青少年特发性脊柱侧凸患者术前肺功能与肺容积相关性研究：利用CT三维重建肺容积

目的 搜集三维CT重建下青少年特发性脊柱侧凸患者术前总肺容积（total lung volume,Vt）、右肺容积（volume of right lung,Vr ）、左肺容积（volume of left lung,Vl ）和左侧肺容积/右侧肺容积比值（Vl/Vr）与年龄相关对照值比较是否存在差异,并且回顾性研究术前肺容积和肺功能参数相关性.方法 共24例患者,平均Cobb角52°.所有患者术前行肺功能检查（通气和弥散）,胸部CT扫描,并进行肺实质三维重建.Vt、Vr、Vl、Vl/Vr和右侧与左侧肺容积差值绝对值（︱Vr-Vl︱）分别与肺功能测量结果进行相关性分析.以肺活量（vital capacity,VC）、用力肺活量（forced vital capacity,FVC）和肺总量（total lung capacity,TLC）为因变量,与肺容积数据建立多元线性回归分析模型,获得回归方程.结果 Vt与VC、FVC呈正相关（P＜0.05）,Vt与TLC近似正相关（P=0.055）,与50%肺活量时最大呼气流量（forced expiratory flow of 50% forced vital capacity,FEF50%）、FEF75%呈负相关,与其他参数均无相关性（P＞0.05）.︱Vr-Vl︱与最大通气量占预计值百分比（percentages of maximal ventilatory volume to predicted values,MVV%）呈负相关,与弥散参数无相关性（P＞0.05）;男性和女性患者Vt与Vr较对照值均减小,女性患者Vl/Vr和对照值差异有统计学意义.结论 青少年特发脊柱侧凸术前Vt与VC、FVC、TLC呈明显正相关;侧凸患者Vt、Vr较正常对照值减小.从单纯的保存肺功能角度,建议后路手术尽量减少两侧肺容积不对称性,可以阻止MVV%继续下降.     

单一后路矫形术对严重脊柱侧凸肺功能的影响

目的探讨单一后路矫形手术对严重脊柱侧凸患者肺功能恢复的影响。方法 2007～2009年间有完整肺功能资料的胸弯Cobb角〉70°伴有肺功能障碍的严重脊柱侧凸患者30例纳入本次研究。患者年龄为10～36岁,平均17.0岁;其中男11例,女19例。使用肺功能检查评估患者术前和术后3个月、2年时的肺功能状况。结果患者术前平均Cobb角为109.1°,脊柱侧凸矫形术后Cobb角平均下降至65.6°,侧凸矫正率平均为43.0%。术后3个月患者肺功能有轻微的改善,与术前相比差异无统计学意义（P〉0.05）。术后2年患者的肺活量（vital capacity,VC）升高了23.8%、VC与预计值的比升高了17.6%、用力肺活量（forced vital capacity,FVC）升高了23.6%、FVC与预计值的比升高了17.1%、1秒用力呼气量（forced expiratory volume in 1 s,FEV1）升高了25.6%,与术前相比差异有统计学意义（P〈0.05）;FEV1与预计值的比升高了21.9%,与术前相比差异无统计学意义（P〉0.05）。患者术前肺功能参数与术前Cobb角成负相关,术后肺功能参数的改善率均与术前Cobb角成正相关。结论单一后路矫形手术可以有效的改善脊柱侧凸患者的肺功能,并随着术后时间的延长肺功能的改善越发显著,术前脊柱侧凸越严重术后肺功能的恢复效果也越明显。     

合并严重肺功能障碍的重度杜氏肌营养不良症型脊柱侧凸的手术治疗

杜氏肌营养不良症(duchenne muscular dystrophy,DMD)是肌营养不良症中最觉见的一种,它往往合并有严重的脊柱侧凸畸形,且畸形进展较特发性脊柱侧凸更为常见和迅速.对于同时合并有严重的肺功能障碍(定义为用力肺活量(forced vital capacity,FVC)小于预测值的30%)的病例,矫形外科医生往往面临两难的局面:一方面侧凸矫形手术对DMD患者十分重要;另一方面又十分担心术后呼吸系统并发症发生;既往文献对手术安全性及肺功能改善情况报道较少,日本北里大学的学者M.Takaso等人报道其成功治疗14例此类患者的经验.     

