Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100730, China.
Chin Med J (Engl). 2012 Jan;125(2):249-52.
It has been stated that preoperative pulmonary function tests are essential to assess the surgical risk in patients with scoliosis. Arterial blood gas tests have also been used to evaluate pulmonary function before scoliotic surgery. However, few studies have been reported. The aim of this study was to investigate the roles of preoperative arterial blood gas tests in the surgical treatment of scoliosis with moderate or severe pulmonary dysfunction.
This study involved scoliotic patients with moderate or severe pulmonary dysfunction (forced vital capacity < 60%) who underwent surgical treatment between January 2002 and April 2010. A total of 73 scoliotic patients (23 males and 50 females) with moderate or severe pulmonary dysfunction were included. The average age of the patients was 16.53 years (ranged 10 - 44). The demographic distribution, medical records, and radiographs of all patients were collected. All patients received arterial blood gas tests and pulmonary function tests before surgery. The arterial blood gas tests included five parameters: partial pressure of arterial oxygen, partial pressure of arterial carbon dioxide, alveolar-arterial oxygen tension gradient, pH, and standard bases excess. The pulmonary function tests included three parameters: forced expiratory volume in 1 second ratio, forced vital capacity ratio, and peak expiratory flow ratio. All five parameters of the arterial blood gas tests were compared between the two groups with or without postoperative pulmonary complications by variance analysis. Similarly, all three parameters of the pulmonary function tests were compared.
The average coronal Cobb angle before surgery was 97.42° (range, 50° - 180°). A total of 15 (20.5%) patients had postoperative pulmonary complications, including hypoxemia in 5 cases (33.3%), increased requirement for postoperative ventilatory support in 4 (26.7%), pneumonia in 2 (13.3%), atelectasis in 2 (13.3%), pneumothorax in 1 (6.7%), and hydrothorax in 1 (6.7%). No significant differences in demographic characteristics or perioperative factors (P > 0.05) existed between the two groups with or without postoperative pulmonary complications. According to the variance analysis, there were no statistically significant differences in any parameter of the arterial blood gas tests between the two groups.
No significant correlation between the results of the preoperative arterial blood gas tests and postoperative pulmonary complications existed in scoliotic patients with moderate or severe pulmonary dysfunction. However, the postoperative complications tended to increase with the decrease of partial pressure of arterial oxygen in the arterial blood gas tests.
据报道，术前肺功能检查对于评估脊柱侧弯患者的手术风险至关重要。动脉血气检查也被用于评估脊柱侧弯手术前的肺功能。然而，相关研究较少。本研究旨在探讨术前动脉血气检查在中重度肺功能障碍的脊柱侧凸手术治疗中的作用。
本研究纳入了 2002 年 1 月至 2010 年 4 月期间接受手术治疗的中重度肺功能障碍（用力肺活量＜60%）的脊柱侧凸患者。共纳入 73 例中重度肺功能障碍的脊柱侧凸患者（男 23 例，女 50 例）。患者平均年龄为 16.53 岁（10-44 岁）。收集所有患者的人口统计学资料、病历资料和影像学资料。所有患者均在术前接受动脉血气检查和肺功能检查。动脉血气检查包括 5 项参数：动脉血氧分压、动脉血二氧化碳分压、肺泡-动脉血氧分压差、pH 值和标准碱剩余。肺功能检查包括 3 项参数：第 1 秒用力呼气容积比、用力肺活量比和呼气峰流速比。方差分析比较两组术后有无肺部并发症患者的动脉血气检查 5 项参数的差异，同样比较两组术后有无肺部并发症患者的肺功能检查 3 项参数的差异。
术前冠状面 Cobb 角平均为 97.42°（50°-180°）。共有 15 例（20.5%）患者发生术后肺部并发症，其中 5 例（33.3%）发生低氧血症，4 例（26.7%）需要术后通气支持，2 例（13.3%）发生肺炎，2 例（13.3%）发生肺不张，1 例（6.7%）发生气胸，1 例（6.7%）发生血胸。术后肺部并发症组和无肺部并发症组在人口统计学特征或围手术期因素方面差异均无统计学意义（P＞0.05）。方差分析显示，两组动脉血气检查各项参数差异均无统计学意义。
中重度肺功能障碍脊柱侧凸患者术前动脉血气检查结果与术后肺部并发症之间无明显相关性。然而，随着动脉血气检查中动脉血氧分压的降低，术后并发症有增加的趋势。
