鼻声反射和鼻阻力检查在鼻内镜下低温等离子射频消融术疗效评价中的临床意义

目的：探讨鼻声反射和鼻阻力（NR）检查作为鼻通气功能的客观检查方法,在鼻内镜下低温等离子射频消融术疗效评价中的临床意义。方法：应用鼻声反射仪和鼻阻力计对以持续性鼻阻塞为主要症状,经正规药物治疗后效果不明显或无效的106例（治疗组）中重度慢性鼻炎患者,于鼻内镜下低温等离子射频消融术前及术后6个月,分别在鼻黏膜收缩前和收缩后,进行鼻声反射及NR检查,记录NR、鼻腔最小横截面积（NMCA）、鼻腔最小横截面积距前鼻孔的距离（DCAN）、鼻腔平均横截面积（MNCA）及鼻腔容积（NCV）。另以36例健康人作为对照组,同样在鼻黏膜收缩前和收缩后,进行鼻声反射及NR检查,应用SAS6．12软件对2组数据进行统计学分析。结合患者的主观症状及视觉模拟量表（VAS）评分,对低温等离子射频消融术疗效进行评价。结果：术前治疗组NR明显高于对照组,NMCA明显低于对照组,差异均有统计学意义（均P〈0．01）。低温等离子射频消融术后治疗组有效率为100％,术后VAS评分均较术前降低,差异有统计学意义（P〈0．01）。治疗组术后NR较术前明显降低,NMCA较术前明显增大,差异有统计学意义（P％0．01）。同组内鼻黏膜收缩前和收缩后,NR和NMCA差异无统计学意义（P〉0．05）。治疗组术后NR和NMCA与对照组之间差异无统计学意义（P〉0．05）。结论：鼻内镜下低温等离子射频消融术对于中重度慢性鼻炎患者鼻通气功能的改善有显著疗效,鼻声反射和NR检杏能客观准确地评价低温等离子射频消融术的疗效。     

天津地区健康成年人鼻通气功能的客观评估

目的:建立天津地区健康成年人鼻声反射、鼻阻力、鼻呼吸量参数的参考值范围,分析年龄、性别及侧别对其的影响,探讨各测量值间的相关性,为天津地区健康成年人鼻通气功能检查提供诊断数据.方法:利用A1鼻声反射仪测量天津地区466例健康成年人的鼻腔最小截面积(MCA)、鼻腔最小截面积距前鼻孔距离(DCAN)、鼻腔0～5 cm容积(V5)、2～5 cm容积(V2～5);利用NR6鼻阻力仪测量受试者经鼻压差为150 Pa、75 Pa下及用broms测量的鼻腔单侧吸气阻力(IR)、呼气阻力(ER);通过计算得出双侧吸气总阻力(TIR)、双侧鼻腔呼气总阻力(TER)及左右鼻腔阻力差异比(Rlr);利用NV1鼻呼吸量仪测量单侧鼻腔吸气量、呼气量,通过计算得出鼻呼吸量差异比(NPR,包括吸气量差异比NRPi和呼气量差异比NRPe).实际测量下鼻甲前端至前鼻孔的距离(L),并与DCAN比较.对3种检查不同指标做相关性分析.结果:鼻声反射参数:MCA男为(0.45±0.16)cm2,女为(0.44±0.16)cm2;V2～5男为(3.52±1.38)cm3,女为(3.36±1.22)cm2;V5男为(5.10±1.47)cm3,女为(4.86±1.12)cm3;DCAN存在2个位置,男分别为(2.22±0.39)cm、(0.53±0.62)cm,女分别为(2.10±0.37)cm、(0.67±0.15)cm;L男为(2.48±0.36)cm,女为(2.1 5±0.26)cm.MCA、V5、V2～5在性别、侧别、年龄上均差异无统计学意义,DCAN在年龄、侧别上无差异,男女间差异有统计学意义.鼻阻力参数:经鼻压差在150 Pa、75 Pa、broms测量下IR、ER、TIR、TER在侧别及年龄上均差异无统计学意义,男女差异有统计学意义.鼻呼吸量参数:IC男为(2.06±1.10)L/20 s,女为(1.37±0.34)L/20 s;EC男为(2.15±1.23)L/20 s,女为(1.39±0.58)L/20 s;NPRi、NPRe分别为0.11[0.05,0.23]、0.11[0.05,0.19].IC、EC在侧别上无差异;在性别上有差异.NPR在性别、年龄上无差异.MCA与IR、ER呈负相关(r=-0.21、-0.22,均P<0.05),MCA与IC、EC间均存在正相关(r=0.12、0.17,均P<0.05),IR与IC、ER与EC间呈负相关(r=-0.10、-0.10,均P<0.05),Rlr与NPRi、NPRe均呈负相关(r=-0.19、-0.18,均P<0.05).结论:鼻声反射、鼻阻力、鼻呼吸量参数可以作为评估鼻通气功能的参考指标,三者结合参考价值更大.     

