基于3D打印透明鼻腔模型的鼻阻力变化规律研究

Study on changes of nasal resistance based on 3D printing transparent nasal cavity models

目的:探讨鼻腔内最小截面积与鼻阻力互为因果的变化规律。方法:3D打印全透明可拆卸功能性鼻窦内镜手术(FESS)术后鼻腔模型30侧,在不同解剖部位用密封材料彻底堵塞气道,然后用不同截面积的可通气鼻腔引流管再通鼻腔,测量鼻阻力,再进行统计学分析。结果:(1)术后患者实测、3D打印模型鼻阻力分别为(0.38±0.15) Pa·s/mL、(0.39±0.02) Pa·s/mL,两组之间差异无统计学意义(P>0.05),术前患者鼻阻力为(0.56±0.09) Pa·s/mL,术后模型较术前显著下降约31%,差异有统计学意义(P<0.05);(2)当截面积为3.14 mm;的可通气鼻腔引流管位于总鼻道上部、鼻阈区时鼻腔均中度阻塞,鼻阻力分别为阻塞前的(1.80±0.30)倍、(2.02±0.36)倍,位于总鼻道下部时鼻腔轻度阻塞,鼻阻力为阻塞前的(1.68±0.28)倍;(3)当截面积为6.28 mm;的可通气鼻腔引流管位于总鼻道下部、总鼻道上部、鼻阈区时,鼻阻力值分别为阻塞前的(1.44±0.23)倍、(1.50±0.25)倍、(1.60±0.27)倍;(4)当截面积为9.42 mm;的可通气鼻腔引流管位于以上部位时,鼻腔通气均接近正常,无明显鼻塞,鼻阻力值分别为阻塞前的(1.17±0.18)倍、(1.26±0.21)倍、(1.33±0.24)倍;(5)鼻阻力与通气管截面积、部位相关,相关系数分别为-0.895和0.339,差异均有统计学意义(P<0.05)。结论:(1)3D打印可快速精准地复制鼻腔解剖结构,可作为定量测量鼻阻力的研究方法;(2)鼻腔最小截面积为鼻阻力主要决定因素;(3)部位为鼻阻力的次要决定因素,当阻塞程度相同时,鼻阈区鼻阻力略高于总鼻道。

Objective: To investigate the causal relationship between the minimum cross-sectional area of nasal cavity and nasal resistance. Methods: Thirty transparent detachable 3 D printing nasal cavity models were made. The airway was completely blocked with sealing material at different anatomical sections. Then ventilatable nasal drainage tubes with different cross-sectional areas were used to pass through the nasal cavity. Nasal resistance was measured. SPSS was used for statistical analysis. Results:(1)The postoperative nasal resistances of patients and 3 D printing nasal cavity models were(0.38±0.15)Pa· s/mL and(0.39±0.02)Pa· s/mL respectively. There was no statistical difference between the two groups.The preoperative nasal resistance of patients was(0.56±0.09)Pa· s/mL, and the postoperative nasal resistance of the models was significantly descreased by 31% compared with preoperative nasal resistance of the patients, with statistically significant difference(P<0.05).(2)When the ventilatable nasal drainage tubes with a cross-sectional area of 3.14 square millimeters was located in the the upper part of common meatus and the nasal valve area, the nasal cavity is moderately blocked, and the nasal resistances were(1.80±0.30) times and(2.02±0.36) times of that before the obstruction respectively. When the ventilatable nasal drainage tube was located in the lower part of common meatus, the nasal resistance was(1.68±0.28) times of that before the obstruction.(3)When the ventilatable nasal drainage tubes with a cross-sectional area of 6.28 square millimeters and were located in the lower part of common meatus, the upper part of common meatus and nasal valve area, the nasal resistances were(1.44±0.23) times,(1.50±0.25) times and(1.60±0.27) times of those before obstruction, respectively.(4)When the ventilatable nasal drainage tubes with a cross-sectional area of 9.42 square millimeters were located in the above areas, nasal ventilation was nearly normal without obvious nasal obstruction. The nasal resistances were(1.17±0.18) times,(1.26±0.21) times and(1.33±0.24) times of those before obstruction, respectively.(5)The nasal resistance was statistically significant correlated with the cross-sectional area of the ventilation tubes and the obstruction sites. The correlation coefficients were-0.895 and 0.339, respectively(P<0.05). Conclusion:(1)3 D printing can quickly and accurately replicate anatomical structure of the nasal cavity, and can be used as a research method for quantifitative measurement of nasal resistance.(2)The minimum cross-sectional area of nasal cavitiy is the main determinant of nasal resistance.(3)The obstruction site is the secondary determinant of nasal resistance. When the degree of nasal obstruction is the same, the nasal resistance in the nasal valve area is sightly higher than that in the common meatus.