学龄前单侧唇腭裂术后患儿鼻通气状况的研究

Study of postoperative nasal ventilation condition in preschool children with the unilateral cleft lip and palate

目的本研究通过对学龄前先天性唇腭裂术后患儿鼻通气阻力的检测,探讨唇腭裂伴发鼻畸形对鼻通气功能的影响。方法本研究选择平均7.1岁行先天性单侧唇腭裂修复未行鼻畸形修复的儿童57例,另选择同龄组正常儿童60例作对照组。利用鼻阻力检测仪对其左、右鼻孔的通气时的阻力大小进行测量,对两组的总鼻阻力值进行t检验,以判断两组内是否存在有统计学意义上的差异,从而探讨唇腭裂及鼻畸形对鼻通气的影响。对其鼻外阀、鼻内阀直径大小、牙颌形态、上颚形态、牙列排列情况进行检查。最后询问每位儿童是否存在自觉鼻通气困难的症状。结果 57例单侧唇腭裂患儿114侧鼻阻力值的平均值为(0.890±0.291)Pa/(s·cm^3);60例正常儿童组120侧鼻阻力均值为(0.611±0.179)Pa/(s·cm^3),统计学t检验结果,差异有统计学意义(P=0.038<0.05),两组间鼻阻力值存在统计学意义的显著性差异。唇腭裂组儿童均存在不同程度的鼻中隔偏曲、患侧鼻背板及鼻翼软骨塌陷、牙齿拥挤、牙列排列不齐、上前牙唇倾现象,其中71%的儿童存在自觉鼻通气困难症状;而对照组16%的儿童自觉有鼻通气困难症状。结论先天性唇腭裂畸形及伴发鼻畸形会导致鼻通气阻力增大及不同程度的鼻通气困难。

Objective This study aimed to evaluate postoperative nasal ventilation condition in preschool children with congenital unilateral cleft lip and palate by nasal resistance assessment and further discuss the effect of secondary nasal deformity of unilateral cleft lip and palate on nasal ventilation. Methods In this study,57 children（mean age, 7.1 years） who underwent unilateral cleft lip and palate repair without nasal deformity repair were selected. Another 60 cases of normal preschool children around the same age were selected as the control group. The nasal resistance of left and right nostrils were measured for both groups. T-test was performed on the total nasal resistance from both groups to determine statistical significance, to further discuss the effect of secondary nasal deformity and cleft lip on nasal ventilation. The diameter of the nasal valve, the diameter of the nasal valve, the shape of the jaws, the shape of the upper jaw, and the arrangement of the teeth were examined. Finally, each child was asked if they had symptoms of difficulty in nasal ventilation. Results The average value of the 114 lateral nasal resistance values in 57 children with unilateral cleft lip and palate was （0.890±0.291）Pa/（s/cm^3）, and 120 side nasal resistance of 60 normal children was （0.611±0.179）Pa/（s/cm^3）. Statistical t test results were statistically significant（P=0.038〈0.05）. There were significant differences in nasal resistance values between the two groups. In the cleft lip and palate group, there were different degrees of deviation of nasal septum, the collapse of the lateral nasal dorsal plate and the alar cartilage, the crowding of the teeth, the irregular alignment of the teeth and the lip of the anterior teeth, of which 71% of the children had the symptoms of difficult nasal ventilation, while 16% of the children in the control group had the symptoms of nasal ventilation. Conclusion Congenital unilateral cleft lip and secondary nasal deformity can cause nasal resistance increase and varied degree of dyspnea.