Naslov
Analiza kardiorespiratorne funkcije bolesnika poslije kirurške korekcije skoliotične kralješnice
(Analysis of cardiorespiratory function in patients after surgically correction of scoliotic spine)

Autori
Zdravčević - Šakić, Katarina

Vrsta, podvrsta i kategorija rada
Ocjenski radovi, doktorska disertacija

Fakultet
Medicinski fakultet

Mjesto
Zagreb

Datum
06.07

Godina
1988

Stranica
167

Mentor
Prof. dr. sc. Marko Pećina, dr. med. ; prof. dr. sc. Fadila Pavičić, dr. med.

Ključne riječi
kardiorespiratorna funkcija; kirurška korekcija; skolioza
(cardiorespiratory function; surgical correction; scoliosis)

Sažetak
It has been indisputebly proved by the previous research that the form of thorax and volume of the lungs from many aspects cause the respiration function and the lungs hypertension in scoliosis. By surgical treatment we endavour to correct or at least to stop progress of spine deformation. The problem becomes topical, because the result of treatment, particuraly surgical, affects the prognosis of scoliosis, observed as a cause of cardiopulmonal illness, yet not only anatomic abnormality. The aim of this research is to set „respiratory criteria“ with respect to indication and estimation of the success of surgical reconstructive treatment in correlation on cardiorespiratory function of slight not-operated scoliosis, by preoperative and late (16-25 months) postoperative examination of cardiopulnmonal function of patients with idiopathic thoracal scoliosis Research was carried out on two strictly defined patients' groups of average age of 15 years, 33 exeminees operated with angle of 72° (52-129°) according to Cobb on 32, 6° and 30 not operated examinees of the same age with the average angle of 33° (15-39), who were chosen as a comparable group. The data obtained by the analysis of breathing mechanic, statical and dynamical volumes of lungs, gas analysis in arterial blood, loading test, enable us to explain and to understand the clinical manifestation caused by spinal deformation, thus it has been found the following: 1. There is a negative correlation grade of scoliotic curve bigger from 70° on and restriction of vital capacity, reduced maximum oxygen consumption and duration of loading test. 2. On the basis of preoperative analysis of the cardiorespiratory function, there were set the respiratory criteria with respect to indication of surgical and perioperative treatment and they are: - if vital capacity is less than 60% of anticipated values, there is a potential need for postoperative prolonged mechanical ventilation and decision should be made preoperative, - if vital capacity is less than 1000 ml there is a vital indication for operation with preoperative preparation, - if Pa CO2 is bigger than 50 mm Hg and Pa O2 less than 50 mm Hg, they present contraindication for operation with recommendation for intensive physical breathing therapy during the period of 6-12 months with retesting and holotraction, and with improved results they become candidates for surgical treatment, - at the obstructive troubles because of extrathorecal compression of tracheas and bronchia, the prolonged intubation with controlled breathing is defined when FEV1 is under 55% of reached vital capacity and Rt is over 5 cm H2O. 3. The success of corrective operation on the spine of average 54% showed by statistical results’ revision of cardiopulmonary function on increase of vital capacity FEV1, MMF25-75% of duration of loading test (t-differentia test) after operation. There is a correlation of angle’s correlation of scoliotic curve and improvement of cardiorespiratory function (r = -1). 4. By dividing of thoracal scoliosis on upper (Th5-Th8) and lower (Th9-Th11) with surgical correction of a spine bigger than 30%, by analyses of a variance, the difference was set in variables VC with respect to hand’ spread, FEV1, which were improved but yet statistically considerably smaller with respect to lower ones, which prove the existence of more difficult changes of respiratory system before operation in upper thoracal scoliosis. 5. By statistical analyses of variance of a cardiopulmonary function with respect to the period shorter or longer than one year after operation, it has been found a significant difference in maximum oxygen consumption and duration of loading test, which comes as a result of better ventilation. 6. By a multivariant analyses of variance and discriminatory analyses between operated and not-operated with the same degree of a slight spine curve (32.6° and 33°), it has been concluded a difference of cardiopulmonal function on variables VC and PaO2% from the expected, which points at the seriousness and irreversibility of disturbed relation of ventilation and perfusion before operation and possible influence of partial rigidity of a thorax because of spondilodesis of one part of a spine with respect to yet undisturbed elasticity of thorax in slighter scoliosis at that age. However, the aim of surgical correction is to stop the progress of spine deformation and deterioration of cardiopulmonary function, if possible, up to 70°, when there is no considerable change of a function of the respiratory system.

Izvorni jezik
Hrvatski

Znanstvena područja
Kliničke medicinske znanosti

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