低肺活量：影响脊髓损伤患者功能预后的独立危险因素

关键词：脊髓损伤  预后  基础肺功能  相关因素

Keywords:spinal cord injury  prognosis  basic lung function  related factors

摘要：

      摘要 目的：探讨基础肺功能指标与脊髓损伤（spinal cord injury， SCI）患者功能预后的相关性，为临床早期精准判断预后及提高康复效果提供依据。 方法：回顾性分析2018年6月至2022年5月由空军军医大学第一附属医院康复医学科收治的SCI患者398例。收集患者入院时年龄、性别、身体质量指数（body mass index， BMI）、入院距损伤时间、住院天数、ASIA（American Spinal Injury Association）分级、损伤平面、血液学指标（白细胞计数、红细胞计数、血红蛋白浓度）、入院时基础肺功能指标包括潮气量（tidal volume， VT）、肺活量（vital capacity， VC）、用力肺活量（forced vital capacity， FVC）、第一秒用力呼气容积（forced expiratory volume in one second， FEV1）、一秒率（forced expiratory volume in one second/forced vital capacity， FEV1/FVC）、呼气峰流速（peak expiratory flow， PEF）、用力呼出25%肺活量时的呼气流速（FEF25）、用力呼出50%肺活量时的呼气流速（FEF50）、用力呼出75%肺活量时的呼气流速（FEF75）、最大通气量（maximal voluntary ventilation， MVV）、最大通气量占预计值百分比（maximal voluntary ventilation/maximal predicted voluntary ventilation， MVV/MVVpre）等资料。以改良Barthel指数的平均相对功能恢复百分比（mean relative function gain， mRFG）作为因变量，利用单因素及多因素线性回归方法分析筛选出影响SCI患者预后的相关因素，尤其是基础肺功能指标。 结果：单因素及多因素线性回归分析结果显示，SCI患者预后与ASIA分级（B=11.064， P=0.019）、住院天数（B=0.125， P=0.005）及VC（B=5.177， P=0.014）有显著相关性。VC判断SCI患者预后的临界值为2.39L。 结论：低VC是SCI患者功能预后的独立危险因素。入院时检测基础肺功能有助于判断SCI患者功能预后，其中VC为2.39L以下患者提示预后更差，对于这类患者应予以重点关注，介入更充分地康复治疗， 最大程度改善患者的日常生活能力。

Abstract:

      Abstract Objective：To investigate the correlation between basic lung function indicators and functional prognosis of spinal cord injury （SCI）， and provide a basis for accurately judging the prognosis and improving the recovery effect in the early clinical stage. Method：A retrospective analysis was made of 398 patients who met the inclusion and exclusion criteria in the department of rehabilitation medicine of the first affiliated hospital of the air force military medical university from June 2018 to May 2022. The data of patients' age， sex， body mass index （BMI）， time from admission to injury， length of stay， ASIA classification and injury level， hematological indicators （white blood cell count， red blood cell count， hemoglobin concentration）， and basic lung function test indicators at admission including tidal volume （VT）， vital capacity （VC）， forced vital capacity （FVC）， forced expiratory volume in one second （FEV1）， forced expiratory volume in one second/forced vital capacity （FEV1/FVC）， peak expiratory flow （PEF）， 25% forceful exhalation forced expiratory flow at 25% of FVC exhaled（FEF25）， forced expiratory flow at 50% of FVC exhaled（FEF50）， forced expiratory flow at 75% of FVC exhaled（FEF75）， maximal voluntary ventilation （MVV）， maximal voluntary ventilation/maximal predicted voluntary ventilation （MVV/MVVpre） were collected. The mean relative function gain （mRFG） of the modified Barthel index was used as the dependent variable， and the unit and multiple linear regression methods were used to identify the relevant factors affecting the prognosis of SCI patients， especially the underlying lung function indicators. Result：The single and multiple linear regression analysis showed that the prognosis of SCI patients was significantly related to the ASIA classification （B=11.064， P=0.019）， length of stay （B=0.125， P=0.005） and VC （B=5.177， P=0.014）. The cut-off value for VC judging the prognosis of SCI patients was 2.39L. Conclusion： Low VC is an independent risk factor for functional outcome in patients with SCI.The detection of basic lung function at the time of admission can help to judge the functional prognosis of patients with SCI. For the patients with VC below 2.39L， the prognosis is worse. Close attention should be paid to these patients， and more adequate rehabilitation treatments should be involved to maximize the improvement of patients' daily living ability.