目的 探讨青少年特发性脊柱侧凸患者术后首次离床活动直立不耐受的影响因素。 方法 对2021年6月至2023年6月南京大学医学院附属鼓楼医院收治的226例青少年特发性脊柱侧凸患者的临床资料进行回顾性分析，根据术后首次离床活动是否发生直立不耐受情况，将发生直立不耐受患者纳入直立不耐受组，将未发生直立不耐受患者纳入无直立不耐受组。收集两组患者一般资料、术后首次离床活动不同体位血压情况，对青少年特发性脊柱侧凸患者术后首次离床活动直立不耐受的影响因素进行单因素、多因素logistic回归分析。 结果 226例患者术后首次离床活动有102例发生直立不耐受，发病率为45.13%（102/226）。直立不耐受组坐位、站立位的收缩压、舒张压均低于未直立不耐受组（P < 0.05）。单因素分析显示，直立不耐受组术后卧床时间、坐位疼痛评分、站立位疼痛评分、术后住院时间及体位适应性训练比例与无直立不耐受组比较，差异有统计学意义（P < 0.05）。多因素logistic回归分析显示，术后卧床时间长、坐位疼痛程度、站立位疼痛程度、不进行体位适应性训练是造成直立不耐受的危险因素（P < 0.05）。 结论 术后卧床时间长、坐位疼痛、站立位疼痛及不进行体位适应性训练均是影响青少年特发性脊柱侧凸患者术后首次离床活动直立不耐受的主要危险因素。

Objective The aim of this study was to explore the influencing factors of orthostatic intolerance in adolescent idiopathic scoliosis patients after surgery for the first time out of bed movement. Methods A retrospective analysis was conducted on the clinical data of 226 adolescent idiopathic scoliosis patients admitted to Nanjing Drum Tower Hospital from June 2021 to June 2023. Based on whether upright intolerance occurred during the first postoperative ambulation， patients with upright intolerance were included in the upright intolerance group， and patients without upright intolerance were included in the non upright intolerance group. Collect general data of two groups of patients， as well as their blood pressure at different positions during their first postoperative out of bed activity. Conduct univariate and multivariate logistic regression analysis on the influencing factors of upright intolerance during their first postoperative out of bed activity in adolescent idiopathic scoliosis patients. Results Out of 226 patients who underwent their first postoperative ambulation， 102 experienced orthostatic intolerance， accounting for 45.13% （102/226） of the cases. The systolic and diastolic blood pressure in both sitting and standing positions were lower in the orthostatic intolerance group than in the non orthostatic intolerance group （P < 0.05）. Through univariate analysis， it can be seen that the postoperative bed rest time， sitting pain score， standing pain score， postoperative hospitalization time， and proportion of posture adaptation training in the orthostatic intolerance group were significantly different from those in the non orthostatic intolerance group （P < 0.05）. Through multiple logistic regression analysis， it can be seen that long postoperative bed rest time， degree of sitting pain， degree of standing pain， and lack of posture adaptation training are risk factors for upright intolerance （P < 0.05）. Conclusion Long postoperative bed rest time， sitting pain， standing pain， and lack of posture adaptation training are the main risk factors affecting upright intolerance of adolescent idiopathic scoliosis patients after surgery for the first time out of bed activity.