老年肩袖损伤手术患者术前肺功能的影响因素

doi:10.19723/j.issn.1671-167X.2021.05.015

摘要/Abstract

摘要：

目的: 分析肩袖损伤手术患者术前肺功能情况以及可能的相关影响因素。方法: 回顾北京大学第三医院2020年1—6月所有术前进行了肺功能检查的肩袖损伤手术患者,通过数据库管理系统对其围术期病历资料及肺功能主要参数进行研究,分析性别、年龄、体重指数(body mass index,BMI)、有无吸烟史、损伤时间长短、疼痛视觉模拟评分(visual analogue scale,VAS)等因素对围术期患者肺功能检查结果的影响。结果: 共纳入29例肩袖损伤患者,其中1例报告限制性通气功能障碍,2例报告阻塞性通气功能障碍,均否定呼吸疾病病史,且无呼吸道相关症状。所有患者的平均第1秒用力呼气容积(forced expiratory volume in one second,FEV1)/用力肺活量(forced vital capacity,FVC)为79.2%±5.9%,VAS评分均值为3.66±1.26。入组患者中,超过半数动态肺功能FVC及FEV1低于预计值,2/3患者的肺总量(total lung capacity,TLC)低于预计值。三项肺功能检查指标在不同性别之间差异有统计学意义,BMI正常组(18 kg/m²2)和超重/肥胖组(BMI≥24 kg/m²)间的TLC占预计值的百分比差异有统计学意义,不同损伤时间组(≥1年和<1年)患者FVC和TLC差异有统计学意义。结论: 除性别及年龄外,损伤时间、疼痛程度及是否超重/肥胖可能会影响老年肩袖手术患者的肺功能结果。术前肺功能情况可以作为围术期患者呼吸训练和康复的基础评估指标之一,可针对性地对肺功能各影响因素进行提前干预。

关键词: 肩袖损伤, 矫形外科手术, 呼吸功能试验, 疼痛测定, 危险因素

Abstract:

Objective: To analyze the preoperative pulmonary function in rotator cuff injury patients and the possible influencing factors. Methods: All the rotator cuff surgery patients who underwent pre-operative pulmonary function examination in Peking University Third Hospital from Jan. 2020 to Jun. 2020 were retrospectively reviewed. Their perioperative medical records and main parameters of pulmonary function were collected from database management system, and their gender, age, body mass index (BMI), smoking history, time from injury, visual analogue scale (VAS) and other factors impacting on preoperative pulmonary function were studied. Results: Twenty-nine patients with rotator cuff injury were included, among whom 1 patient was reported to have restrictive ventilation dysfunction and 2 patients to have obstructive ventilation dysfunction. All the three patients denied the history of respiratory diseases, and had no respiratory symptoms. In all enrolled patients, the mean forced expiratory volume in one second (FEV1)/ forced vital capacity (FVC) was 79.2%±5.9%, and the mean VAS pain score was 3.66±1.26. In addition, the dynamic pulmonary functions (FVC, FEV1) were reduced in more than half of the elderly, and the total lung capacity (TLC) was lower than the estimated value in 2/3 of the elderly. There were significant differences in three main indexes of pulmonary functions between genders, and the percentage of the estimated TLC between normal BMI group (18 kg/m²2) and overweight/obesity group (BMI≥24 kg/m²) was significantly different. Based on the injury time longer than 1 year or not, the results indicated that FVC and TLC were significantly different between the two groups. Conclusion: In addition to gender and age, time from injury and severity of pain, as well as overweight/obesity, may influence pulmonary function outcomes in the elderly rotator cuff patients. Targeted intervention can be carried out on these factors before surgery. Preoperative lung function test can be used as one of the basic evaluation indexes for respiratory training and rehabilitation of patients.

Key words: Rotator cuff injuries, Orthopedic procedures, Respiratory function tests, Pain measurement, Risk factors

中图分类号:

R684.73

朱敬先,鲁胜楠,蒋艳芳,姜玲,王健全. 老年肩袖损伤手术患者术前肺功能的影响因素[J]. 北京大学学报（医学版）, 2021, 53(5): 902-906.

Jing-xian ZHU,Sheng-nan LU,Yan-fang JIANG,Ling JIANG,Jian-quan WANG. Influencing factors of preoperative pulmonary function in elderly patients undergoing rotator cuff surgery[J]. Journal of Peking University (Health Sciences), 2021, 53(5): 902-906.

图/表 3

表1

患者基本信息汇总"

Gender	Age/years, $x ?$ ±s	BMI, n		Time from injury, n		Injury side, n
Gender	Age/years, $x ?$ ±s	18-24 kg/m²	≥24 kg/m²	<1 year	≥1 year	Left	Right
Male (n=11)	63.9±4.7	4	7	10	1	2	9
Female (n=18)	63.4±4.4	11	7	10	8	7	11

表1

表2

表3

参考文献 21

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Index	FVC/L	FVC%	FEV1/L	FEV1%	TLC/L	TLC%
Gender
Male	3.31±0.55	92.45%±11.77%	2.79±0.49	91.45%±13.80%	5.93±0.64	92.55%±9.58%
Female	2.49±0.34^*	90.94%±14.92%	2.00±0.31^*	93.67%±14.92%	4.61±0.73^*	97.94%±15.99%
BMI
18-24 kg/m²	2.90±0.72	95.80%±11.07%	2.28±0.53	96.67%±11.76%	5.15±0.85	101.33%±12.63%
≥24 kg/m²	2.92±0.65	86.93%±14.97%	2.32±0.57	88.71%±16.05%	5.06±1.04	90.07%±13.36%^#
Time from injury
<1 year	3.08±0.69	93.05%±12.46%	2.41±0.54	93.20%±14.86%	5.40±0.88	97.80%±12.76%
≥1 year	2.52±0.50^△	88.11%±15.95%	2.05±0.47	92.00%±13.79%	4.46±0.76^△	91.67%±16.06%

Influencing factors	FVC	FVC%	FEV1	FEV1%	TLC	TLC%
Age	-0.1 (-0.1, 0)^*	-0.7 (-1.9, 0.5)	-0.1 (-0.1,0)^*	-0.7 (-1.9, -0.6)	0 (-0.1, 0.1)	0.5 (-0.7, 1.7)
VAS pain score	-0.2 (0, -0.4)^#	0 (-4.4, 4.4)	0.1 (0, 0.3)	-0.9 (-5.6, 3.7)	0.3 (0, 0.5)	0.7 (-3.8, 5.2)