结构性鼻通气障碍手术前后的主客观评估及相关性分析

Subjective and objective evaluation and correlation analysis of pre-and post-operation in patients with structural nasal obstruction

目的 对鼻腔结构异常导致通气障碍的患者进行手术前后鼻通气功能的主客观评估及相关性分析,为鼻部手术适应证和疗效预测提供临床依据.方法 纳入3组患者作为研究对象：组1为结构性鼻炎组,共计78例;组2为慢性鼻-鼻窦炎不伴鼻息肉组,共计72例;组3为对照组,共计75例.3组患者分别进行鼻塞视觉模拟量表（visual analogue scale,VAS）评分、鼻声反射和鼻阻力测量.记录前两个鼻腔最小截面积（minimum cross-sectional area of nasal cavity,MCA）1和MCA2,及它们距离前鼻孔的距离（distance between the nostril to minimum cross-sectional area,MD）1和MD2,同时记录距离前鼻孔 5 cm的鼻腔容积（nasal volume of5 cm depth from nostril,NV5）,并分别计算双侧鼻腔上述指标的比值;记录鼻腔总阻力（nasal resistance total,RT）并计算双侧鼻腔阻力差异比（right-left nasal resistance ratio,Rlr）.组1与组2患者行鼻内镜手术,术后3个月再次进行上述主客观评估与测量.对各组手术前后的结果进行比较和相关性分析.结果 术前3组MCA1、MD1、MCA2、MD2、NV5和RT值的差异均无统计学意义（F值分别为0.945、0.245、1.380、0.036、0.866、1.651,P值均＞0.05）;各数据比值除MD1a/MD1b外,其他差异均有统计学意义（F值分别为5.242、1.726、4.882、4.005、5.066、5.316,P值分别为0.013、0.199、0.019、0.024、0.018、0.011）.组1和组2术前VAS评分与MCA1、MD1、MCA2、MD2、NV5、RT比值之间均存在正相关（组1 r值分别为0.471、0.418、0.260、0.324、0.305、0.459,组2r值分别为0.373、0.403、0.288、0.366、0.402、0.249,P值均＜0.05）.手术前后组1 VAS评分的差异有统计学意义（=35.122,P＜0.05）.术后3组MD1、MD2、RT值的差异均无统计学意义（F值分别为0.178、0.582、0.905,P值均＞0.05）,MCA1、MCA2、NV5值的差异均有统计学意义（F值分别为4.010、5.126、4.901,P值均＜0.05）;术后3组MCA1、MD1、NV5比值和Rlr的差异均无统计学意义（F值分别为1.023、0.944、0.524、0.996,P值均＞0.05）;术后3组MCA2和MD2比值的差异均有统计学意义（F值分别为4.859、4.357,P值均＜0.05）.结论 鼻塞严重程度与双侧鼻腔结构的对称程度有一定关联;结构性鼻通气障碍手术的侧重点是恢复鼻腔结构的对称性.

Objective To analyze the subjective and objective results and the correlation of nasal obstruction because of nasal structural variation pre and post operation,and to provide clinical evidence for surgery and curative effect.Methods Three groups were included in this study：group 1 were 78 patients with structural rhinitis,group 2 were 72 patients with chronic sinusitis （without nasal polyp） and group 3 were healthy controls of 75 cases.Assessment of nasal obstruction was achieved by visual analog scale （VAS）,and objective measurement was achieved by rhinomanometry and acoustic rhinometry.The first two minimum cross-sectional area of nasal cavity （MCA1,MCA2）,their distances from the nostrils （MD1,MD2） and the nasal volume of 5 cm depth from the nostril （NV5） were recorded.The ratio of the parameters of the two sides of the nasal cavity was calculated respectively.Nasal resistance total （RT） and calculated right-left nasal resistance ratio （Rlr） were recorded.Patients of group 1 and group 2 accepted endoscopic surgery and received the above evaluation again at three months after surgery.Three groups were compared with statistical test.Results The preoperative values of three groups （MCA1,MD1,MCA2,MD2,NV5,RT） showed no statistical significance （F value was 0.945,0.245,1.380,0.036,0.866,1.651,respectively;all P 〉 0.05）,while their ratio had statistical differences except MD1 （F value was 5.242,1.726,4.882,4.005,5.066,5.316;P =0.013,0.199,0.019,0.024,0.018,0.011,respectively）.Statistical results between the ratio of values （MCA1,MD1,MCA2,MD2,NV5,RT） and VAS of nasal obstruction of group 1 and group 2 showed significant positive correlations pre operation （r of group 1 value was 0.471,0.418,0.260,0.324,0.305,0.459,respectively;r of group 2 value was 0.373,0.403,0.288,0.366,0.402,0.249,respectively;all P 〈 0.05）.VAS scores pre and post operation of group 1 had statistically difference （t =35.122,P 〈0.05）.Postoperative value of MD1,MD2 and RT among three groups had no statistical difference （F value was 0.178,0.582,0.905,respectively;all P 〉 0.05）.Postoperative value of MCA1,MCA2,NV5 among three groups had statistical difference （F value was 4.010,5.126,4.901,respectively;all P 〈 0.05）.Postoperative ratio of MCA1,MD1,NV5 and Rlr among three groups had no statistical difference （F value was 1.023,0.944,0.524,0.996,respectively;all P 〉 0.05）.Postoperative ratio of MCA2 and MD2 among three groups had statistical difference （F value was 4.859,4.357,respectively;all P 〈 0.05）.Conclusion Severity of nasal obstruction is related to structural variation of nasal cavity and the purpose of surgery is to restore structural symmetry of bilateral nasal cavity.