Boyer J, Amin N, Taddonio R, Dozor A J
Department of Pediatrics, New York Medical College, Valhalla 10595, USA.
Chest. 1996 Jun;109(6):1532-5. doi: 10.1378/chest.109.6.1532.
Restrictive pulmonary function abnormalities are reported in children and adolescents with idiopathic scoliosis. We hypothesized that spirometry alone, without more extensive testing, including the measurement of lung volumes, is inadequate in characterizing lung function in these children and may miss obstructive abnormalities including significant gas trapping. To examine this hypothesis, we reviewed the pulmonary function tests of 44 children (36 female, 8 male) between the ages of 10 and 18 years with idiopathic scoliosis prior to surgical correction. Spirometry, measurements of lung volumes with both plethysmographic and helium dilution techniques, and bronchodilator response were analyzed for evidence of reversible airway obstruction and gas trapping. Eighteen of 44 (41%) subjects had significant restriction. Only 3 (7%) subjects met standard criteria for airflow obstruction. However, 20 (46%) subjects had an elevated total gas volume by plethysmography-functional residual capacity by helium dilution ratio indicative of moderate or severe gas trapping, 10 (23%) subjects showed mild gas trapping, 8 (18%) subjects had a ratio suggestive of gas trapping, and only 6 (14%) subjects were normal. Additionally, significant improvement in airway mechanics was noted after bronchodilator administration. Specific conductance improved in all subjects, with a mean increase of 62% +/- 8.0 (p<0.001). The residual volume-total lung capacity ratio and total gas volume by plethysmography also decreased significantly (mean decrease, 22.5% +/- 3.0 and 15% +/- 1.0, respectively, p<0.001) in response to inhaled bronchodilators. In conclusion, although restrictive defects are commonly present in children with idiopathic scoliosis, significant gas trapping and responses to bronchodilators also commonly occur. These abnormalities may be missed without extensive pulmonary function testing.
据报道，特发性脊柱侧弯的儿童和青少年存在限制性肺功能异常。我们推测，仅靠肺活量测定法，而不进行包括肺容积测量在内的更广泛检测，不足以全面描述这些儿童的肺功能，可能会遗漏包括严重气体潴留在内的阻塞性异常。为验证这一推测，我们回顾了44名年龄在10至18岁之间、接受手术矫正前的特发性脊柱侧弯儿童（36名女性，8名男性）的肺功能测试结果。分析了肺活量测定、用体积描记法和氦稀释技术测量肺容积以及支气管扩张剂反应，以寻找可逆性气道阻塞和气体潴留的证据。44名受试者中有18名（41%）存在明显受限。只有3名（7%）受试者符合气流阻塞的标准。然而，20名（46%）受试者通过体积描记法测得的总气体量与通过氦稀释法测得的功能残气量之比升高，表明存在中度或重度气体潴留；10名（23%）受试者有轻度气体潴留；8名（18%）受试者的该比值提示有气体潴留；只有6名（14%）受试者正常。此外，给予支气管扩张剂后气道力学有显著改善。所有受试者的比传导率均有所提高，平均增加62%±8.0（p<0.001）。吸入支气管扩张剂后，残气量与肺总量之比以及通过体积描记法测得的总气体量也显著下降（平均下降分别为22.5%±3.0和15%±1.0，p<0.001）。总之，尽管特发性脊柱侧弯儿童通常存在限制性缺陷，但明显的气体潴留和对支气管扩张剂的反应也很常见。如果不进行广泛的肺功能检测，这些异常情况可能会被遗漏。