鼻声反射测量对鼻塞主客观相关性的研究

目的:探讨鼻声反射技术(acoustic rhinometry,AR)客观测量指标与鼻塞患者主观感受的相关性及相关程度.方法:将365例因鼻部病变就诊的患者分为鼻塞组220例和无鼻塞组145例,另征集健康志愿者(对照组)70例.3组均行AR,测试内容为鼻腔最小横截面积(NMCA),鼻腔容积(NV),鼻气道阻力(NAR),鼻腔最小横截面积到前鼻孔的距离(DCAN);鼻塞主观测试采取VAS评分测量,进行统计学分析.结果:鼻塞组与对照组在NAR、NV、DCAN中显示差异均有统计学意义(均P<0.05);VAS评分与NMCA、NV、NAR、DCAN存在直线相关关系,RNAR=0.7385;RNV=-0.8532;RNMCA=-0.7454;RDCAN=0.3697.结论:AR测量指标中NAR及NV的结果与患者的主观感受高度一致,可以作为评价患者主观是否具有鼻塞症状的客观评价测量工具.     

声反射鼻测量计在鼻畸形患者中的应用

目的研究声反射鼻测量计在鼻畸形患者术前评价中的应用价值。方法因鼻病引起鼻畸形患者（鼻畸形组）及无鼻病健康志愿者（对照组）各15例进行声反射鼻测量计测试,记录鼻腔最小横截面积（nasal minimal cross-sectional area,NMCA）、鼻腔容积（nasal cavity volume,NCV）,NMCA至前鼻孔的距离（distance of the minimal cross-sectional area to the nostril,DCAN）及鼻阻力（nasal resistance,NR）,并进行统计学分析。结果对照组左、右侧鼻腔NMCA、DCAN、NCV、NR差异均无统计学意义（P〉0．05）：鼻畸形组阻塞侧与非阻塞侧NMCA、DCAN、NCV、NR差异有统计学意义（P〈0．001）：鼻畸形组阻塞侧NCV、NR、NMCA均明显小于对照组（P〈0．001）;NMCA和NCV与NR呈反比,而与DGAN无明显相关性（P〉0．05）。结论声反射鼻测量计在鼻畸形患者术前评价中具有重要作用,对鼻畸形患者鼻腔功能及几何形态的评估可为手术提供重要的临床价值。     

结构性鼻炎患者鼻通气功能的主客观评估

目的对结构性鼻炎患者进行术前鼻通气的主客观评估,为手术提供临床依据。方法结构性鼻炎患者56例,收缩鼻腔前后分别进行鼻堵视觉模拟量表(visualanalogue scale,VAS)评分并分为两组:组1,30例,VAS评分>7;组2,26例,VAS评分<7。组3,正常对照组,24例,VAS评分=0。3组分别进行鼻声反射和鼻阻力测量。记录两侧鼻腔前2个最小截面积(minimum cross-sectional area of nasal cavity,MCA1)、MCA2及其距离前鼻孔距离(the distance between the nostril to minimumcross-sectional area,MD1)、MD2,并分别记算两侧的比值;测量距离前鼻孔5 cm、2～5 cm、5～7 cm的两侧鼻腔容积(nasal volume,V5)、V2-5、V5-7并分别记算两侧的比值;测量双侧鼻腔总阻力(nasal resistance total,RT),计算双侧鼻腔阻力差异比(Rlr)。取收缩鼻腔后数值进行统计学检验。结果 3组MCA1、MD1、MCA2、MD2和RT值均无统计学差异;3组间各比值,除MD1、V5-7差异无统计学意义外,其余比值差异均存在统计学意义;组1测量结果较组2或组3有明显差异,结构异常也更加明显。结论鼻堵严重程度与两侧鼻腔结构异常程度有一定关联;鼻堵VAS评分、鼻声反射和鼻阻力测量应作为结构性鼻炎术前评估的常规手段。     

