鼻功能诊断系统对鼻阻塞患者手术效果评估的临床应用价值

发布时间：2018-04-30 22:31

本文选题：鼻阻塞 + 鼻声反射　；参考：《郑州大学》2013年硕士论文

【摘要】：背景和目的鼻阻塞(nasal obstruction)是耳鼻咽喉科学临床工作中的常见疾病,引起鼻阻塞的原因很多,成人和婴幼儿及儿童的病因各不相同。临床上对鼻阻塞程度的评估主要根据患者的主观感觉,治疗的主要手段之一是行手术治疗,对患者术后鼻塞改善的程度也主要依靠其自身的主观感觉,故对鼻阻塞程度及术后疗效评估缺乏客观的参考依据和指标。鼻功能诊断系统包括鼻(咽)声反射仪、鼻阻力仪及鼻呼吸量仪,近年来已广泛应用于耳鼻喉科临床工作中,它能从客观上反映鼻腔阻塞程度、部位及性质,并具有术前术后疗效对比功能,客观反映手术效果,很大程度上能克服临床工作中患者主诉与实际不符的难题,有效避免医患矛盾。本文总结我科2011年11月～2012年12月收治的150例鼻阻塞患者(分别为腺样体肥大组60例,鼻中隔偏曲组、慢性鼻窦炎组及鼻腔鼻窦占位性病变组各30例)资料,分别根据患者具体情况行鼻内窥镜手术治疗,同时对患者术前及术后行鼻功能检查,并将各组数据进行统计学分析,同时选正常成人对照组和正常儿童对照组各30例并行鼻功能检测,将鼻阻塞各组与之对比分析,探讨鼻功能诊断系统在鼻阻塞患者行鼻内窥镜手术效果中的临床应用价值。方法将150例鼻阻塞患者分为4组,即腺样体肥大组(A组,其中单纯腺样体肥大患者30例即a组、腺样体伴扁桃体肥大患者30例即b组)、鼻中隔偏曲组(B组)、慢性鼻窦炎组(C组)和鼻腔鼻窦占位性病变组(D组),分别行术前及术后鼻功能检测,分析各组临床资料；正常成人对照组30例即E组和正常儿童对照组30例即F组分别行鼻功能检测,并进行统计学分析。结果 E组正常成人对照组双侧NMCA1.48±0.12cm2,双侧NCV18.67±1.49cm3,双侧NAR0.182±0.017kPa·s/L,双侧VT8.194±0.312L；单侧NMCA0.72±0.06cm2,单侧NCV10.16±0.51cm3,单侧NAR0.341±0.030kPa·s/L,单侧VT4.014-0.306L。F组正常儿童对照组双侧NMCA0.70±0.12cm2,双侧NPV19.05±1.62cm3,双侧NAR0.225±0.052kPa·s/L,双侧VT6.321±0.615L。 A组(腺样体肥大组)患者术前NMCA0.65±0.12cm2,NPV12.20±2.16cm3, NAR0.301±0.040kPa-s/L, VT3.444±0.344L;术后3月复查鼻功能, NMCA0.72±0.10cm2, NPV19.60±1.78cm3, NAR0.239±0.043kPa·s/L, VT6.429±0.535L,术后较术前相比,NMCA、NPV、VT增大,NAR减小,差异有统计学意义(P0.05),与正常儿童对照组各检测指标相比无明显差异(P0.05)。B组(鼻中隔偏曲组)患者术前NMCA0.59±0.17cm2, NCV8.13±1.24cm3, NAR0.421±0.031kPa-s/L, VT5.024±0.521L;术后3月复查鼻功能,NMCA1.57±0.19cm2, NCV19.04±2.43cm3, NAR0.176±0.029kPa·s/L, VT8.212±0.461L,术后较术前相比,NMCA、NCV、VT增大,NAR减小,差异有统计学意义(P0.05),与正常成人对照组双侧鼻腔各检测指标相比无明显差异(P0.05)。C组(慢性鼻窦炎组)患者术前NMCA0.67±0.13cm2, NCV8.03±1.68cm3, NAR0.407±0.055kPa·s/L, VT4.926±0.615L;术后3月复查鼻功能,NMCA1.46±0.27cm2, NCV19.14±3.50cm3, NAR0.179±0.035kPa·s/L, VT8.013±0.660L,术后较术前相比,NMCA、NCV、VT增大,NAR减小,差异有统计学意义(P0.05),与正常成人对照组双侧鼻腔各检测指标相比无明显差异(P0.05)。D组(鼻腔鼻窦占位性病变组)患者术前NMCA0.26±0.08cm2, NCV5.09±1.27cm3, NAR1.605±0.409kPa·s/L, VT0.936±0.320L;术后3月复查鼻功能,NMCA0.58±0.07cm2, NCV10.33±1.75cm3, NAR0.323±0.076kPa·s/L, VT3.909±0.830L,术后较术前相比,NMCA、NCV、VT增大,NAR减小,差异有统计学意义(P0.05),与正常成人对照组单侧鼻腔各检测指标相比,NMCA差异有统计学意义(P0.05), NCV、VT、NAR无明显差异(P0.05)。结论术前对鼻阻塞患者行鼻功能检测,可对患者鼻阻塞部位、程度进行精确判断,可帮助手术方案的选择和手术操作的进行;术后再次行该检测并与术前进行对比,可客观、直接、有效的呈现手术效果。鼻功能诊断系统能客观、准确的反映鼻腔的通气状况,所以在一定程度上鼻功能诊断系统可作为评价鼻阻塞程度及鼻阻塞患者行鼻内窥镜手术效果的客观评价指标。
[Abstract]:Background and purpose
Nasal obstruction (nasal obstruction) is a common disease in the scientific clinical work of otorhinolaryngology. There are many causes of nasal obstruction. The causes of adults and infants and children are different. The evaluation of the degree of nasal obstruction mainly depends on the subjective feeling of the patients. One of the main means of treatment is the operation treatment, and the patient's nasal congestion. The degree of improvement mainly depends on its own subjective feeling, so it lacks objective reference and index for the degree of nasal obstruction and the evaluation of postoperative effect. The nasal function diagnosis system includes the nasal (pharynx) acoustic reflexometer, the nose resistance instrument and the nasal breathing apparatus. In recent years, it has been widely used in the clinical work in the Department of ENT. It can reflect the nasal cavity objectively. The degree, location and nature of obstruction, and the effect of preoperative and postoperative effect comparison, objectively reflect the effect of the operation, to a great extent, to overcome the difficult problems of the patients' complaints and practice in clinical work, and to effectively avoid the contradiction between doctors and patients.
