Association between subjective nasal patency and airflow characteristics of nasal cavity on nasal septum deviation
-
摘要: 目的: 运用数值模拟的方法,分析鼻中隔偏曲患者术前术后的鼻腔气流特征,并探讨鼻塞主观评价与鼻腔气流参数的相关性。方法: 42例鼻中隔偏曲患者,术前术后均进行鼻塞主观症状的VAS评分,建立CFD数值模型,并分析术前和术后的鼻腔气流特征。结果: 鼻中隔偏曲患者术后主观鼻塞症状较术前有明显改善(P<0.01);偏曲侧鼻腔流经的气流量从术前的(34.94±14.82)%增加到术后的(47.67±3.58)%,差异有统计学意义(P<0.01);偏曲侧鼻腔的ΔP下鼻甲前端从术前的(7.657±4.839)Pa降低到术后的(4.500±2.403)Pa,ΔT下鼻甲前端则从术前的(8.482±1.767)K降低到术后的(7.096±1.127)K,ΔT鼻中隔后端由术前的(11.386±0.505)K降到术后的(10.895±0.736)K,三者均显示有显著差异(P<0.01);NR1从手术前的(0.040 3±0.021)Pa·s/ml降低到术后的(0.030 0±0.016)Pa·s/ml,差异有统计学意义(P<0.05),NR2仅从(0.071 0±0.035)Pa·s/ml降为(0.061 5±0.048)Pa·s/ml,差异无统计学意义(P>0.05);相关性分析显示,鼻塞主观VAS评分与ΔT下鼻甲前端和偏曲侧鼻腔的通气量相关程度较高,分别是R2=0.619 6和R2=0.508 7,其次是ΔP下鼻甲前端(R2=0.326 7)与NR2(R2=0.298 1),VAS评分与ΔT鼻中隔后端(R2=0.045 1)和NR1(R2=0.072 1)无相关性。结论: 鼻中隔偏曲患者双侧鼻腔呈现不同压强和温度梯度表现,尤其在偏曲部位;手术矫正能够使双侧鼻腔的气流流量趋于平衡,并改善鼻塞的主观感受;相关性研究显示,鼻阻力与患者主诉的鼻塞主观症状严重程度不一致,反而鼻腔的流量大小与鼻塞主观症状相关,尤其是鼻腔前端黏膜温度的下降更能敏感地反映患者的鼻塞主观感觉。Abstract: Objective: To investigate the pre-and post-operative intranasal airflow characteristics on nasal septum deviation and the correlation between subjective nasal patency and airflow characteristics by numerical simulation.Method: Forty-two nasal septum deviation cases were enrolled in this study. Pre-and post-operative VAS score of subjective nasal patency were recorded. We created computational fluid dynamics (CFD) nasal cavity airway models based on computed tomography and investigated the pre- and post-operative intranasal airflow characteristics.Result: Postoperative subjective nasal patency on patients with septal deviation showed significant improvement than preoperative (P<0.01). The intranasal airflow on deviated side nasal cavity increased from preoperative (34.94±14.82)% to postoperative (47.67±3.58)% (P<0.01). The parameters of ΔP(anterior inferior turbinate),ΔT(anterior inferior turbinate) and ΔT(posterior end of the septum)decreased significantly from preoperative (7.657±4.839)Pa to postoperative (4.500±2.403)Pa,preoperative (8.482±1.767)K to postoperative (7.096±1.127)K,and preoperative (11.386±0.505)K to postoperative (10.895±0.736)K respectively (P<0.01). The value of NR1 decreased from (0.043±0.021) Pa·s/ml to (0.038 0±0.016) Pa·s/ml, showed statistically significant difference (P<0.05), but the value of NR2 decreased from (0.071 0±0.035)Pa·s/ml to (0.061 5±0.048) Pa·s/ml, showed no statistically significant difference (P>0.05). The related degree of subjective nasal patency VAS score on ΔT(anterior inferior turbinate) and intranasal airflow of deviated side nasal cavity are higher (R2=0.619 6 and R2=0.508 7)than ΔP(anterior inferior turbinate)and NR2(R2=0.326 7 and R2=0.298 1).It suggested that there is no correlation between subjective nasal patency VAS score and ΔT(posterior end of the septum),NR1(R2=0.0451 and R2=0.0721). Conclusion: It showed different pressure and temperature gradient in bilateral nasal cavity of nasal septal deviation. The septoplasty improved the patient's feeling of subjective nasal patency, and recovered the balance of the airflow distribution on bilateral nasal cavity. By correlation analysis, we concluded that nasal resistance could not represent the severity of subjective nasal patency, but the intranasal airflow showed good correlations with subjective nasal patency, especially the temperature drop in mucous membrane at the nasal front end is more sensitive to reflect subjective nasal patency feeling.
