先天性脊柱侧弯胸弯对心肺功能的影响

Effect of thoracic curve on cardiopulmonary function in congenital scoliosis

摘要:

［目的］ 分析先天性脊柱侧凸 （congenital scoliosis, CS） 患者心肺功能特点，探讨 Cobb 角对心肺功能影响。［方法］ 回顾性分析 2020 年 10 月—2021 年 10 月本院收治的 50 例胸弯为主的 CS 患者的临床资料，根据胸弯 Cobb 角，分为重度组 （Cobb 角≥90°） 30 例，中度组 （40°≤Cobb 角<90°） 20 例。比较两组心脏结构、功能及肺功能参数，采用 Pearson 或 Spearman 相关性分析 Cobb 角对其他参数的影响。［结果］两组患者心脏结构及功能测值均在正常范围内，重度组房室腔大小显著小于中度组（P<0.05），左室舒张功能参数 E/A、e’/a’均显著小于中度组（P<0.05），而 E/e’显著大于中度组（P<0.05）。两组患者肺功能均有不同程度的降低，重度组限制性通气功能、小气道功能及换气功能参数均显著低于中度组（P<0.05）。相关分析表明，CS 患者 Cobb 角与左房室腔大小（LA、LVD、LVS）及舒张功能参数（E/A、e/a）呈显著负相关（P<0.05）；CS 患者 Cobb 角与限制性通气功能参数呈显著负相关（P<0.05）。［结论］CS 的 Cobb 角对心脏结构及舒张功能产生影响，Cobb 角越大左房室腔内径越小。此外，Cobb 角也会影响左室舒张功能。Cobb 角与肺功能受损程度相关，Cobb 角越大肺功能越差。

Abstract:

[Objective] To investigate the cardiopulmonary function in patients with congenital scoliosis (CS) , and further to discuss the effect of Cobb angle of the thoracic curve on cardiopulmonary function. [Methods] From October 2020 to October 2021, a total of 50 pa- tients who suffered from CS were included into this study. Based on the extent of scoliosis, 30 patients were fall into the severe groups with Cobb angle＜90°, while the remaining 20 patients were into the moderate group with Cobb angle of ≥40°~＜90°. The parameters related to cardiac structure, cardiac function and pulmonary function were measured and compared between the two groups. In addition, correlation analysis were conducted to search the relationships between the Cobb’s angle and parameters regarding the cardiac structure, cardiac func- tion and pulmonary function. [Results] Although the cardiac structure and function parameter in all patients of both groups remained in the normal ranges, the severe group proved significantly inferior to the moderate group in terms of atrial size, ventricular size and diastolic func- tion, including E/A and e’/a’ parameters (P＜0.05) . In addition, both groups got decreased pulmonary function in some extent, and the se- vere group was significantly inferior to the moderate group in terms of restrictive ventilation function, small airway function and ventilation function parameters (P＜0.05) . As results of correlation analysis, the Cobb angle in these CS patients proved significantly negatively related to the left atrial size, involving LA, LVD and LVS, as well as diastolic function, involving E/A and e’/a’. Moreover, the Cobb angle was also significnalty negatively correlated with restrictive ventilatory function parameters (P＜0.05) . [Conclusion] The Cobb angle does impact the cardiac structure and function, in which the diastolic function and diameter of LA and LV decreases with the increasing of Cobb angle. Fur- thermore, the Cobb angle also influence pulmonary function, the larger Cobb angle, the worse pulmonary function.