摘要目的:探讨漏斗胸（pectus excavatum，PE）患儿的心肺运动试验（cardiopulmonary exercise testing，CPET）表现，以及多种胸廓畸形指数与其相关性。方法:回顾性分析上海交通大学医学院附属上海儿童医学中心2023年9月至2024年9月接受术前CPET评估的漏斗胸患儿53例，其中男39例，女14例；年龄6~18岁，平均（12.5±2.5）岁。收集并计算患儿Haller指数（HI）、校正指数（CI）及胸骨凹陷指数（SDI）等畸形程度指标。CPET关键参数包括最大单位体质量摄氧量（VO?/kg-max）、最大摄氧量占预计值百分比（VO ?-max% Pred）、最大氧脉搏（O 2/HR-max）、第1秒用力呼气量占预计值百分比（FEV1% Pred）、呼吸储备、二氧化碳通气效率斜率（VE/VCO 2 slope）等。采用线性回归和 t检验分析畸形指数与运动参数的相关性。 结果:患儿平均HI为4.2±1.8，其中32例为重度畸形（HI>3.5）。CPET显示患儿VO ?-max%显著降低［（60±19）%，正常>80%］，40例患儿表现出与运动受限模式不符的高呼吸储备（最大呼吸储备>30%），33例患儿VE/VCO 2 slope下降（≥30）。多元线性回归分析表明：HI和SDI与运动功能显著相关，而其他畸形指数无显著关联。分组分析进一步验证：HI≥3.8组VO 2-max% Pred显著低于HI<3.8组（54.35% 对 64.93%， P=0.03）；SDI≥2.3组VO 2/kg-max［（25.56±7.43）ml·kg -1·min -1 对（29.28±6.90）ml·kg -1·min -1］、VO 2-max% Pred（51.23% 对 65.27%）及FEV1% Pred（70.85% 对 85.43%）均显著低于SDI<2.3组（均 P<0.05）。 结论:漏斗胸患儿心肺运动功能较正常儿童降低且与胸廓畸形严重程度相关。HI及SDI是预测心肺运动功能损害的有效指标。漏斗胸患儿存在独特的通气代偿策略。术前应综合评估多种畸形指数，以识别高风险个体。

abstractsObjective:To investigate the correlations between various thoracic deformity indices and cardiopulmonary function as assessed by cardiopulmonary exercise testing (CPET) in children with pectus excavatum (PE).Methods:A retrospective analysis was conducted on 53 PE children who underwent preoperative CPET assessment at Shanghai Children′s Medical Center between September 2023 and September 2024. There were 39 males, with a mean age of(12.5±2.5) years. Deformity severity indices including Haller index (HI), correction index (CI), and sternal depression index (SDI) were collected and calculated. Key CPET parameters included max oxygen uptake per unit weight (VO 2/kg-max), oxygen uptake as a percentage of predicted (VO 2-max%Pred), max oxygen pulse (O 2/HR max), forced expiratory volume in the first second as a percentage of predicted value (FEV1% Pred), breathing reserve (BR), and ventilatory efficiency (VE/VCO 2 slope). Linear regression and t-tests were used to analyze the correlations between deformity indices and exercise parameters. Results:The mean Haller index was 4.2±1.8, with 60% (32 cases) having severe deformity (HI>3.5). CPET revealed a significantly reduced of VO 2-max% Pred [(60±19)%, normal>80%], high breathing reserve (BR-max>30%) in 76% of patients (40 cases), and decreased ventilatory efficiency (VE/VCO 2 slope≥30) in 63% of patients(33 cases). Multiple linear regression analysis indicated that HI and SDI were significantly correlated with exercise function, while other deformity indices showed no significant associations. Group analysis further confirmed: the group with HI≥3.8 had a significantly lower VO?-max% Pred than the low HI group (54.35% vs 64.93%, P=0.03); the group with SDI≥2.3 had significantly lower VO?/kg-max [(25.56±7.43) ml·kg -1·min -1 vs (29.28±6.90) ml·kg -1·min -1], VO 2-max% Pred (51.23% vs 65.27%), and FEV1% Pred (70.85% vs 85.43%) (all P<0.05). Conclusion:Cardiopulmonary exercise function is reduced in children with PE and correlates with the severity of thoracic deformity. The HI and SDI are effective indicators for predicting cardiopulmonary impairment. PE children exhibit unique ventilatory compensation strategies. Preoperative assessment should comprehensively evaluate multiple deformity indices to identify high-risk individuals.