-
[1] 韩朝, 王德辉, 黄一波, 等.鼻中隔偏曲影响因素临床分析临床研究[J].临床和实验医学杂志, 2013, 12 (1):55-57.
[2] 王秀敏, 舒畅, 陈建超, 等.鼻声反射测量对鼻塞主客观相关性的研究[J].临床耳鼻咽喉头颈外科杂志, 2011, 25 (11):486-488.
[3] KIMBELL J S, FRANK D O, LAUD P, et al.Changes in nasal airflow and heat transfer correlate with symptom improvement after surgery for nasal obstruction[J].J Biomech, 2013, 46:2634-2643.
[4] LINDEMANN J, REICHERT M, KRÖGER R, et al.Numerical simulation of humidification and heating during inspiration in nose models with three different located septal perforations[J].Eur Arch Otorhinolaryngol, 2016, 273:1795-1800.
[5] ZHU J H, LIM K M, THONG K T, et al.Assessment of airflow ventilation in human nasal cavity and maxillarysinus before and after targeted sinonasal surgery:a numerical case study[J].Respir Physiol Neurobiol, 2014, 194:29-36.
[6] CHUNG S K, KIM D W, NA Y.Numerical study on the effect of uncinectomy on airflow modification and ventilation characteristics of the maxillary sinus[J].Respir Physiol Neurobiol, 2016, 228:47-60.
[7] 魏君, 李琳.鼻腔气流动力学研究进展[J].临床耳鼻咽喉头颈外科杂志, 2017, 31 (8):647-649.
[8] WANG T, MU X, DENG J, et al.Investigation on the structure of nasal cavity and its airflow field in Crouzon syndrome[J].J Craniofac Surg, 2011, 22:166-172.
[9] WANG T, CHEN D, WANG P H, et al.Investigation on the nasal airflow characteristics of anterior nasal cavity stenosis[J].Braz J Med Biol Res, 2016, 49:e5182.
[10] KIM S K, NA Y, KIM J I, et al.Patient specific CFDmodels of nasal airflow:overview of methods and challenges[J].J Biomech, 2013, 46:299-306.
[11] 唐媛媛, 苏英锋, 关庆捷, 等.鼻腔结构异常者有限元数值模型建立及气流场特征分析[J].中国医科大学学报, 2015, 44 (3):209-213.
[12] 郭宇峰, 单雅敏, 蔡惠坤, 等.计算机流体力学在模拟下鼻甲手术中的应用[J].临床耳鼻咽喉头颈外科杂志, 2017, 31 (4):257-266.
[13] ZHAO K, CRAIG J R, COHEN N A, et al.Sinus irrigations before and after surgery-visualization through computational fluid dynamics simulations[J].Laryngoscope, 2016, 126:E90-96.
[14] HILDEBRANDT T, GOUBERGRITS L, HEPPT WJ, et al.Evaluationof the intranasal flow field through computational fluiddynamics[J].Facial Plast Surg, 2013, 29:93-98.
[15] KIM S K, HEO G E, SEO A, et al.Correlation between nasal airflow characteristics and clinical relevance of nasal septal deviation to nasal airway obstruction[J].Respir Physiol Neurobiol, 2014, 192:95-101.
[16] CAL I R, CERCOS-PITA J L, DUQUE D.The incompressibility assumption in computational simulations of nasal airflow[J].Comput Methods Biomech Biomed Engin, 2017, 20:853-868.
[17] SULLIVAN C D, GARCIA G J, FRANK-ITO D O, et al.Perception of better nasal patency correlates with increased mucosal cooling after surgery for nasal obstruction[J].Otolaryngol Head Neck Surg, 2014, 150:139-147.
[18] ZHAO K, JIANG J, BLACKER K, et al.Regional Peak Mucosal Cooling Predicts the Perception of Nasal Patency[J].Laryngoscope, 2014, 124:589-595.
计量
- 文章访问数: 134
- PDF下载数: 71
- 施引文献: 0