早期发病脊柱侧弯儿童的最大呼吸肌力量和肺活量。
Maximal Respiratory Muscle Strength and Vital Capacity in Children With Early Onset Scoliosis.
机构信息
Department of Pediatrics, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, WA.
Department of Pediatrics, Children's Hospital of Philadelphia.
出版信息
Spine (Phila Pa 1976). 2017 Dec 1;42(23):1799-1804. doi: 10.1097/BRS.0000000000002351.
STUDY DESIGN
Descriptive cross-sectional study.
OBJECTIVE
To measure respiratory muscle function in children with early onset scoliosis (EOS), determine the frequency of respiratory muscle weakness, and correlate these measures with vital capacity, body mass index, and Cobb angle.
SUMMARY OF BACKGROUND DATA
Progressive restrictive respiratory disease is common among children with moderate to severe EOS. Reduced respiratory muscle strength is associated with the loss of lung function in adolescents and adults with scoliosis. We hypothesized that reduced inspiratory and expiratory respiratory muscle strength also occur in children with EOS and correlate with reduced vital capacity, poor nutritional status, and severity of the spine deformity.
METHODS
We measured maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP), forced vital capacity (FVC), body mass index IBMI), and Cobb angle in 49 children with EOS but with no diagnosis of underlying muscle weakness. We measured these indices in 12 children serially over 18 months to see if abnormal respiratory muscle function was sustained.
RESULTS
FVC averaged 51% (SD 21) of predicted norms with 26 subjects having an FVC <50% predicted. The mean MIP was 57% (SD 25) and the mean MEP was 53% (SD 23) of predicted norms. Thirteen (27%) of the group had MIP values >2SD below the age and sex-based norms. BMI ranged between 1% and 99% of age-based norms. Cobb angle averaged 59° (SD27). MIP% and MEP% significantly correlated with FVC% (r =0.37, P = 0.01 and r = 0.52, P < 0.001 respectively)) but not with BMI or Cobb angle. Reduced MIP% and MEP% were sustained over 7 to 41 months.
CONCLUSION
Respiratory muscle weakness is common and persistent in children with EOS and correlates with reductions in vital capacity. Mechanisms for abnormal respiratory function are unclear but must be determined to develop surgical treatment strategies that preserve respiratory muscle function in children with EOS throughout childhood.
LEVEL OF EVIDENCE
研究设计
描述性的横断面研究。
目的
测量早发性脊柱侧凸（EOS）患儿的呼吸肌功能，确定呼吸肌无力的频率，并将这些测量结果与肺活量、体重指数和 Cobb 角相关联。
背景数据概要
进展性限制性呼吸疾病在中重度 EOS 患儿中很常见。呼吸肌力量的减弱与青少年和成年人脊柱侧凸患者肺功能的丧失有关。我们假设，EOS 患儿也会出现吸气和呼气呼吸肌力量减弱的情况，并且与肺活量降低、营养状况不佳和脊柱畸形严重程度相关。
方法
我们测量了 49 例 EOS 患儿的最大吸气压力（MIP）和最大呼气压力（MEP）、用力肺活量（FVC）、体重指数（IBMI）和 Cobb 角，但这些患儿没有潜在肌肉无力的诊断。我们对 12 例患儿进行了 18 个月的连续测量，以观察异常呼吸肌功能是否持续存在。
结果
FVC 平均值为预测值的 51%（标准差 21%），26 例患儿的 FVC 低于预测值的 50%。平均 MIP 为预测值的 57%（标准差 25%），平均 MEP 为预测值的 53%（标准差 23%）。13 例（27%）患儿的 MIP 值低于基于年龄和性别制定的正常范围的 2 个标准差。BMI 范围在基于年龄的正常范围的 1%至 99%之间。Cobb 角平均为 59°（标准差 27°）。MIP%和 MEP%与 FVC%显著相关（r=0.37，P=0.01 和 r=0.52，P<0.001），但与 BMI 或 Cobb 角无关。MIP%和 MEP%的降低在 7 至 41 个月内持续存在。
结论
EOS 患儿的呼吸肌无力很常见且持续存在，与肺活量降低相关。异常呼吸功能的机制尚不清楚，但必须确定，以便为 EOS 患儿制定手术治疗策略，在整个儿童期保护呼吸肌功能。
证据水平
2 级。
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