马方和类马方综合征合并脊柱侧凸患者肺功能障碍的模式及影响因素

目的 探讨合并脊柱侧凸的马方和类马方综合征患者肺功能损害的模式及其影响因素.方法 回顾性分析1998年2月至2007年9月行脊柱侧凸矫形内固定手术且有术前肺功能资料的25例马方和类马方综合征患者(A组)的临床资料,其中男性11例,女性14例;年龄11～20岁,平均15岁.分析其肺功能指标(实测值与预计值的比值)与冠状面Cobb角、胸弯顶椎位置、受累节段数以及胸椎后凸角的关系.并与同期行脊柱侧凸矫形内固定术且弯型与此匹配的38例青少年特发性脊柱侧凸(MS)患者(B组)的肺功能指标进行比较分析.结果 A组患者肺活量(VC)、用力肺活量(FVC)、第1秒最大呼气容积(FEVI)等指标与冠状面Cobb角呈显著负相关(r=0.514、-0.503、-0.464,P<0.05);VC、FVC、FEV1以及最大呼气中期流量(MMEF)等指标明显小于B组(P<0.05);顶椎位置在T_(4～8)与在T_(9～12)的患者之间肺功能指标差异无统计学意义;受累节段≥8的患者,VC、FVC、FEV1和最大自主通气量(MVV)等指标小于受累节段<8者(P<0.05);胸椎后凸角与肺功能指标之间无明显相关性.结论 合并脊柱侧凸的马方和类马方综合征患者肺功能损害较MS患者严重,其肺功能主要受胸弯受累节段数和胸弯冠状面Cobb角共同影响.     

青少年特发性胸段脊柱侧凸患者肺功能受限的决定因素

目的：通过对脊柱侧凸患者呼吸功能障碍程度与脊柱畸形特点间关系的研究来探讨脊柱畸形矫治术改善肺功能的可能性。方法：本文对７２例青少年特发性胸段脊柱侧凸患者的肺功能及脊柱侧凸角的大小、后凸角的大小、顶椎旋转程度、顶椎的位置、侧凸节段的长短做了仔细的检查和测量，并对两者间的关系进行了多元相关分析。结果：肺容量（以肺活量实测值占预计值的百分比ＶＣ％代表）及肺通气量（以最大通气量实测值占预计值的百分比ＭＶＶ％代表）与侧凸角及侧凸累及的胸椎椎体数目呈显著负相关关系（Ｐ＜０．０５）；与顶椎所在的位置在胸段的排列顺序呈显著正相关（Ｐ＜０．０５）；而与后凸角及顶椎旋转程度无明显相关。表明脊柱侧凸患者肺功能受损害的程度是由顶椎位置、侧凸节段长短及侧凸角度大小决定的。换句话说，顶椎在胸段的位置越高、累及的胸椎数目越多、侧凸角度越大，肺功能受限就越严重。结论：本研究结果提示改善肺功能必须大幅度矫正侧凸角，如能使之为０°，则可同时消除侧凸位置及节段的影响。     

短节段肋骨切除胸廓成形对脊柱侧凸患者肺功能的影响

目的探讨特发性脊柱侧凸后路矫形凸侧短节段肋骨切除胸廓成形术对肺功能的影响。方法 2006年1月至2007年5月,19例特发性胸椎侧凸患者行后路三维矫形术,并经同一切口行凸侧短节段肋骨切除胸廓成形术。男9例,女10例,年龄11～20岁,平均14.5岁。Lenke分型：1型13例,2型6例;术前Cobb角60°～104°,平均73.9°;术中切除肋骨4～6根,平均5.4根,切除长度1.5～2cm。所有患者术前均进行肺功能检查,选择用力肺活量（forced vital capacity,FVC）、第1秒最大呼气量（forced expiratory volume in 1 second,FEV_1）及二者占预计值百分比（FVC%,FEV_1%）作为观察指标,并分别于术后3个月、6个月、1年、2年复查肺功能,了解肺功能变化情况。所得数据用统计学方法进行分析。结果本组病例术后Cobb角10°～59°,平均26.5°,侧凸矫正率为64.1%;术后3个月时,FVC、FEV_1、FVC%及FEV_1%较术前均有下降,但其差异无统计学意义,术后6个月时接近术前水平,术后1年及2年较术前均有升高。校正年龄和身高对肺功能的影响后,FVC%及FEV_1%的动态变化显示术后3个月至2年患者肺功能在持续改善。结论脊柱侧凸后路三维矫形结合凸侧短节段肋骨切除胸廓成形对患者的肺功能干扰小,术后肺功能恢复快,可作为脊柱侧凸合并中重度胸牢的治疗选择。     

