Idiopathic scoliosis. Gas exchange and the age dependence of arterial blood gases.
Idiopathic scoliosis. Gas exchange and the age dependence of arterial blood gases.
复制标题
特发性脊柱侧弯。
DOI：
10.1172/jci108535
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发表时间：
1976
期刊：
影响因子：
--
通讯作者：
E. Kafer
中科院分区：
文献类型：
--
作者：
E. Kafer
目的是检查脊柱侧凸患者的气体交换和动脉血气异常，以及这些异常与年龄和畸形严重程度的相关性。51例患者平均年龄25.4 +/- 17.5岁，脊柱侧凸角度80.2 +/- 29.9 (SD)，肺活量1.94 +/- 0.91 (SD)（60.6 +/- 19.2%的预测），PaO2 85.8 +/- 12.0 (SD), PaCO2 42.4 +/- 8.0，生理死亡空间与潮气量比0.438 +/- 0.074 (SD)，肺泡动脉血氧差14.9 +/- 8.9 （SD）。PaCO2、生理死气量与潮气量比随年龄增大而增大，PaO2、肺泡通气量随年龄增大而减小。PaO2、肺泡通气量、潮气量与脊柱侧凸角度呈负相关，与肺活量、预测肺活量百分比、呼吸系统顺应性直接相关。生理死气量与潮气量比、肺泡动脉血氧差与肺活量、预测肺活量百分比、呼吸系统顺应性呈负相关。PaCO2与呼吸系统弹性直接相关。我们认为胸腔畸形导致的通气-血流分布不均匀是主要的气体交换异常，并且随着年龄的增长，气体交换逐渐恶化。PaCO2的年龄依赖性增加和肺泡通气的减少是由于生理性死亡空间与潮气量比的增加和代偿性通气增加的失败。
The aims were to examine the gas exchange and arterial blood gas abnormalities among patients with scoliosis, and the correlation of these abnormalities with age and severity of deformity. Means among 51 patients were as follows: age 25.4 +/- 17.5 yr, angle of scoliosis 80.2 +/- 29.9 (SD), vital capacity 1.94 +/- 0.91 (SD) (i.e. 60.6 +/- 19.2% of predicted), PaO2 85.8 +/- 12.0 (SD), PaCO2 42.4 +/- 8.0, physiological dead space to tidal volume ratio 0.438 +/- 0.074 (SD), and alveolar-arterial oxygen difference breathing air 14.9 +/- 8.9 (SD). Statistically significant correlations were as follows: the PaCO2 and physiological dead space to tidal volume ratio increased with age, and the PaO2 and alveolar ventilation decreased with age. The PaO2, alveolar ventilation, and tidal volume were inversely related to the angle of scoliosis and directly related to the vital capacity, precent predicted vital capacity, and the compliance of the respiratory system. The physiological dead space to tidal volume ratio and the alveolar-arterial oxygen difference were inversely related to the vital capacity, percent predicted vital capacity, and the compliance of the respiratory system. PaCO2 was directly related to the elastance of the respiratory system. We conclude that ventilation-blood flow maldistribution as a result of deformity of the rib cage was the primary abnormality in gas exchange, and that with age there was progressive deterioration in gas exchange. The age-dependent increase in PaCO2 and decrease in alveolar ventilation were due to the increasing physiological dead space to tidal volume ratio and failure of a compensatory increase in ventilation.