空鼻综合征鼻腔空气动力学研究

发布时间：2019-04-25 22:20

【摘要】：目的研究空鼻综合征下鼻甲型(Empty Nose Syndrome-Inferior Turbinate, ENS-IT)及中鼻甲型(Empty Nose Syndrome-Middle Turbinate, ENS-MT)的鼻腔空气动力学特征及变化。从鼻腔空气动力学角度对ENS的发生机制进行初步探索。方法获得7例健康成年男性的鼻腔鼻窦区薄层计算机断层(Computed Tomography, CT)影像。根据正常CT影像,分别构建双侧下鼻甲完全切除及双侧中鼻甲完全切除两种术后鼻腔结构,以分别模拟ENS-IT及ENS-MT鼻腔。对正常、ENS-IT、 ENS-MT鼻腔鼻窦内空气流场进行边界提取及网格划分。选取稳态、层流模型,计算正常、ENS-IT、ENS-MT鼻腔鼻窦流场内空气动力学参数(气流速度、压强、流量分布、迹线及剪切力分布)。通过与正常鼻腔空气动力学参数比较,获得ENS-IT及ENS-MT鼻腔空气动力学相应参数的变化趋势。结果 1.与正常生理状态比较,ENS-MT: (1)吸气相：鼻腔阻力降低；鼻腔中后部流速普遍降低,矢状位鼻腔速度分布与正常相似；气流迹线、流量分布、剪切力分布均与正常差异相对小。部分研究对象蝶腭神经节区域速度较正常增大。 (2)呼气相：蝶腭神经节区域气流速度高于正常。其余变化趋势同吸气相。 2.与正常生理状态比较,ENS-IT: (1)吸气相：鼻腔阻力降低更明显,鼻前庭至下鼻甲头部压强下降平缓；流速降低范围更大,以下鼻甲头部、鼻腔中后部为著；气流更为紊乱,部分研究对象鼻腔(原)下鼻道出现新的涡旋；气流向(原)下鼻甲中上部集中分布；较大剪切力区域缩小。 (2)呼气相：7例研究对象鼻腔流场特征变化趋势与吸气相相似。结论 1.双侧下鼻甲完全切除术后,鼻腔流场特征可发生显著变化。双侧中鼻甲完全切除术后,鼻腔流场特征虽与正常差异相对小,但蝶腭神经节区域速度显著增大,可能与呼吸相关头痛发生有关。故行双侧中、下鼻甲根治切除术均应慎重。 2.鼻腔空气动力学研究是预测患者术后鼻腔流场变化的有力工具。 3.ENS的发生为多因素共同作用的结果,鼻腔空气动力学特征的变化与其发生有一定关联,需在后续研究中建立ENS临床表现与鼻腔流场变化的进一步关系。 4.双侧中、下鼻甲切除术后,同地区、同种族不同个体间鼻腔流场存在一定相似的变化趋势。
[Abstract]:Objective to study the characteristics and changes of nasal aerodynamics in patients with hollow nose syndrome (A-(Empty Nose Syndrome-Inferior Turbinate, ENS-IT) and middle nose (A-(Empty Nose Syndrome-Middle Turbinate, ENS-MT). The mechanism of ENS was studied from the angle of nasal aerodynamics. Methods thin slice computed tomography (Computed Tomography, CT) images of nasal cavity and sinuses were obtained in 7 healthy adult males. According to the normal CT images, the nasal cavity structures after bilateral complete inferior turbinectomy and bilateral middle turbinectomy were constructed to simulate ENS-IT and ENS-MT nasal cavity respectively. The boundary extraction and meshing of the air flow field in the nasal cavity and sinuses of ENS-IT, ENS-MT were performed. The steady state, laminar flow model was selected to calculate the aerodynamic parameters (air velocity, pressure, flow distribution, trace and shear force distribution) in the flow field of normal ENS-IT,ENS-MT nasal cavity and paranasal sinuses. Compared with the normal nasal aerodynamics parameters, the variation trend of ENS-IT and ENS-MT nasal aerodynamics parameters was obtained. Outcome 1. Compared with normal physiological state, ENS-MT: (1) suction: nasal resistance decreased, the velocity of middle and posterior nasal cavity generally decreased, and the velocity distribution of sagittal nasal cavity was similar to that of normal nasal cavity. The airflow trace, flow rate distribution and shear force distribution are relatively small with the normal difference. The velocity of sphenopalatine ganglia in some subjects was larger than normal. (2) expiratory phase: the velocity of airflow in sphenopalatine ganglia was higher than normal. The rest of the variation trend coincided with inspiratory phase. 2. Compared with normal physiological state, ENS-IT: (1) suction: nasal resistance decreased more obviously, the pressure of nasal vestibule to inferior turbinate head decreased smoothly, the velocity of flow decreased more widely, the inferior turbinate head and the middle and posterior nasal cavity were more obvious. In some of the subjects, new vortices appeared in the nasal cavity (original) inferior nasal meatus; the central and upper parts of the middle and upper parts of the inferior turbinate were concentrated in the direction of air flow; and the larger shear force area was narrowed. (2) expiratory phase: the change trend of nasal fluid field in 7 cases was similar to that of inspiratory. Conclusion 1. After bilateral complete inferior turbinectomy, the flow field of nasal cavity can be changed significantly. After bilateral middle turbinectomy, the velocity of sphenopalatine ganglia increased significantly, which might be related to respiratory-related headache. Therefore, in both sides, radical resection of inferior turbinate should be cautious. 2. Nasal aerodynamics study is a powerful tool for predicting postoperative nasal fluid flow. The occurrence of 3.ENS is the result of multiple factors, and the change of nasal aerodynamics is related to the occurrence of ENS. It is necessary to establish the further relationship between the clinical manifestation of nasal cavity and the change of nasal fluid field in the follow-up study. 4. In bilateral, after inferior turbinectomy, there was a similar trend of nasal fluid flow in the same area and between different individuals of the same race.
【学位授予单位】：北京协和医学院
【学位级别】：博士
【学位授予年份】：2012
【分类号】：R765

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