Risk factors of respiratory muscle dysfunction in patients with adolescent idiopathic scoliosis
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摘要:
目的 调查青少年特发性脊柱侧凸患者并发呼吸肌功能障碍情况，分析其危险因素，并提出针对性干预措施。 方法 选取温州医科大学附属第二医院2021年1月—2024年12月收治的80例青少年特发性脊柱侧凸患者，所有患者入院后，通过查询电子病历与面对面询问的方式获取患者性别、年龄等一般资料，根据是否发生呼吸肌功能障碍，将80例患者分为已发生组和未发生组，分别采用单因素与多因素logistic回归分析法研究青少年特发性脊柱侧凸患者发生呼吸肌功能障碍的危险因素，并根据高危因素提供针对性干预策略。 结果 （1）80例青少年特发性脊柱侧凸患者中，共有29例患者发生呼吸肌功能障碍，列为发生组，呼吸肌功能障碍发生率为36.25%（29/80）。（2）多因素分析结果显示，Cobb角角度较大、学习舞蹈、呼吸训练不依从是造成青少年特发性脊柱侧凸患者发生呼吸肌功能障碍的危险因素（P < 0.05）。 结论 对于青少年特发性脊柱侧凸患者而言，其呼吸肌功能障碍发生风险仍较高，现况不容乐观；Cobb角角度较大、学习舞蹈、呼吸训练不依从是造成青少年特发性脊柱侧凸患者发生呼吸肌功能障碍的危险因素，根据高危因素制定针对性康复干预策略，有望降低呼吸肌功能障碍发生率。 -
关键词:
- 青少年特发性脊柱侧凸 /
- 呼吸肌功能障碍 /
- 危险因素 /
- 康复策略
Abstract:Objective To investigate the respiratory muscle dysfunction in patients with adolescent idiopathic scoliosis, analyze the risk factors, and propose targeted intervention measures. Methods A total of 80 patients with adolescent idiopathic scoliosis admitted to the Second Affiliated Hospital of Wenzhou Medical University from January 2021 to December 2024 were studied. After admission, general data such as gender and age were obtained by querying electronic medical records and face-to-face inquiries. According to whether respiratory muscle dysfunction occurred, 80 patients were divided into the occurrence group and the non-occurrence group. Univariate and multivariate logistic regression analyses were used to screen the risk factors of respiratory muscle dysfunction in patients with adolescent idiopathic scoliosis. Targeted nursing strategies were provided based on high-risk factors. Results Among 80 patients with adolescent idiopathic scoliosis, 29 cases had respiratory muscle dysfunction and were classified as the occurrence group. The incidence rate of respiratory muscle dysfunction was 36.25% (29/80). Multivariate analysis showed that large Cobb angle, learning dance, and respiratory training non-compliance were risk factors of respiratory muscle dysfunction in patients with adolescent idiopathic scoliosis (P < 0.05). Conclusion For patients with adolescent idiopathic scoliosis, the occurrence risk of respiratory muscle dysfunction is still high, and the status quo is not optimistic. Large Cobb angle, learning dance, and respiratory training non-compliance are risk factors leading to respiratory muscle dysfunction in patients with adolescent idiopathic scoliosis. Targeted rehabilitation nursing strategies based on high-risk factors are expected to reduce the incidence rate of respiratory muscle dysfunction. -
表 1 青少年特发性脊柱侧凸患者发生呼吸肌功能障碍的单因素分析
Table 1. Univariate analysis of respiratory muscle dysfunction in patients with adolescent idiopathic scoliosis
项目 发生组(n=29) 未发生组(n=51) 统计量 P值 性别[例(%)] 4.381a 0.036 男 10(34.48) 30(58.82) 女 19(65.52) 21(41.18) 年龄(x±s，岁) 13.57±1.70 14.01±1.54 1.396b 0.166 BMI(x±s) 20.36±1.13 19.84±1.08 2.036b 0.045 病程(x±s，月) 6.94±1.63 6.51±1.37 1.259b 0.212 不良嗜好[例(%)] 0.070a 0.792 是 4(13.79) 6(11.76) 否 25(86.21) 45(88.24) 家族遗传史[例(%)] 4.293a 0.038 是 14(48.28) 13(25.49) 否 15(51.72) 38(74.51) 侧凸部位[例(%)] 0.548a 0.459 L1~L2 6(20.69) 13(25.49) T3~T4 8(27.59) 16(31.37) T5~T7 8(27.59) 10(19.61) T8~T9 7(24.14) 12(23.53) Cobb角角度(x±s，°) 41.94±6.86 22.18±5.01 14.793b ＜0.001 术后下床活动时间(x±s，d) 2.13±0.51 1.97±0.49 1.383b 0.171 开展核心肌群锻炼[例(%)] 0.145a 0.703 是 26(89.66) 47(92.16) 否 3(10.34) 4(7.84) 学习舞蹈[例(%)] 7.235a 0.007 是 14(48.28) 10(19.61) 否 15(51.72) 41(80.39) 经常运动[例(%)] 0.751a 0.386 是 16(55.17) 23(45.10) 否 13(44.83) 28(54.90) 呼吸训练依从[例(%)] 13.732a ＜0.001 是 10(34.48) 39(76.47) 否 19(65.52) 12(23.53) SAS≥50分[例(%)] 4.579a 0.032 是 18(62.07) 19(37.25) 否 11(37.93) 32(62.75) SDS≥53分[例(%)] 5.169a 0.023 是 16(55.17) 15(29.41) 否 13(44.83) 36(70.59) 注：a为χ2值，b为t值。 
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表 2 自变量赋值情况
Table 2. The assignment situation of independent variables
自变量 赋值方法 性别 女性=1，男性=0 BMI 以实际值赋值 家族遗传史 是=1，否=0 Cobb角角度 以实际值赋值 学习舞蹈 是=1，否=0 呼吸训练依从 否=1，是=0 SAS评分≥50分 是=1，否=0 SDS评分≥53分 是=1，否=0
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表 3 青少年特发性脊柱侧凸患者发生呼吸肌功能障碍的多因素logistic回归分析
Table 3. Multivariate analysis of factors contributing to the respiratory muscle dysfunction in patients with adolescent idiopathic scoliosis
变量 B SE Waldχ2 P值 OR值 95% CI 性别 0.777 0.461 2.481 0.093 2.175 0.881~5.369 BMI 0.813 0.524 2.407 0.122 2.255 0.807~6.297 家族遗传史 0.795 0.482 2.270 0.100 2.214 0.861~5.696 Cobb角角度 0.943 0.360 6.861 0.009 2.568 1.268~5.200 学习舞蹈 0.904 0.435 4.319 0.038 2.469 1.053~5.793 呼吸训练不依从 0.913 0.374 5.959 0.015 2.492 1.197~5.186 SAS评分≥50分 0.794 0.438 3.271 0.071 2.212 0.936~5.230 SDS评分≥53分 0.882 0.468 3.552 0.060 2.416 0.965~6.045
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