【摘要】：第一部分背景與目的此前的研究顯示,脊柱側(cè)凸可能和肺動(dòng)脈壓力升高有關(guān),并可能造成特發(fā)性脊柱側(cè)凸患者死亡率升高,但二者的關(guān)系還存在爭(zhēng)議。該研究的目的是探究特發(fā)性脊柱側(cè)凸的嚴(yán)重程度和肺動(dòng)脈壓力的關(guān)系。方法該研究采用回顧性研究的方法共有338名脊柱側(cè)凸患者被納入肺動(dòng)脈壓力研究。術(shù)前通過影像學(xué)檢測(cè)測(cè)量各彎曲冠狀面Cobb角及頂椎位置。用多普勒超聲測(cè)量三尖瓣反流速度(TRV)和下腔靜脈內(nèi)徑,進(jìn)而可以據(jù)改良伯努利公式計(jì)算肺動(dòng)脈收縮壓(sPAP)。側(cè)彎冠狀面Cobb角和sPAP的相關(guān)性應(yīng)用Spearman檢驗(yàn)分析。結(jié)果在測(cè)量肺動(dòng)脈壓力的338名患者中(女性82.8%,平均年齡15.6歲),共有305人有胸彎,276(90.5%)為右胸彎,均診斷為特發(fā)性脊柱側(cè)凸。sPAP數(shù)值在5.0 mmHg到37.6 mmHg之間。僅有一名患者無法排除肺動(dòng)脈高壓診斷。sPAP和主胸彎冠狀面Cobb角之間有正相關(guān)性(相關(guān)系數(shù)=0.187,p = 0.001)。sPAP與上胸彎、胸腰彎、腰彎無相關(guān)性�；颊遱PAP20 mmHg時(shí),其主胸彎的角度也較大(均值42.16°vs.52.45°,= 0.002)。左側(cè)彎和右側(cè)彎患者的sPAP無差異。結(jié)論特發(fā)性脊柱側(cè)凸胸彎冠狀面Cobb角和肺動(dòng)脈收縮壓正相關(guān)。而肺動(dòng)脈收縮壓和其他彎曲,包括上胸彎、胸腰彎、腰彎的角度間未發(fā)現(xiàn)顯著的相關(guān)性。肺動(dòng)脈收縮壓較高(20 mmHg)的患者胸彎角度也更大。第二部分背景與目的睡眠障礙性呼吸(SDB)會(huì)造成認(rèn)知、記憶、心血管系統(tǒng)的并發(fā)癥。胸廓畸形可能導(dǎo)致SDB。脊柱側(cè)凸是一種嚴(yán)重的胸廓畸形,但對(duì)脊柱側(cè)凸和睡眠呼吸的關(guān)系的研究未見報(bào)道。該研究的目的是探討先天和特發(fā)性脊柱側(cè)凸患者和正常人群相比是否有睡眠呼吸異常。方法該研究采用病例-對(duì)照研究的方法,對(duì)62名診斷特發(fā)性脊柱側(cè)凸或先天性脊柱側(cè)凸的患者,以及25名健康對(duì)照進(jìn)行睡眠呼吸監(jiān)測(cè)。監(jiān)測(cè)應(yīng)用Watch-PAT 200腕式睡眠檢測(cè)儀。睡眠呼吸用以下參數(shù)描述:呼吸障礙指數(shù)(pRDI):睡眠期間平均每小時(shí)的呼吸事件次數(shù);呼吸暫停和呼吸不足指數(shù)(pAHI):代表在睡眠中平均每小時(shí)發(fā)生的呼吸暫停和呼吸不足事件數(shù);LSa02/MSa02:最低血氧飽和度和平均血氧飽和度。再應(yīng)用統(tǒng)計(jì)學(xué)方法計(jì)算側(cè)凸患者和正常對(duì)照指數(shù)的差異。結(jié)果對(duì)于62名進(jìn)行睡眠呼吸監(jiān)測(cè)的患者,其與25名對(duì)照組受試者的年齡、性別分布和BMI無差異。側(cè)凸患者的pRDI更高(中位數(shù)10.10 vs.8.65,p = 0.039),pAHI更高(中位數(shù) 1.60 vs.0.72,p = 0.029)。LSa02較對(duì)照組低(中位數(shù) 93%vs.94%,p =0.005),但MSaO2組無顯著差異。脊柱側(cè)凸患者朝向凸側(cè)側(cè)躺時(shí),其pAHI較凹側(cè)更高(均值2.52 vs.2.27,p=0.045),而對(duì)照組無此差異。結(jié)論脊柱側(cè)凸患者相比對(duì)照人群有更高的呼吸暫停、呼吸不足事件數(shù)和其相關(guān)的覺醒數(shù)量。側(cè)凸患者相比對(duì)照人群,其最低血氧飽和度更低,但平均血氧飽和度相同。朝胸彎的凹側(cè)側(cè)臥時(shí),脊柱側(cè)凸患者比朝凸側(cè)側(cè)臥,其呼吸暫停和呼吸不足事件數(shù)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 擄vs.52.45 擄= 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.
【學(xué)位授予單位】：北京協(xié)和醫(yī)學(xué)院
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2017
【分類號(hào)】：R682.3

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