特发性与先天性脊柱侧凸患者肺功能障碍的差异性比较

目的：比较特发性脊柱侧凸（idiopathic scoliosis，IS）与先天性脊柱侧凸（congenital scoliosis．CS）患者肺功能参数的差异性。方法：术前检测214例脊柱侧凸患者的肺活量（vital capacity，VC）、用力肺活量（forced vital capacity，FVC）、第1秒用力呼气容积（forced expiratory volume in one second，FEV1）、最大呼气中期流量（maximal mid-expiratory flow，MMEF）、最大自主通气量（maximal voluntary ventilation，MVV），计算实测值占预计值百分比（实／预％），其中IS 141洌（IS组），CS73例（CS组），将肺功能指标与Cobb角进行相关分析。依据主弯顶椎所在位置分为胸段及非胸段侧凸两组，胸段侧凸依据Cobb角大小分为：Cobb角〈600（A组）、60&#176;≤Cobb角〈90&#176;（B组）、Cobb角≥90&#176;（C组）3组。分析胸段及非胸段IS、CS患者术前肺功能参数的差异．同时比较年龄≤10岁的IS、CS患者各参数的差异。结果：脊柱侧凸患者VC、FVC、FEV1、MMEF及MVV的实／预％与Cobb角呈显著性负相关（r=-0．40--0.55）。在胸段侧凸患者中，CS组的FEV1实／预％为64．2％，明显低于IS组患者的80．0％（P〈0．05）；不同Cobb角CS组患者的VC、FVC、FEV1、MVV实／预％值都较相应Cobb角的IS组患者低（P〈0．05）。非胸段侧凸患者中，CS组的VC、FVC、MVV的实／预％较IS组患者低（P〈0．05）。年龄≤10岁的CS与IS患者肺功能指标比较也具有显著性差异（P〈0．05）。结论：IS和CS患者均存在肺功能损害，但损害模式不同，IS以限制性通气功能障碍为特征，CS表现为混合性通气功能障碍；年龄和Cobb角相匹配时．无论在胸段还是非胸段，CS患者的肺功能损害均较IS患者严重；且两者肺功能损害的差异性在青春期前就存在。     

可溶性ST-2对接受阿霉素化疗乳腺癌患者的左心功能及结构变化预测价值的研究

目的通过检测乳腺癌患者接受阿霉素化疗后的可溶性致癌抑制因子2(sST-2)水平以及心脏功能指标,评估sST-2水平对左心功能损害的预测价值。方法回顾性收集2016年9月至2018年6月期间于郑州大学第五附属医院乳腺外科接受阿霉素(吡柔比星)化疗的90例乳腺癌患者的临床病理资料。所有患者均于化疗前以及接受蒽环类化疗药物治疗1年时抽取外周静脉血血样检测sST-2水平和心功能指标,同时行超声心动图检查。结果与化疗前比较,化疗1年时的sST-2、左心室收缩末期容积(left ventricular end-systolic volume,LVESV)、左心室舒张末期容积(left ventricular end diastolic volume,LVEDV)、左心室收缩末期内径(left ventricular systolic diameter,LVESD)、左心室舒张末期内径(left ventricular diastolic internal diameter,LVEDD)和二尖瓣舒张早期血流峰值速度与二尖瓣环舒张早期运动峰值速度比值(E/e’)升高,LVEF值降低,差异均有统计学意义(P<0.05)。sST-2水平与LVEF值存在负相关关系(r=–0.618,P<0.05)。受试者工作特征曲线结果显示,sST-2水平为11.9 ng/mL时为最佳临界值,以此预测左心室功能损害的灵敏度和特异度分别为90.6%和69.2%,ROC曲线下面积为0.836(P<0.05)。结论 sST-2对预测接受阿霉素类化疗的乳腺癌患者的左心功能有一定的辅助诊断价值。     