150 cases of nasal obstruction admitted from November 2011 to December 2012 (60 cases of adenoid hypertrophy group, nasal septum deviation group, chronic sinusitis group and 30 cases of nasal sinus paranasal sinus space occupying lesion group) were reviewed in our department. Nasal endoscopic hand surgery was performed on the basis of the patient's specific conditions, and the nasal function examination was performed before and after the operation. At the same time, the data of each group were statistically analyzed, and 30 cases of normal adult control group and normal control group were selected for the parallel nasal function test, and the nasal obstruction groups were compared and analyzed to explore the clinical value of nasal function diagnosis system in the effect of nasal endoscopic surgery in nasal obstruction patients.
Method
150 cases of nasal obstruction were divided into 4 groups, namely, adenoid hypertrophy group (group A, 30 patients with adenoid hypertrophy, 30 cases of adenoid hypertrophy patients, group B), nasal septum deviation group (group B), chronic sinusitis group (group C) and nasal sinus paranasal space occupying venereal disease group (Group D), respectively, before and after the operation of nasal function test. Data from the normal adult control group, 30 cases, namely E group and normal child control group, 30 cases, namely F group, were examined by nasal function and analyzed statistically.
Result
In the normal adult control group, bilateral NMCA1.48 + 0.12cm2, bilateral NCV18.67 + 1.49cm3, bilateral NAR0.182 + 0.017kPa s/L, bilateral VT8.194 + 0.312L, unilateral NMCA0.72 + 0.06cm2, unilateral 0.12cm2 + s/L, unilateral and normal children control group were bilateral. Bilateral NAR0.225 + 0.052kPa? S/L, bilateral VT6.321 + 0.615L.
The patients in group A (adenoid hypertrophy group) were NMCA0.65 0.12cm2, NPV12.20 + 2.16cm3, NAR0.301 + 0.040kPa-s/L, VT3.444 + 0.344L. After the operation, the nasal function was reviewed in March, NMCA0.72 + 0.10cm2. Compared with the normal control group, there was no significant difference (P0.05) in group.B (nasal septum deviation group) before operation NMCA0.59 + 0.17cm2, NCV8.13 + 1.24cm3, NAR0.421 + 0.031kPa-s/L, VT5.024 + 0.521L. After the operation, the nasal function was reviewed in March. Compared with the preoperative NMCA, NCV, VT and NAR, the difference was statistically significant (P0.05). There was no significant difference between the normal adult control group and the control group (P0.05).C group (P0.05).C (chronic nasosinusitis group) before operation NMCA0.67 + 0.13cm2, NCV8.03 +. 46 + 0.27cm2, NCV19.14 + 3.50cm3, NAR0.179 + 0.035kPa s/L, VT8.013 + 0.660L, compared with pre operation, NMCA, NCV, VT increased, NAR decreased, and the difference was statistically significant. There was no significant difference between the normal adult control group and the bilateral nasal sinus space occupying lesion group. 2, NCV5.09 + 1.27cm3, NAR1.605 + 0.409kPa s/L, VT0.936 + 0.320L. After the operation, the nasal function was reviewed in March, NMCA0.58 + 0.07cm2, NCV10.33 + 1.75cm3. The difference of NMCA was statistically significant (P0.05), but there was no significant difference in NCV, VT and NAR (P0.05).
conclusion
The nasal obstruction of the patients before operation can be detected by the nasal function, which can accurately judge the location of the nasal obstruction. It can help the choice of the operation plan and the operation of the operation. After the operation, the examination and comparison with the preoperative can be used to objectively, directly and effectively show the effect of the operation. The nasal function diagnosis system can objectively and accurately reflect the nasal cavity. To a certain extent, the nasal function diagnosis system can be used as an objective evaluation index for evaluating the degree of nasal obstruction and the effect of nasal endoscopic surgery for patients with nasal obstruction.

【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R765.9

【参考文献】