上气道填充三维有限元模型于困难气道评估中应用

发布时间：2018-04-09 17:20

本文选题：上气道　切入点：填充法　出处：《昆明医科大学》2017年硕士论文

【摘要】：[目的]利用正常气道及困难气道患者平卧位到仰卧位气道MRI二维图像原始数据重建上气道填充三维有限元模型,计算气管插管中患者由平卧位到最大仰卧位上气道形态学的改变,分析困难气道上气道解剖的特异性。[方法]选取2015年4-12月昆明医科大学第一附属医院手术麻醉后已经评判定义为正常气道患者和困难气道患者各20名,并已经课题组重建并验证有效的头颈部三维有限元模型分别导入Mimics10.01软件利用填充方法填充正常及困难气道患者的上气道三维有限元模型,并标示出气道的准确位置①门齿点0②咽后壁最高点A③声门裂中点N/D。并用Mimics10.01自带软件精确测量气管插管时患者由平卧位到最大仰卧位由门齿点、咽后壁最高点、声门裂中点组成的口咽角∠OAN、∠OAN'、∠OAD、∠OAD'、上气道最小横截面积(S1、S1'、S2、S2'、S3、S3'、S4、S4')等相关解剖指标数值。分析正常及困难气道患者平卧位到最大仰卧位上气道解剖变化规律,从而得出困难气道患者上气道解剖特异性。[结果]1、正常气道及困难气道口咽角最大仰卧位均较平卧位大;正常气道口咽角不同体位(平卧位、仰卧位)可活动范围较困难气道口咽角不同体位(平卧位、仰卧位)大。正常气道组、困难气道组之间口咽角存在显著差异(P0.05),表明口咽角可以作为困难气道预测的有效指标。2、气管插管时患者由平卧位到仰卧位时,矢状切上气道最小横截面积在增大,且正常气道较困难气道变化大;冠状切上气道最小横截面积无统计学意义(P0.05)。矢状切上气道最小横截面积正常气道较困难气道最小横截面积大;冠状切正常气道及困难气道上气道最小横截面积差异无统计学意义(P0.05)。正常气道组、困难气道组之间上气道矢状切最小横截面积存在显著差异(P0.05),表明上气道矢状切最小横截面积可以作为困难气道预测的有效指标。[结论]应用上气道填充重建三维有限元模型法可有效地从解剖学方向对困难气道做出准确的评估。正常气道组、困难气道组之间口咽角存在显著差异(P0.05),表明由门齿点、咽后壁最高点、声门裂中点组成的口咽角可以作为困难气道预测的有效指标。正常气道组、困难气道组之间矢状切上气道最小横截面积存在显著差异(P0.05),矢状切上气道最小横截面积可以作为困难气道预测的有效指标。
[Abstract]:[objective] to reconstruct the 3D finite element model of upper airway filling with MRI data from normal airway and difficult airway patients in supine position to supine position.The morphologic changes of upper airway in tracheal intubation from supine position to maximum supine position were calculated and the specificity of dissection of difficult upper airway was analyzed.[methods] A total of 20 patients with normal airway and 20 patients with difficult airway were selected from April to December 2015 after anesthesia in the first affiliated Hospital of Kunming Medical University.The effective 3D finite element model of head and neck was imported into Mimics10.01 software to fill the upper airway model of normal and difficult airway patients.The accurate position of the airway was also indicated. The highest point of the posterior pharyngeal wall, the highest point of the posterior pharyngeal wall, the central point of the glottic fissure, was N / D.The patients with tracheal intubation were accurately measured by Mimics10.01 software from supine position to maximum supine position, the highest point of the posterior pharynx wall, and the incisor point in the maximal supine position.The oropharynx angle of glottic fissure, the angle of oropharynx of the glottic fissure, the angle of oropharynx, the distance of OAD, the minimum cross-sectional area of the upper airway, S1, S1, S2, S2, S3, S3, S4, S4, etc., of the glottic fissure, and so on.The anatomic changes of upper airway in normal and difficult airway patients from supine position to maximum supine position were analyzed, and the anatomic specificity of upper airway in patients with difficult airway was obtained.In the normal airway group, there was significant difference in oropharynx angle between the difficult airway group and the difficult airway group (P 0.05), which indicated that the oropharynx angle could be used as an effective index for predicting the difficult airway. During tracheal intubation, the minimum cross-sectional area of the sagittal incised upper airway was increased from supine position to supine position.The change of the normal airway was greater than that of the difficult airway, and the minimum cross sectional area of the upper airway was not statistically significant (P 0.05).The minimum cross sectional area of normal upper airway was larger than that of difficult airway, but there was no significant difference between coronal normal airway and difficult upper airway (P 0.05).There was significant difference between the normal airway group and the difficult airway group in the minimum cross sectional area of the upper airway sagittal incised, indicating that the minimum cross sectional area of the upper airway sagittal cut could be used as an effective index for predicting the difficult airway.[conclusion] the 3D finite element method for reconstruction of upper airway filling can be used to evaluate the difficult airway accurately.There was significant difference in oropharynx angle between the normal airway group and the difficult airway group (P 0.05), indicating that the oropharynx angle composed of the incisor, the highest point of the posterior pharynx wall and the middle point of the glottic fissure could be used as an effective index for predicting the difficult airway.There was significant difference in the minimum cross sectional area of the upper sagittal upper airway between the normal airway group and the difficult airway group. The minimum cross sectional area of the sagittal upper airway could be used as an effective index for predicting the difficult airway.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R614

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