青少年特发性脊柱侧凸患者胸弯对心脏结构和功能的影响

目的:研究青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)患者心脏结构和功能特点,探讨脊柱侧凸胸弯对心脏结构和功能的影响。方法:收集2008年6月~2011年6月南京大学医学院附属鼓楼医院脊柱外科收治的主弯为胸弯的女性AIS患者资料,排除合并有先天性心脏病的15例患者,共374例纳入研究,年龄10~18岁(14.9±1.8岁)。回顾性分析心脏超声多普勒资料,得到AIS患者的心脏结构及功能指标,包括舒张末期室间隔厚度(interventricular septum thickness in end diastole,IVSTD)、舒张末期左室内径(left ventricular inner diameter in end diastole,LVDD)、收缩末期左室内径(left ventricular inner diameter in end systole,LVIDS)、舒张末期左室后壁厚度(posterior wall of left ventricle in end diastole,LVPWD)、主动脉根径(diameter of aortic root,DAR)、舒张末期左房内径(left atrial dimension,LAD)、射血分数(ejection fraction,EF)、肺动脉直径(diameter of arteria pulmonalis,DAP)、左室舒张早期血流充盈峰值流速(E峰),舒张晚期充盈峰值流速(A峰)、主动脉流速(aortic flow velocity,AV)。根据脊柱侧凸冠状面角不同,分为小Cobb角组(Cobb角≤70°)和大Cobb角组(Cobb角70°),比较两组心脏结构和功能指标;依据矢状面角不同,分为后凸减小(Cobb角10°)、正常后凸(Cobb角10°~40°)及后凸增加(Cobb角40°)3组,比较心脏结构和功能指标,确立对心脏结构和功能产生影响的相关单因素。再通过多重线性回归分析,研究对心脏结构和功能产生影响的独立因素及影响强度大小。结果:所有患者心脏结构和功能指标(LVDD、LVIDS、IVSTD、DAR、LVPWD、LAD、DAP、EF、E、A、E/A及AV)数值均在正常范围。在胸椎冠状面角度≤70°组与70°组之间的LVDD、LVIDS、AV有显著性差异(P0.05),IVSTD、DAR、LVPWD、LAD、DAP、EF、E、A、E/A两组之间无统计学差异(P0.05)。在矢状面角度10°组与10°~40°组之间的LVDD有显著性差异(P0.05),在矢状面角度10°组与40°组之间的IVSTD、LAD、DAP有显著性差异(P0.05),在矢状面角度10°~40°组与40°组之间的EF有显著性差异(P0.05),3组间LVIDS、DAR、LVPWD、E、A、E/A及AV无统计学差异(P0.05)。多重线性回归分析显示,冠状面角度是LVDD、LVIDS的独立影响因素(P0.05),其标准化偏回归系数分别为-0.150、-0.162;年龄是LVDD、LVIDS的独立影响因素(P0.05),其标准化偏回归系数分别为0.139、0.146;其标准化偏回归系数绝对值冠面角度大于年龄;年龄亦是IVSTD、DAR的独立影响因素(P0.05),其标准化偏回归系数分别为0.217、0.272。结论:AIS患者的心脏结构和功能指标基本上处于正常范围,但胸弯的冠矢状面畸形仍对AIS患者心脏结构产生影响,冠状面角度越大,左室内径值越小。     