声反射鼻测量计对婴幼儿进行鼻腔测量

目的 :研究正常婴幼儿鼻腔最小横截面积 (MCA)及其距前鼻孔的距离 (DCA)、双侧鼻腔容积 (NV)、双侧鼻咽部容积 (NPV)的正常值范围。方法 :应用声反射鼻测量计测量正常婴幼儿 175例 ,同时测量急性上呼吸道感染婴幼儿 10 8例作为对照。结果 :正常婴幼儿双侧MCA范围为 0 .2 0～ 0 .5 0cm2 ,DCA范围 1.93～ 2 .47cm ,NV范围 2 .6 9～ 4.75cm3 ,NPV范围 3.83～ 8.92cm3 ,与对照组比较 ,MCA、DCA、NV差异均有显著性意义 (P <0 .0 5 )。结论 :声反射鼻测量计可以客观地评价婴幼儿鼻气道 ,本检测可为婴幼儿鼻腔生理、病理研究 ,鼻腔疾病的辅助诊断及疗效判定提供参考依据。     

鼻声反射在鼻中隔偏曲中的临床应用研究

目的　利用鼻声反射测量,寻找对鼻中隔偏曲诊断及手术效果评估的客观依据。方法　应用鼻声反射测量鼻腔不同部位的截面积和各段鼻腔的容积,分析鼻中隔偏曲患者与正常人、生理性偏曲者的各参数差异,结合视觉模拟量表（visual analogue scale,VAS）评分,分析手术前、后各组鼻声反射参数与主观鼻塞的相关性。结果　正常组鼻腔与生理性偏曲组中偏曲侧鼻腔的MCA2、MD3有统计学差异。病例组中鼻堵侧鼻腔与生理性偏曲组中偏曲侧鼻腔的MD2、V2～3有统计学差异。术前鼻塞症状的VAS评分与MCA2、MCA3、V2～3、V3～5、V0～7呈负相关。手术前后VAS评分的改变与MCA3、V3～5、V0～7的改变呈负相关。结论　鼻声反射检查可为鼻中隔偏曲的诊断提供客观量化依据,用于手术效果的评估。     

鼻声反射和鼻阻力检查在气道炎症应用中的评价

目的探讨在上下气道炎症研究中鼻声反射、鼻阻力检查的参数选择及临床应用价值。方法应用鼻声反射仪及鼻阻力计对变应性鼻炎、哮喘患者及正常人鼻激发试验前后鼻腔通气功能进行测量，比较两种检查方法的差异，分析上下气道炎症的关系。结果①与正常对照组比较，鼻激发试验前后变应性鼻炎组、哮喘组鼻腔容积（nasal volume，NV）变化有显著性差异（P〈0．05），鼻腔阻力（nasal airway resistance，NAR）变化也有显著性差异（P〈0．05）。②变应性鼻炎组、哮喘组NV与NAR变化率均呈负相关（r鼻炎=-0．673；r哮喘=-0．497，P〈0．01），但NAR变异系数（coefficient of variation，CV）较大。正常组NV与NAR变化率无明显相关（r正常组=0．120，P〉0．05）。③以鼻声反射NV减少20％或NAR增加20％作为阳性标准，变应性鼻炎组、哮喘组与正常对照组NV阳性率的差异有统计学意义（X^2=23．03，P〈0．01），NAR阳性率差异也有统计学意义（X^2=28．06，P〈0．01）。结论①AR、NAR检查均可作为评价鼻激发试验（nasal provocation testing，NPT）前后鼻腔通气功能的客观检查，但是，AR比NAR检查更为简便、迅速，精确度更高，重复性更好。②上、下气道炎症存在密切相关性。     

上海市崇明地区成年人鼻阻力和鼻声反射的初步研究

目的 通过对上海市崇明地区健康成年人鼻通气功能的客观测定,建立崇明地区健康成年人鼻阻力(RM)、鼻声反射(AR)等参数的正常参考值范围,并初步分析两者相关性.方法 采用NR6鼻阻力计采集受试者经鼻压差为150Pa下前端测量的单侧鼻腔吸气阻力(Ri)、呼气阻力(Re)等数据,通过计算机软件计算后得出单侧总阻力(RI)、双...     

