鼻中隔偏曲的鼻塞主观评价与鼻腔气流特征的相关性研究

Association between subjective nasal patency and airflow characteristics of nasal cavity on nasal septum deviation

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);NR_1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),NR_2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R^2=0.619 6和R^2=0.508 7,其次是ΔP_(下鼻甲前端)(R^2=0.326 7)与NR_2(R^2=0.298 1),VAS评分与ΔT_(鼻中隔后端)(R^2=0.045 1)和NR_1(R^2=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。

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 ofΔP（anterior inferior turbinate）,ΔT（anterior inferior turbinate）andΔT（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 onΔT（anterior inferior turbinate）and intranasal airflow of deviated side nasal cavity are higher（R^2=0.619 6 and R^2=0.508 7）thanΔP（anterior inferior turbinate）and NR2（R^2=0.326 7 and R^2=0.298 1）.It suggested that there is no correlation between subjective nasal patency VAS score andΔT（posterior end of the septum）,NR1（R^2=0.0451 and R^2=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.