伴呼吸衰竭脊柱侧凸的围手术期处理及治疗策略

目的 探讨伴有呼吸衰竭的脊柱侧凸的术前肺功能评估及相应的临床治疗策略.方法 2000年9月至2008年6月,收治16例脊柱侧凸患者接受系统完整的术前呼吸功能训练并成功接受后路矫形内固定手术,动脉血气分析达到呼吸衰竭的诊断标准,肺活量(vital capacity,VC)为预计值的25%～34%.5例为特发性脊柱侧凸,男2例,女3例;年龄10～16岁,平均13.5岁.11例为先天性脊柱侧凸,男5例,女6例;年龄10～14岁,平均12.4岁;椎体形成不良2例,分节不良4例,混合型5例;其中8例存在并肋畸形,7例合并肋骨缺失.按照累及部位划分,胸段脊柱侧凸10例,胸腰段脊柱侧凸1例;胸腰双主弯3例,三弯2例.16例患者术前Cobb角平均126.6°±15.5°;身高120～160 cm,平均137.6cm;体重18～40 kg,平均32.5 kg.根据术前肺功能状况和畸形严重程度决定手术方法.术前呼吸功能治疗包括:清醒状态下无创呼吸机辅助呼吸,Halo牵引,呼吸训练.结果 16例患者经过规范的呼吸训练和呼吸机及牵引治疗后,呼吸状况均有明显改善,可以耐受脊柱侧凸矫形手术.10例患者术后1 h顺利拔除气管插管,能够自主呼吸;另6例患者术后须转ICU,呼吸机辅助呼吸,24 h内恢复自主呼吸而拔管.术后2例患者发生肺水肿(其中1例合并肺部感染),未出现肺不张及重要脏器功能衰竭等严重并发症.术后Cobb角72.0°±13.2°,平均矫正率43%,外观改善明显.结论 通过完备的术前肺功能评估和围手术期准备,伴有呼吸功能衰竭的脊柱侧凸患者可以接受脊柱矫形手术并获得良好的治疗效果.     

Effects of scoliosis on respiratory muscle strength in patients with neuromuscular disorders

Background contextNeuromuscular disorders (NMD) are characterized by loss of lung volume and respiratory muscle weakness, but the effects of scoliosis on lung function are unclear.PurposeTo compare pulmonary function and respiratory muscle strength in patients with NMD with and without scoliosis as well as in healthy controls.Study design/settingProspective comparison of pulmonary function testing and respiratory muscle strength were made at the pediatric pulmonology and cardiopulmonary rehabilitation units of a university hospital.Patient sampleTwenty-two patients with NMD and scoliosis, 17 patients with NMD without scoliosis, and 24 age- and sex-matched healthy controls. Outcome measures were compared in patients with NMD with and without scoliosis and healthy subjects using Student t test, Mann-Whitney U test, chi-square test, one-way analysis of variance (ANOVA), Kruskal-Wallis one-way ANOVA, Pearson correlation coefficients, and Spearman rank correlation, as appropriate.Outcome measures1) Pulmonary function: forced vital capacity (FVC), forced expiratory volume in 1 second (FEV₁), peak expiratory flow rate (PEF), forced expiratory flow between 25% and 75% of FVC (FEF_25–75%), and maximum expiratory flows at 75%, 50%, and 25% of FVC (MEF₇₅, MEF₅₀, and MEF₂₅, respectively); 2) oxygen saturation: pulse oxymeter reading; and 3) respiratory muscle strength: maximal inspiratory mouth pressure (MIP) and maximal expiratory mouth pressure (MEP).MethodsPulmonary function, oxygen saturation, MIP, and MEP were measured and compared in patients with NMD, patients with and without scoliosis, and in healthy subjects.ResultsThe patients with NMD, both with and without scoliosis, had significantly lower PEF, MIP, MEP, % predicted MIP (%MIP), and % predicted MEP (%MEP) than those of healthy subjects (p<.05). The patients with NMD and scoliosis had significantly lower values than those with NMD without scoliosis and controls (p<.05) for FVC, FEV₁, and FEF_25–75%.ConclusionBoth inspiratory and expiratory muscle strength were diminished in patients with NMD compared with healthy controls. Significant differences were also noted in pulmonary function in patients with NMD with or without scoliosis. This suggests that NMD may impact respiratory function independently of the effects of scoliosis. Clinicians treating patients with NMD should be aware of the possibility of compromised respiratory function in these patients to address possible complications.     