鼻声反射与鼻阻力检查在原发性萎缩性鼻炎诊断中的应用

目的探讨鼻声反射和鼻阻力检查在原发性萎缩性鼻炎患者诊断中的应用价值。方法31例实验者中选取25例正常成年受试者为对照组,6例原发性萎缩性鼻炎患者为实验组,分别行鼻声反射(acoustic rhinometry,AR)和鼻阻力(rhinomanometry,RM)测量,获得单侧鼻腔第1狭窄面积、单侧鼻腔第2狭窄面积、单侧鼻腔最小截面积、单侧及总的0～5 cm和2～5 cm鼻腔容积(UV5、UV2～5、TV5、TV2～5)、单侧吸气阻力、单侧呼气阻力及鼻气道总阻力参数,比较两组间的差异并进行相关性分析。结果实验组单侧鼻腔第1狭窄面积明显小于对照组(T=9.189,P<0.05),其余各参数差异无统计学意义。结论鼻阻力与鼻声反射检查可为原发性萎缩性鼻炎的诊断和治疗提供客观参数。     

应用声反射鼻测量计对人鼻周期的观察

目的：探讨成人、儿童鼻周期的类型、特点及鼻粘膜病理状态对鼻周期的影响。方法：应用声反射鼻测量计测量了１６例正常成人，１１例正常儿童，１４例双侧鼻阻塞患者的鼻周期。测量时间为４￣８．５ｈ，间隔时间为３０ｍｉｎ。结果：所有受试者均有明显的鼻周期，正常成人组国病组以典型鼻周期为最常见，正常儿童组以一致型为最常见鼻病组与正常成人之间在鼻周期类型、周期时间方面无明显差异，但鼻腔容积变化幅度小于正常成人组，正     

Correlation between nasal obstruction symptoms and objective parameters of acoustic rhinometry and rhinomanometry

Acoustic rhinometry and rhinomanometry have been used to assess nasal airway patency objectively. We compared nasal obstruction symptoms before and after decongestion with several parameters of these objective tests. The patients assessed their nasal obstruction using a visual analogue scale (VAS). Cross-sectional areas and nasal resistance were measured by acoustic rhinometry and rhinomanometry before and after topical application of 1% phenylephrine solution in 32 patients with nasal obstruction symptoms. There was no significant correlation between the difference in the VAS and the difference in nasal resistance. There was also no significant correlation between the difference in the VAS and minimal cross-sectional area and cross-sectional areas at 3.3 cm (CA3.3), CA4.0 and CA6.4 from the nosepiece both in the wide and narrow sides and in both nasal cavities before and after nasal decongestion. It is concluded that rhinomanometry and acoustic rhinometry may have no diagnostic value in estimating the severity of nasal obstruction symptoms.     

Correlation between nasal resistance and different acoustic rhinometry parameters in children and adolescents with and without allergic rhinitis

Acoustic rhinometry and rhinomanometry are important tests used to assess nasal function. The degree to which the parameters of these tests are correlated is yet to be established.ObjectiveThis paper aimed to study the correlations between nasal resistance (NR) and acoustic rhinometry parameters in children and adolescents with allergic rhinitis and controls.MethodTwenty patients with allergic rhinitis and 20 controls were enrolled. NR, volumes (V4, V5, V2-5), and minimal cross-sectional areas (MC1, MC2) were measured in three moments: baseline, after induction of nasal obstruction and after topical decongestant administration.ResultsPatients with allergic rhinitis had significant correlation between NR and all volumes (V5: r = -0.60) and with MC2. Among controls, MC1 was the parameter with the strongest correlation with NR at baseline (r = -0.53) and after decongestant administration. In the combined analysis, V5 had the highest correlation coefficients at baseline (r = -0.53), after obstruction (r = -0.58) and after decongestant (r = -0.46).ConclusionsOur data showed that NR and acoustic rhinometry parameters have negative and significant correlations. Nasal volumes are, in general, better correlated than minimal cross-sectional areas. V5 was the parameter with the highest correlation in the rhinitis group and in the combined analysis.     

