脊柱侧凸对肺动脉压力及睡眠呼吸的影响

发布时间：2018-08-10 17:45

【摘要】：第一部分背景与目的此前的研究显示,脊柱侧凸可能和肺动脉压力升高有关,并可能造成特发性脊柱侧凸患者死亡率升高,但二者的关系还存在争议。该研究的目的是探究特发性脊柱侧凸的严重程度和肺动脉压力的关系。方法该研究采用回顾性研究的方法共有338名脊柱侧凸患者被纳入肺动脉压力研究。术前通过影像学检测测量各弯曲冠状面Cobb角及顶椎位置。用多普勒超声测量三尖瓣反流速度(TRV)和下腔静脉内径,进而可以据改良伯努利公式计算肺动脉收缩压(sPAP)。侧弯冠状面Cobb角和sPAP的相关性应用Spearman检验分析。结果在测量肺动脉压力的338名患者中(女性82.8%,平均年龄15.6岁),共有305人有胸弯,276(90.5%)为右胸弯,均诊断为特发性脊柱侧凸。sPAP数值在5.0 mmHg到37.6 mmHg之间。仅有一名患者无法排除肺动脉高压诊断。sPAP和主胸弯冠状面Cobb角之间有正相关性(相关系数=0.187,p = 0.001)。sPAP与上胸弯、胸腰弯、腰弯无相关性。患者sPAP20 mmHg时,其主胸弯的角度也较大(均值42.16°vs.52.45°,= 0.002)。左侧弯和右侧弯患者的sPAP无差异。结论特发性脊柱侧凸胸弯冠状面Cobb角和肺动脉收缩压正相关。而肺动脉收缩压和其他弯曲,包括上胸弯、胸腰弯、腰弯的角度间未发现显著的相关性。肺动脉收缩压较高(20 mmHg)的患者胸弯角度也更大。第二部分背景与目的睡眠障碍性呼吸(SDB)会造成认知、记忆、心血管系统的并发症。胸廓畸形可能导致SDB。脊柱侧凸是一种严重的胸廓畸形,但对脊柱侧凸和睡眠呼吸的关系的研究未见报道。该研究的目的是探讨先天和特发性脊柱侧凸患者和正常人群相比是否有睡眠呼吸异常。方法该研究采用病例-对照研究的方法,对62名诊断特发性脊柱侧凸或先天性脊柱侧凸的患者,以及25名健康对照进行睡眠呼吸监测。监测应用Watch-PAT 200腕式睡眠检测仪。睡眠呼吸用以下参数描述:呼吸障碍指数(pRDI):睡眠期间平均每小时的呼吸事件次数;呼吸暂停和呼吸不足指数(pAHI):代表在睡眠中平均每小时发生的呼吸暂停和呼吸不足事件数;LSa02/MSa02:最低血氧饱和度和平均血氧饱和度。再应用统计学方法计算侧凸患者和正常对照指数的差异。结果对于62名进行睡眠呼吸监测的患者,其与25名对照组受试者的年龄、性别分布和BMI无差异。侧凸患者的pRDI更高(中位数10.10 vs.8.65,p = 0.039),pAHI更高(中位数 1.60 vs.0.72,p = 0.029)。LSa02较对照组低(中位数 93%vs.94%,p =0.005),但MSaO2组无显著差异。脊柱侧凸患者朝向凸侧侧躺时,其pAHI较凹侧更高(均值2.52 vs.2.27,p=0.045),而对照组无此差异。结论脊柱侧凸患者相比对照人群有更高的呼吸暂停、呼吸不足事件数和其相关的觉醒数量。侧凸患者相比对照人群,其最低血氧饱和度更低,但平均血氧饱和度相同。朝胸弯的凹侧侧卧时,脊柱侧凸患者比朝凸侧侧卧,其呼吸暂停和呼吸不足事件数更少。
[Abstract]:Background and objective previous studies have shown that scoliosis may be associated with increased pulmonary artery pressure and may lead to an increase in mortality in patients with idiopathic scoliosis, but the relationship between the two may be controversial. The aim of the study was to explore the relationship between the severity of idiopathic scoliosis and pulmonary artery pressure. Methods 338 patients with scoliosis were included in the pulmonary artery pressure study using a retrospective study. The Cobb angle of each curved coronal plane and the position of the apex vertebra were measured by imaging examination before operation. Using Doppler ultrasound to measure tricuspid regurgitation velocity (TRV) and inferior vena cava diameter (IVC), the pulmonary artery systolic pressure (sPAP).) can be calculated according to the modified Bernoulli formula. The correlation between Cobb angle and sPAP was analyzed by Spearman test. Results among 338 patients (female 82.8 with an average age of 15.6 years), 305 (90.5%) had right thoracic curvature, all of whom were diagnosed as idiopathic scoliosis between 5.0 mmHg and 37.6 mmHg. Only one patient could not rule out a positive correlation between the diagnosis of pulmonary hypertension and the coronal Cobb angle of the main thoracic curvature (correlation coefficient: 0.187 p = 0.001) .sPAP had no correlation with upper thoracic curvature, thoracolumbar bending and lumbar curvature. The angle of the main thoracic curvature of the patients with sPAP20 mmHg was larger (mean 42.16 掳vs.52.45 掳= 0.002). There was no difference in sPAP between patients with left and right curvature. Conclusion the Cobb angle on the coronal plane of idiopathic scoliosis is positively correlated with pulmonary artery systolic pressure. There was no significant correlation between pulmonary systolic pressure and other curvature, including upper thoracic, thoracolumbar, and lumbar bending angles. Patients with higher pulmonary systolic pressure (20 mmHg) also had greater thoracic curvature. Background and objective (SDB) can cause cognitive, memory and cardiovascular complications. Thoracic malformations may cause SDBs. Scoliosis is a severe thoracic deformity, but the relationship between scoliosis and sleep breathing has not been reported. The aim of the study was to investigate whether patients with congenital and idiopathic scoliosis had abnormal sleep apnea compared with the normal population. Methods Sleep respiration was monitored in 62 patients with idiopathic scoliosis or congenital scoliosis and 25 healthy controls. Watch-PAT 200 wrist sleep detector was used. Sleep respiration was described by the following parameters: respiratory disorder index (pRDI): the average number of respiratory events per hour during sleep; Apnea and apnea index (pAHI): represents the average number of apnea and insufficient events per hour in sleep: minimum oxygen saturation and mean oxygen saturation. Then the statistical method was used to calculate the difference of index between the patients with scoliosis and the normal control group. Results there was no difference in age, sex distribution and BMI between 62 patients and 25 control subjects. PRDI in patients with scoliosis was higher (median 10.10 vs.8.65 p = 0.039). LSa02 was lower than that in control group (median 1.60vs.0.72p = 0.029), but there was no significant difference in MSaO2 group. The pAHI of scoliosis patients with scoliosis was higher than that of concave side (mean 2.52 vs 2.27 p0. 045), but there was no difference in control group. Conclusion compared with the control group, the patients with scoliosis have higher number of apnea, insufficient breathing events and their associated arousal. The lowest oxygen saturation in patients with scoliosis was lower than that in controls, but the mean oxygen saturation was the same. Patients with scoliosis had fewer apnea and insufficient breathing events when lying on the concave side of the chest bend than in the protruding side.
【学位授予单位】：北京协和医学院
【学位级别】：博士
【学位授予年份】：2017
【分类号】：R682.3

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