64层螺旋CT低剂量双相扫描测定肺体积评价慢性阻塞性肺疾病患者肺功能

目的探讨64层CT低剂量双相扫描肺体积测量指标评估慢性阻塞性肺疾病(COPD)患者肺功能的价值。方法选择经临床肺功能检查确诊的36例COPD患者(COPD组)及30名健康体检者(正常对照组),采用64层CT行深吸气末、深呼气末全肺低剂量(50mAs)及常规剂量(100mAs)吸气末扫描,得出每次扫描的容积CT剂量指数(CTDIvol)和剂量长度乘积(DLP),并换算出有效剂量(ED)。以配对样本t检验比较两组间不同扫描剂量及不同呼吸状态下的CT-DIvol、DLP、ED;应用Fisher确切概率法比较CT图像质量。按扫描层数将全肺分为上、中、下3个肺区,应用Pulmo软件测量和计算COPD组与正常对照组的各体积指标:深吸气末体积(Vin)、深呼气末体积(Vex)、体积差(Vin-Vex)、体积比(Vex/Vin)、体积变化百分比(Vin-Vex)/Vin×100%。于CT检查前后3天完成PFT检查,对比研究指标为第1秒用力肺活量(FEV1)的实测值与预计值的比值(FEV1%)及FEV1与用力肺活量(FVC)的比值(FEV1/FVC)。结果所有图像均成功用于自动分割技术与数据处理。与正常对照组比较,COPD组除各肺区的Vin及上肺区Vin-Vex外,其余各体积指标差异均有统计学意义(P均<0.05);Vex、Vex/Vin、(Vin-Vex)/Vin×100%均与FEV1%、FEV1/FVC存在相关性(P<0.01)。结论 64层CT低剂量双相扫描肺体积指标可较好评价COPD患者肺功能,临床应用价值较高。     

Improvement in pulmonary function in asthmatic patients after bariatric surgery: a systematic review and meta-analysis

BackgroundThe association between obesity and asthma is well-established. Some evidence suggests that weight loss may improve asthma outcomes; however, the effect of bariatric surgery on pulmonary function in asthmatic patients remains inconclusive. This systematic review and meta-analysis of observational studies assessed the impact of bariatric surgery on patients with asthma.ObjectivesTo investigate the effect of bariatric surgery on pulmonary function in patients with asthma.SettingSystematic review and meta-analysis of published studies.MethodsA comprehensive search of the MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) databases was conducted. The sole inclusion criterion was published studies that evaluated the effects of bariatric surgery on pulmonary function in asthmatic patients. The outcomes of interest were forced expiratory volume in 1 second (FEV₁), forced vital capacity (FVC), and FEV₁/FVC. A meta-analysis of studies comparing pre- and postsurgery spirometric measures, and of studies comparing surgery and control groups was performed.ResultsFrom 25 full-text articles, 6 observational studies met the inclusion criteria and were included in this meta-analysis based on the random-effects model. A significant increase in FEV₁ and FVC was observed after bariatric surgery among studies without a control group (mean difference: .21 L, 95% confidence interval: .07–.35 for FEV₁, and mean difference: .34 L, 95% confidence interval: .14–.53 for FVC). There was no significant change in FEV₁/FVC after bariatric surgery compared with control.ConclusionsFEV₁ and FVC were both found to be significantly improved after bariatric surgery; however, no significant postsurgical improvement was observed for FEV₁/FVC.     

Severe idiopathic scoliosis with respiratory insufficiency treated with preoperative traction and staged anteroposterior spinal fusion with a 2-level apical vertebrectomy

Background contextSevere adolescent idiopathic scoliosis with respiratory insufficiency is infrequently seen in North America currently.PurposeTo present the case of a teenager from Moscow, Russia who was referred to our center with a severe scoliosis and respiratory compromise.Study design/settingA case report on the evaluation and surgical treatment of a severely deformed teenager.MethodsA 14+10-year-old was referred to our center for treatment of a 149° thoracic scoliosis. Preoperative pulmonary function tests (PFTs) revealed severe restrictive disease with a forced vital capacity (FVC) of 1.3 L (34% predicted) and a forced expiratory volume in 1 second (FEV₁) of 0.99 L (31% predicted). She underwent a 2-stage anterior and posterior 2-level vertebral column resection (VCR) with preoperative and in between anterior and posterior stage perioperative halo-gravity traction.ResultsHer thoracic scoliosis was corrected to 48° over 3 years postoperative. Her 3-year follow-up PFT revealed an FVC of 1.85 L (52% predicted) and an FEV₁ of 1.6 L (50% predicted).ConclusionsA staged anterior and posterior VCR with intervening halo-gravity traction is a viable option to treat severe scoliosis in patients with restrictive pulmonary function.     

