Significant ventilatory functional restriction in adolescents with mild or moderate scoliosis during maximal exercise tolerance test
Significant ventilatory functional restriction in adolescents with mild or moderate scoliosis during maximal exercise tolerance test
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DOI：
10.1097/01.brs.0000169447.55556.01
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发表时间：
2005-07-15
期刊：
影响因子：
3
通讯作者：
Laguía, M
中科院分区：
文献类型：
--
作者：
Barrios, C;Pérez-Encinas, C;Laguía, M
研究设计。青少年特发性脊柱侧弯患者心肺耐受性的前瞻性评估。目的：评估轻度和中度曲度特发性脊柱侧弯患者在最大运动耐力试验中的呼吸功能限制，并将其与年龄匹配的健康青少年进行类似试验的结果进行比较。青少年特发性脊柱侧弯患者在常规静态肺活量测定法测量的呼吸参数方面没有明显的限制。很少有报告涉及青少年特发性脊柱侧凸轻度至中度曲度对最大运动的心肺反应。尽管结果似乎显示这些患者的运动耐量降低，但由于先前研究中重要的设计限制，限制工作能力的频率和意义尚不确定。对37例确诊为青少年特发性脊柱侧凸的女孩，年龄11~16岁，平均32.8°Cobb(20~45°)，在最大运动耐量试验中进行基础肺活量测定和动态呼吸参数的研究。在10名年龄匹配的健康女孩的对照组中进行了类似的研究。运动测试包括在跑步机上以0.75米/秒(2.7公里/小时)的速度开始，以每分钟0.2米/秒(0.72公里/小时)的速度递增。所有受试者完成力竭测试，测定最大摄氧量(VO2(Max))和呼吸机效率参数。脊柱侧弯女童的基础通气量(FVC、FEV1)与健康女童无差异。然而，特发性脊柱侧弯青少年对运动试验的耐受性较差，最大运动平均速度(9.4公里/小时比11.5公里/小时，P<；0.005)，最大运动时的换气效率(VE：68.9 L/分钟比82.3 L/分钟，P<；0.001)，早期无氧阈值，以及以体重标准最大摄氧量(最大摄氧量)下降23%表示的有氧功率较低(38.6mL/kg/min比49.0mL/kg/min，P<；0.001)。VEmax与脊柱侧弯的严重程度相关。曲度越严重的患者通气量限制越大(r=-0.374，P<；0.05)。脊柱侧弯女孩的最大呼吸频率更高(54比47，P<；0.05)，这表明在高强度运动中，针对低通气量采用了一种代偿机制。当通过VE/VO2比率来考虑呼吸效率时，脊柱侧弯女孩的值高于对照组(平均35.2vs29.6P<；0.001)，表明她们的换气效率低下。在基础肺活量测定和运动耐量试验中，在进行呼吸机功能评估时佩戴支具的患者没有表现出任何差异。尽管轻度或中度脊柱侧弯患者在基础静态条件下没有表现出心肺受限，但他们对最大运动的耐受性明显降低。呼吸效率低下、低通气量和低VO2(最大摄氧量)可能是导致特发性脊柱侧凸青少年运动耐量降低的原因。脊柱侧弯患者的运动解除条件不能归因于支具治疗。
Study Design. A prospective evaluation of cardiopulmonary tolerance to maximal exercise in adolescent idiopathic scoliosis.Objectives. To evaluate ventilatory functional restrictions during a maximal exercise tolerance test in idiopathic scoliosis patients with mild and moderate curves and to compare them with the results obtained in healthy adolescents matched in age undergoing similar test.Summary of Background Data. Adolescents with idiopathic scoliosis with mild curves do not exhibit significant restrictions in ventilatory parameters measured by conventional static spirometry. Few reports have dealt with cardiorespiratory response to maximal exercise in adolescent idiopathic scoliosis with mild to moderate curves. Although results seem to show a reduced exercise tolerance in these patients, the frequency and signification of the restricted work capacity is uncertain because of important design limitations in previous studies.Methods. Thirty-seven girls diagnosed with adolescent idiopathic scoliosis with a mean age of 13 years ( range, 11-16) and an average scoliotic curve of 32.8 degrees Cobb ( range, 20-45 degrees) were studied by basal spirometry and dynamic ventilatory parameters during a maximal exercise tolerance test. Similar studies were performed in a control group of 10 healthy girls matched in age. Exercise test consisted of a ramp protocol on treadmill starting at a speed of 0.75 m/second ( 2.7 km/hour) with increments of 0.2 m/second ( 0.72 km/hour) per minute. All subjects completed the test to exhaustion to determine maximal oxygen uptake (VO2 (max)) and ventilatory efficiency parameters.Results. There were no differences between scoliotic and healthy girls in basal ventilatory parameters ( FVC, FEV1). However, adolescents with idiopathic scoliosis showed worse tolerance to exercise test with lower maximal speed average ( 9.4 km/hour versus 11.5 km/hour, P < 0.005), lower ventilatory efficiency at maximal exercise ( VE: 68.9 L/minute versus 82.3 L/minute, P < 0.01), early anaerobic threshold, and a lower aerobic power expressed by 23% decreased body weight normalized VO2 (max) ( 38.6 mL/kg/minute versus 49.0 mL/kg/minute, P < 0.001). VEmax values were correlated to the severity of the scoliotic curve. Patients with more severe curves had greater limitation of ventilatory capacity ( r = -0.374, P < 0.05). Maximal breath frequency was higher in scoliotic girls ( 54 versus 47, P < 0.05) suggesting a compensatory mechanism adopted in response to the lower ventilatory capacity during demanding exercise. When ventilatory efficiency was considered by the VE/VO2 ratio, scoliotic girls disclosed higher values than control ( average 35.2 versus 29.6, P < 0.001) indicating an inefficiency in their ventilation. Patients wearing a brace at the time of ventilatory functional assessment did not exhibit any difference in the parameters investigated both at basal spirometry and during exercise tolerance test.Conclusion. Although patients with mild or moderate scoliosis do not exhibit cardiopulmonary restrictions in basal static conditions, they do show a significant lower tolerance to maximal exercise. Respiratory inefficiency together with lower ventilation capacity and lower VO2 (max) may be responsible for reduced exercise tolerance in adolescents with idiopathic scoliosis. Exercise deconditioning in scoliotic patients cannot be attributed to brace treatment.