摘要
目的探讨鼻声反射对腺样体肥大患儿的临床应用价值,联合建立上气道气流场生物力学数值模型,定性分析患儿鼻腔、鼻咽腔形态特征及气流场分布情况。方法对35例腺样体肥大患儿行鼻咽侧位片及鼻声反射检查,根据腺样体/鼻咽腔(adenoid/nasopharynx,A/N比率)分为三组(A/N≤0.60,0.60<A/N≤0.70,A/N>0.70),分析三组间鼻腔最小横截面积(minimal cross-sectional area,MCSA)、鼻腔最小横截面积距离前鼻孔的距离(distance of the minimal cross-sectional area from the nostril,DMCA)、鼻腔阻力(nasal airway resistance,NR)、鼻腔容积(nasal volume,NV)及鼻咽腔容积(nasopharyngeal volume,NPV)的参数有无显著性差异。据其中9例受试者上气道CT影像,三维重建上气道生物力学数值模型,分析气流流场特征。结果 35例受试者鼻声反射曲线特点为后段低平。随A/N比率增大NR逐渐增大,NV、NPV下降,各组间MCSA、DMCA、NR、NV无显著性差异(P>0.05),NPV有显著性差异(P=0.000)。患儿鼻咽部气流形态紊乱,压强变化梯度主要集中在鼻阈及腺样体与扁桃体交界区域,呼吸道的高流速区主要集中在鼻阈、中鼻道和鼻咽部。结论鼻声反射可用于腺样体肥大患儿鼻咽腔容积的定量分析,可验证患儿上气道计算机仿真模型的真实及可靠性,二者结合可从三维立体角度考虑患儿上气道的阻塞因素,不仅能应用于腺样体肥大患儿的筛查工作,也可为临床因人制宜采取不同的手术方案及术后评估提供参考。
OBJECTIVE To assess the clinical application of acoustic rhinometry in children with adenoid hypertrophy and establish the model of upper airway, analyze the morphological and airflow characters in the nasal cavity and nasopharyngeal cavity. METHODS Thirty-five children with adenoid hypertrophy were submitted to take lateral X-ray and acoustic rhinometry. Then we measure the ratio of A/N（adenoid /nasopharyngeal volume）. Based on the A/N, all children assigned to three groups（A/N≤0.60, 0.60〈A/N≤0.70, A/N〉0.70）. The minimal cross-sectional area（MCSA）, distance of the minimal cross-sectional area from the nostril（DMCA）, nasal airway resistance（NR）, nasal volume（NV） and nasopharyngeal volume（NPV）, were achieved from the acoustic rhinometry curve. Finally the above parameters were compared by the ANOVA. At the same time, on the basis of CT images of the 9 children with adenoid hypertrophy, we build models with threedimensional reconstruction and analyze the character of airf low in upper airway. RESULTS The features of acoustic rhinometry in children with adenoid hypertrophy was lower in posterior segment. With the increasing of the size of the adenoid, NR presented an increasing tendency, while NV and NPV decreasing gradually. No significant difference was observed in MCSA, DMCA, NR and NV among the groups. While the NPV showed a significant difference among the three groups（P =0.000）. The shape of the air current in the pharynx was deranged, the change of the pressure was concentrated in the area of limen nasi and the junctional zone of the adenoid and the tonsil, the high air flow rate of the respiratory passage was concentrated in the limen nasi, middle nasal meatus and nasopharynx. CONCLUSION Acoustic rhinometry can be used to analyze the volume of the nasopharyngeal cavity, and can verify the validity and reliability of the model of upperairway. Using them can reflect the characteristic of upper airway in patients, provide information for clinical therapy and to evaluate the therapeutic effect.
出处
《中国耳鼻咽喉头颈外科》
CSCD
2014年第8期398-402,共5页
Chinese Archives of Otolaryngology-Head and Neck Surgery
关键词
鼻测量
声学
鼻咽
X线
成像
三维
模型
生物学
腺样体肥大
Rhinometry
Acoustic
Nasopharynx
X-Rays
Imaging
Three-Dimensional
Models
Biological
adenoid hypertrophy