The impact of metabolic parameters on the change of pulmonary function in obese patients

BackgroundEthnic differences exist in the function and distribution of adipose tissue, which influences whole body metabolism, including pulmonary function. The object of this study was to examine the relationships between serum metabolic parameters and pulmonary function in a morbidly obese Asia-Pacific population.MethodsOne-hundred thirty-seven morbidly obese Chinese patients, aged≥18 years with a body mass index (BMI)>32 kg/m² who were being evaluated for bariatric surgery between July 2007 and December 2008, were studied. Cross-sectional associations between serum metabolic parameters, including lipids, glucose, insulin, leptin, and adiponectin levels with forced vital capacity (FVC) and forced expiratory volume in the first second (FEV₁) assessed by spirometry, were analyzed. Multiple regression analyses also were conducted, with age, gender, smoking history, and various anthropometric measurements of obesity as confounders.ResultsSerum adiponectin and HDL cholesterol had a positive correlation with FVC and FEV₁. In addition, insulin resistance, determined by the homeostatic model assessment method (HOMA), was negatively correlated with FVC. In the multiple linear regression analysis, only serum adiponectin was significantly correlated with FVC and FEV₁, independent of obesity level.ConclusionsSerum adiponectin level was positively and independently associated with pulmonary function in morbidly obese Chinese adults.     

Assessment of pulmonary function in patients before and after laparoscopic and open esophagogastric surgery

Background Laparoscopy is a technique used in various surgical procedures. Few studies in the literature compare stress between laparoscopic and open surgery used for esophagogastric surgical procedures. Pulmonary function is known to be significantly affected in open surgeries, increasing postoperative morbidity and mortality. The current study aimed to assess pulmonary function in patients before and after open and laparoscopic esophagogastric surgery.Methods For this study, 75 patients were divided into two groups: 50 patients undergoing laparoscopy and 25 patients undergoing open surgery. The following parameters were determined by spirometry before and after surgery: forced expiratory volume in the first second (FEV₁), forced vital capacity (FVC), and forced expiratory flow in the midexpiratory phase (FEF_25–75%).Results A decrease in FEV_1, FVC, and FEF_(25–75%) was observed in the two groups on postoperative days 2, 3, and 4, as compared with the preoperative period. Likewise, FEV₁ and FVC showed a significant reduction on postoperative days 2, 3, and 4 in the patients who underwent to open surgery, but only on the day 2 in those who underwent to laparoscopic surgery. A significant decrease in FEF_(25–75%) was observed only on postoperative day 2 in the group that underwent open surgery. Significant differences in FEV₁ between the groups were observed on postoperative days 2, 3, and 4. No significant difference in FVC was noted between the groups, and a difference in FEF_(25–75%) was observed only on postoperative day 4.Conclusions Postoperative pulmonary dysfunction was more important for the patients undergoing open surgery than for those undergoing laparoscopic surgery.     

Functional aerobic exercise capacity limitation in adolescent idiopathic scoliosis

Background context

Exercise limitation has been described in patients with adolescent idiopathic scoliosis (AIS); however, whether the walking performance is impaired in these patients should be elucidated.

Purpose

Thus, we aimed to evaluate the physiologic responses to the incremental shuttle walk test (ISWT) in patients with AIS.

Study design/setting

Cross-sectional study.

Patient sample

Twenty-nine patients with AIS and 20 healthy adolescents aged between 11 and 18 years old.

Outcome measures

Oxygen uptake (VO₂), incremental shuttle walk distance (ISWD), ΔVO₂/Δwalking velocity, ΔHR/ΔVO₂, ΔVE/ΔVCO₂, and linearized Δtidal volume (VT)/ΔlnVE, forced expiratory volume in the first second of expiration (FEV₁), and forced vital capacity (FVC).