腺样体肥大患儿鼻声反射联合上气道气流场生物力学数值模型的特征分析

目的　探讨鼻声反射对腺样体肥大患儿的临床应用价值,联合建立上气道气流场生物力学数值模型,定性分析患儿鼻腔、鼻咽腔形态特征及气流场分布情况。方法　对35例腺样体肥大患儿行鼻咽侧位片及鼻声反射检查,根据腺样体/鼻咽腔（adenoid/nasopharynx,A/N比率）分为三组（A/N≤0.60,0.60＜A/N≤0.70,A/N＞0.70）,分析三组间鼻腔最小横截面积（minimal cross-sectional area,MCSA）、鼻腔最小横截面积距离前鼻孔的距离（distance of the minimal cross-sectional area from the nostril,DMCA）、鼻腔阻力（nasal airway resistance,NR）、鼻腔容积（nasal volume,NV）及鼻咽腔容积（nasopharyngeal volume,NPV）的参数有无显著性差异。据其中9例受试者上气道CT影像,三维重建上气道生物力学数值模型,分析气流流场特征。结果　35例受试者鼻声反射曲线特点为后段低平。随A/N比率增大NR逐渐增大,NV、NPV下降,各组间MCSA、DMCA、NR、NV无显著性差异（P＞0.05）,NPV有显著性差异（P =0.000）。患儿鼻咽部气流形态紊乱,压强变化梯度主要集中在鼻阈及腺样体与扁桃体交界区域,呼吸道的高流速区主要集中在鼻阈、中鼻道和鼻咽部。结论　鼻声反射可用于腺样体肥大患儿鼻咽腔容积的定量分析,可验证患儿上气道计算机仿真模型的真实及可靠性,二者结合可从三维立体角度考虑患儿上气道的阻塞因素,不仅能应用于腺样体肥大患儿的筛查工作,也可为临床因人制宜采取不同的手术方案及术后评估提供参考。     

鼻中隔偏曲矫正术的主客观评估及相关性分析

目的　探讨鼻中隔偏曲患者行鼻中隔矫正术前、术后的主、客观评估及相关性,评价该手术治疗鼻中隔偏曲的作用。方法　以46例鼻中隔偏曲伴不同程度鼻塞的 患者为研究对象,分别于术前、术后6～8周进行评估,主观方面应用视觉模拟量表（visual analogue scale,VAS）评分,客观方面应用鼻声反射及鼻阻力计,记录双侧鼻腔最小横截面积（nasal minimal cross-sectional area,NMCA）、鼻腔容积（nasal cavity volume,NCV）及鼻阻力（nasal resistance,NR）,应用配对t 检验对各主、客观指标及其之间有无相关性进行统计学分析。结果　术前、术后在VAS、NCV及NR中显示差异均具有统计学意义（P <0.05）,在NMCA中显示差异无统计学意义（P >0.05）。VAS与NMCA,NCV,NR三者之间没有统计学意义上的相关性。结论　鼻中隔偏曲矫正术能有效改善鼻中隔偏曲患者鼻塞症状。鼻腔通气功能的客观检查可以直观并量化的说明手术前、后鼻气道阻力和鼻腔结构的变化,是一种很好的评价参数且不与患者的主观感受一致。     

Acoustic rhinometry in the evaluation of nasal obstruction

Acoustic rhinometry (AR) is a recently developed objective technique for assessment of geometry of the nasal cavity. The technique is based on the analysis of sound waves reflected from the nasal cavities. It measures cross-sectional areas and nasal volume (NV). To obtain dependable assessments of nasal resistance by rhinomanometry or cross-sectional area measurements by AR, it is essential that the structural relations of the compliant vestibular region remain undisturbed by the measuring apparatus. The use of nozzles in making these measurements carries a great risk of direct distortion of the nasal valve. We used a nasal adapter that does not invade the nasal cavity and a chin support that stabilizes the head. In 51 healthy nasal cavities, the average minimum cross-sectional area (MCA) was 0.62 cm² at 2.35 cm from the nostril and 0.67 cm² at 2 cm from the nostril, respectively, before and after topical decongestion of the nasal mucosa. The MCA and NV findings in this group were significantly higher than MCA and NV (P<0.001) in people with structural or mucosal abnormalities before mucosal decongestion. After mucosal decongestion, the MCA and NV were significantly higher in healthy nasal cavities than in nasal cavities with structural abnormalities (P<0.001) but were not higher than nasal cavities with mucosal abnormalities (MCA, P = 0.05; NV, P = 0.06). A nozzle was applied in 20 healthy nasal cavities after mucosal decongestion, and a significantly higher MCA was found compared to measurements made with the nasal adapter (P = 0.02). We conclude that the nasal adapter, which does not invade the nasal cavities, avoids the distortion of the nasal valve and gives more accurate results.