各心腔及主动脉内径数据比较均无显著统计学差异(P>0.05);各组间比较其左心室射血分数亦无统计学差异(P>0.05)。冠状面Cobb角<40°组与>80°组在其左心室前后径、右心室前后径、左心室射血分数上相比有显著统计学差异(P<0.05)。结论先天性脊柱畸形患者合并心脏异常发生率较高,但心功能无明显下降。冠状面上Cobb角的大小对心脏结构发育及心功能状态有一定影响。故术前应常规行超声心动图检查,以准确评估心脏的结构及功能。Objective To study the incidence and the cardiac function of cardiac abnormalities in patients with con- genital spinal deformity and discuss influence factors on the incidences and the cardiac function in order to offer some ref- erences to the perloperative safety. Methods Clinical data, electrocardiographic and echocardiographic results of 127 pa- tients with congenital spinal deformity were analyzed. The diagnosis was verified by X-ray film of the total spine, three dimension reconstruction and MRI. There were 60 male, 67 female, ranging from 4 to 22 years old. The mean age was 13.86 years old. The incidences of cardiac abnormalities and the cardiac function were calculated. The changes of cardiac structures and functions between patients with cardiac abnormalities and without cardiac abnormalities, between function- al cardiac abnormalities and structural cardiac abnormalities were also inspected respectively. The potential influence fac- tors, such as ages, degrees of Cobb angle, types of the malformed vertebrals, were investigated. Results Cardiac abnor- malities were found in 56 （44.09 %） patients according to the records of echocardiography. Abnormal electrocardiograph- ic presentations were detected in 16 of the 56 patients with cardiac abnormalities, physical examination showed abnormal findings in 5 patients. The genders, ages, degrees of Cobb angle, inner diameters of each heart chambers and aorta, es- pecially the values of left ventricular ejection fraction were not significantly different between cardiac abnormahttes group and non-cardiac abnormalities group, between structural cardiac abnormalities group and functional cardiac abnormalities group （all P〉0.05）. The age, types of the malformed vertebrals, Cobbs angel of the coronal plane had no statistical in- fluence on the incidences of cardiac abnormalities （P〉0.05）. There were significantly differences in LV,RV, EF between the groups of which Cobbs angel in the coronal plane was less than 40°and more than 80°（P〈0.05）. Co

关 键 词：脊柱畸形 心脏异常 手术风险 

分 类 号：R681.5[医药卫生—骨科学]