Methods

We performed two ISWTs, and the data used were acquired in the second test. We also evaluated the lung function and respiratory muscle strength through spirometry test and manovacuometry, respectively. All authors confirm that there are no conflicts of interest. To compare the means or medians of variables between patients and healthy subjects, we used the unpaired t test or Mann-Whitney U test, respectively. The correlations were assessed by Pearson or Spearman coefficients according to the distribution of the studied variables. The probability of alpha error was set at 5% for all analyses.

Results

Adolescent idiopathic scoliosis patients showed significant lower values of ISWD, VO₂, and ventilation at the end of the ISWT, as well as lower FEV₁ and FVC; they also presented significantly shallower slope of ΔVT/ΔlnVE, whereas VO₂ related significantly with ISWD (r=0.80), FVC (r=0.78), FEV₁ (r=0.73), and ΔVT/ΔlnVE (r=0.58).

Conclusions

Adolescent idiopathic scoliosis correlated to walking limitation and was associated to reduced pulmonary function and worse breathing pattern during exercise. Our results suggest that walking-based aerobic exercises should be encouraged in these patients.     

Pulmonary function in normal Jordanian children

A sample of 204 male and 224 female healthy Jordanian children was selected to determine the normal ventilatory functions of this Arab population. Forced vital capacity (FVC), one-second forced expiratory volume (FEV₁), and forced mid-expiratory flow rate (FMFR 25-75%) were determined with a dry bellows spirometer. Multiple linear regression formulae and correlation coefficients were computed for the group. Jordanian values for FVC and FEV₁ were similar to those of Caucasians living in the Western hemisphere.     

Adaptation to reduced lung function in children and young people with spinal deformity

BackgroundSevere scoliosis can affect respiratory function in growing patients and produce cardiopulmonary complications, leading to significant morbidity. The development of spinal deformity may impact on young patients’ level of function and reported quality of life (QOL). The aim of this study was to investigate the relationship between lung function, exercise capacity and quality of life in young patients with spinal deformity.MethodsThis is a retrospective analysis of 104 patients (31% male, 69% female with mean age 14.9yrs). 77% of patients had an adolescent idiopathic scoliosis, with the remainder having other scoliosis diagnoses or Scheuermann’s kyphosis. Principal outcomes included Spirometry [FEV₁, FVC], Whole Body Plethysmography, Cardiopulmonary Exercise Testing [CPET] and patient outcome questionnaires (with SRS-22). CPET measures included maximal exercise capacity [VO_2peak] as well as VO₂ at ventilatory threshold [VT] expressed as %predicted VO_2max-a measure of physical conditioning, and minute ventilation [V_E] from which breathing reserve [BR] could be calculated.ResultsMean (±SD) main thoracic scoliosis was 59.9⁰ (±15.2⁰), and mean kyphosis in those with Scheuermann’s condition was 95.3⁰ (±11.5⁰). No correlation was elicited between FEV₁ or FVC (%predicted) and VO_2peak (%predicted) in this patient cohort. Greater thoracic curves were associated with lower FEV₁ (%predicted), r = −0.343, p = 0.001, FVC (%predicted), r = −0.307, p = 0.003 and BR (%) at the end of exercise (r = −0.-0.459, p < 0.001). The patient cohort had a mean (sd) VO₂peak of 98(17) %predicted, with greater VO₂peak levels recorded in female subjects, those of younger age and those with higher scoliosis angles. Those with better lung function [FEV₁ (%predicted)] had better BR (%) at the end of exercise (r = 0.483, p < 0.001). SRS-22 scores correlated significantly with VO_2peak (%predicted) (total SRS-22 versus VO_2peak (%predicted), r = 0.336, p = 0.002).ConclusionLarger thoracic scoliotic curves are associated with poorer lung function but better exercise capacity, likely related to higher levels of physical conditioning. Higher QOL scores were recorded in patients who had greater VO_2peak levels, suggesting that exercise capacity may be a protective factor for emotional well-being in patients with spinal deformity.