严重儿童脊柱侧弯继发严重肺功能损害术后肺部并发症的危险因素  

Risk factors of postoperative pulmonary complications in children with severe scoliosis secondary to severe pulmonary dysfunction

作　　者：李军伟 蔡经纬 牛鸣 王同 王旭勃 王凯 LI Jun-wei;CAI Jing-wei;NIU Ming;WANG Tong;WANG Xu-bo;WAN GKai(Department of Orthopedics,People's Hospital of Ganzhou District,Zhangye,Gansu 734000,China)

机构地区：[1]甘州区人民医院骨科,甘肃张掖734000

出　　处：《颈腰痛杂志》2022年第6期790-793,共4页The Journal of Cervicodynia and Lumbodynia

摘　　要：目的探讨严重脊柱侧弯继发严重肺功能损害(severe pulmonary dysfunction secondary to severe idiopathic scoliosis,SPDSIS)儿童术后肺部并发症的危险因素。方法选择2016年1月~2020年6月在本院接受手术治疗的73例SPDSIS患儿作为研究对象,收集患儿围手术期临床资料(年龄、性别、诊断、血气值、Cobb角、手术类型、手术时间、术中失血量、术后1 d引流量、围手术期输血量、手术节段、肺部并发症发生率等)和睡眠呼吸参数[呼吸暂停低通气指数(apnea hypopnea index,AHI)、阻塞性呼吸暂停低通气/低通气指数(obstructive apnea hypopnea index,OAHI)、血氧饱和度(SaO_(2))、经皮二氧化碳分压(TcPCO_(2))、急性CO_(2)潴留],采用单因素和多因素分析观察影响SPDSIS患儿术后肺部并发症的危险因素,采用相关性分析观察睡眠呼吸参数和肺功能参数的相关性。结果并发症组夜间最低SaO_(2)低于无并发症组,急性CO_(2)潴留、AHI、OAHI水平高于无并发症组,差异均有统计学意义(P<0.05)。多因素Logistic分析显示,Cobb角≥79°是术后肺部并发症的风险因素(P<0.05),术前用力肺活量(forced vital capacity,FVC)是术后肺部并发症的保护性因素(P<0.05)。术前FVC≥38%、1秒用力呼气量(forced expiratory volume in 1 second,FEV1)与基线SaO_(2)、夜间最低SaO_(2)呈正相关(P<0.05),与峰值TcPCO_(2)、基线TcPCO_(2)、急性CO_(2)潴留、AHI和OAHI均呈负相关(P<0.05)。结论术前FVC是术后肺部并发症的保护性因素,Cobb角≥79°是影响SPDSIS患儿术后肺部并发症的风险因素;睡眠呼吸参数与肺功能指标存在显著相关性。Objective To investigate the risk factors of postoperative pulmonary complications in children with severe pulmonary dysfunction secondary to severe idiopathic scoliosis(SPDSIS).Methods From January 2016 to June 2020,73 SPDSIS patients in our hospital were selected in this research.The clinical data(including age,gender,diagnosis,blood gas value,Cobb angle,operation type,operation time,intraoperative blood loss,drainage volume on the first day after operation,perioperative blood transfusion volume,operative segment,incidence of pulmonary complications)and sleep breathing parameters[apnea hypopnea index(AHI),obstructive apnea hypopnea index(OAHI),blood oxygen saturation(SaO_(2)),transcutaneous carbon dioxide partial pressure(TcPCO_(2)),acute CO_(2) retention]were collected.Univariate and multivariate analysis were used to analyze the risk factors of postoperative pulmonary complications in children with SPDSIS,and correlation analysis was used to observe the correlation between sleep breathing parameters and pulmonary function parameters.Results The minimum nighttime SaO_(2) in the pulmonary complications group was lower than that of the no pulmonary complications group,and the levels of acute CO_(2) retention,AHI and OAHI were higher than those of the no pulmonary complications group,and the differences were statistically significant(P<0.05).Multivariate logistic analysis showed that Cobb angle≥79°was a risk factor for postoperative pulmonary complications(P<0.05),and preoperative forced vital capacity(FVC)≥38%was a protective factor for postoperative pulmonary complications(P<0.05).FVC and forced expiratory volume in 1 second(FEV1)were positively correlated with baseline SaO_(2) and the lowest SaO_(2) at night(P<0.05),and were negatively correlated with peak TcPaCO_(2),baseline TcPaCO_(2),acute CO_(2) retention,AHI and OAHI(P<0.05).Conclusion Preoperative FVC is a protective factor for postoperative pulmonary complications,and Cobb angle≥79°is risk factor for postoperative respiratory complications in ch

关 键 词：脊柱侧弯 肺功能损害 肺部并发症 风险因素 阻塞性睡眠呼吸障碍 

分 类 号：R619[医药卫生—外科学]