鼻阻塞的主观评价与客观鼻测量的相关性研究

目的 探讨鼻阻塞时检查者和患者的主观评价与客观鼻测量之间是否有相关性.方法 检查者和患者均采用视觉模拟量表(visual analog scale,VAS)对鼻阻塞程度进行评价.客观鼻测量采用主动后鼻测压仪和鼻声反射测量仪进行.以配对t检验分析检查者的临床评价和患者VAS均数的差异,以Spearman等级相关分析评价客观鼻测量结果单侧鼻气流阻力与单侧鼻道容积、单侧鼻腔最小横截面积的关系,以及检查者的临床评价、患者VAS与上述客观鼻测最结果的相关性.结果 本组病例经统计学分析,316例患者中,减充血前后单侧鼻气流阻力与单侧鼻道容积、单侧鼻腔最小横截面积间呈负相关(r值分别为-0.430、-0.554、-0.373、-0.600,P值均＜0.001).减充血前后,检查者的临床评价与患者VAS均数呈正相关,差异均有统计学意义(r值分别为0.630、0.526,P值均＜0.001),二者均与鼻气流阻力有一定的正相关关系(减充血前:检查者的临床评价与鼻气流阻力r=0.530,P=0.000,患者VAS与鼻气流阻力r=0.351,P=0.000;减充血后:检查者的临床评价与鼻气流阻力r=0.452,P=0.000,患者VAS与鼻气流阻力r=0.216,P=0.000),与鼻道容积和鼻腔最小横截面积均有一定的负相关关系(减充血前:检查者的临床评价与鼻道容积r=-0.411,P=0.000,患者VAS与鼻道容积r=-0.325,P=0.000,检查者的临床评价与鼻腔最小横截面积r=-0.507,P=0.000,患者VAS与鼻腔最小横截面积r=-0.384,P=0.000;减充血后:检查者的临床评价与鼻道容积r=-0.391,P=0.000,患者VAS与鼻道容积r=-0.209,P=0.000,检查者的临床评价与鼻腔最小横截面积r=-0.471,P=0.000,患者VAS与鼻腔最小横截面积r=-0.286,P=0.000).检查者的临床评价与客观鼻测量参数的相关系数大于患者VAS与客观鼻测最参数的相关系数.结论 鼻阻力测压与鼻声反射测量的结果有一定的相关性.检查者的临床评价与患者VAS存在一定的正相关关系.两者均与客观鼻测量参数存在一定的直线相关关系.

Correlation between subjective assessment and objective measurement of nasal obstruction

OBJECTIVE: To investigate the correlation between subjective assessment from clinician and patients and the objective measurement from active posterior rhinomanometry and acoustic rhinometry. METHODS: Clinician and patients' assessment of nasal patency was achieved by visual analogue scale (VAS). Objective measurement included active posterior rhinomanometry and acoustic rhinometry. The mean of clinician's assessment and patients' VAS was compared by using paired-samples t-test. The correlation between unilateral nasal airflow resistance and unilateral nasal airway volume, unilateral minimal cross section area, and also subjective assessment and objective measurement of nasal patency were analysed by using Spearman correlation analysis in total patients. RESULTS: In total of 316 patients, pre-decongestion and post-decongestion, unilateral nasal airflow resistance and unilateral nasal airway volume, unilateral minimal cross section area had significant negative correlation respectively (P = 0.000). The mean of clinician's assessment and patients' VAS had significant difference (P < 0.001) before and after decongestion. Clinician's assessment had significant positive correlation with patients' VAS, nasal airflow resistance, and significant negative correlation with nasal airway volume, minimal cross section area of nasal cavity before and after decongestion (P = 0.000). Patients' VAS had significant positive correlation with nasal airflow resistance, and significant negative correlation with nasal airway volume, minimal cross section area of nasal cavity before and after decongestion (P = 0.000). The correlation coefficients from clinician's assessment and objective measurements were greater than those from patients VAS and objective measurements. CONCLUSIONS: The parameter of active posterior rhinomanometry had significant negative correlation with the parameters of acoustic rhinometry. Clinician assessment of nasal patency had significant positive correlation with patients' VAS; both of them had significant correlation with the parameters of rhinomanometry and acoustic rhinometry. Clinician's assessment was more objective and reliable to the parameters of objective measurement than patients' VAS.