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。     

鼻声反射测试法在鼻中隔偏曲患者中的应用

目的 :研究鼻中隔偏曲患者鼻声反射参数值。方法 :应用Eccovision型声反射鼻测量计对 6 0例鼻中隔偏曲患者进行测试 ,记录鼻腔最小横截面积 (NMCA) ,鼻腔容积 (NCV) ,NMCA至前鼻孔距离 (DCAN)和鼻阻力 (NR) ,并进行统计学分析。结果 :NMCA为 (0 .37± 0 .14 )cm2 ;NCV(12 .30± 2 .32 )cm3 ;DCAN (2 .10± 0 .15 )cm ;NR(0 .348± 0 .115 )kPa·L-1·min-1。经统计学分析提示 ,NMCA和NVC的大小与NR呈反比 ,与DCAN无明显相关性。结论 :鼻声反射可作为鼻腔通气功能评价的客观指标 ,且可以精确确定NMCA的位置 ,为临床手术提供参考。     

成年人鼻声反射与鼻阻力测量的正常参数

目的:研究正常成人鼻声反射(AR)及鼻阻力(RM)测量的正常值,以及它们之间的关系.方法:健康成人82例,采用AR检查,获得单侧鼻腔第一狭窄面积(UA1),第二狭窄面积(UA2),最小截面积(UMCA),0～5 cm、2～5 cm鼻腔容积(UV5、UV2～5).RM为通过前鼻主动测压法测量鼻压差为150 Pa 时的RM值,如鼻压差达不到150 Pa,则采用Broms(半径为200 Pa)的RM值表示,分别测量单侧吸气阻力(URins150、URins200)、单侧呼气阻力(URexp150、URexp200)及鼻气道总阻力(TRins150、TRins200、TRexp150、TRexp200),并对RM和AR测量结果进行相关性分析.结果:健康成年男女UA1分别为(0.63±0.14)、(0.60±0.14)cm2;UA2分别为(0.72±0.48)、(0.6±0.4)cm2;UMCA分别为(0.50±0.16)、(0.47±0.18)cm2;UV5分别为(5.68±1.73)、(5.16±1.85)cm3 ;UV2～5分别为(4.13±1.56)、(3.83±1.66)cm3.男女各参数值比较均差异无统计学意义(T值分别为0.093、0.134、0.392、0.408,均P>0.05).有25例鼻压差未达到150 Pa,采用Broms测量,URins150、URins200、URexp150、URexp200、TRins150、TRinst200、TRexp150、TRexp200结果分别为(0.86±0.96)、(0.45±0.61)、(0.83±0.71)、(0.52±0.88)、(0.38±0.34)、(0.18±0.24)、(0.38±0.27)、(0.19±0.24)Pa/(cm3·s).URins150、URexp150、TRins150、TRexp150与UMCA、UV5、UV2～5有显著相关性(均P<0.05).结论:RM与AR测量结果有一定相关性,可为临床提供鼻腔状态的客观参数.     

鼻声反射在OSAS患者鼻功能评估中的应用

目的：探讨修正性鼻内镜手术联合中鼻甲切除术综合治疗难治性鼻-鼻窦炎的手术效果及应用价值。方法35例难治性鼻-鼻窦炎经CT检查、鼻内窥镜检查、局部用药等规范术前准备,行改良鼻丘径路额窦开放为主修正手术加中鼻甲全部或部分切除,术后凭鼻内镜保健手册进行定期复查,规范随访。26例合并鼻中隔偏曲者其中16例行内镜下传统矫正切除,10例行局限性矫正切除;15例合并变应性鼻炎者对下鼻甲前端、中鼻甲对应鼻中隔等部位黏膜电凝。结果35例患者门诊内镜随诊3-6月以上,治愈11例（31.4%）,黏膜完全上皮化;好转18例（51.4%）,黏膜可以上皮化,但变应性鼻炎发作时,术腔黏膜水肿,经局部处理及药物治疗后可恢复上皮化;无效6例（17.2%）。总有效率82.8%,6例无效均为合并变应性鼻炎及哮喘患者。结论修正性鼻内镜手术联合中鼻甲切除术综合治疗难治性鼻-鼻窦炎,疗效较为确切,值得临床推广。     

鼻声反射测量的临床应用进展

鼻腔是呼吸道的起始部分,在正常经鼻呼吸过程中,鼻腔阻力约占整个呼吸道阻力的一半,鼻腔通气状态的轻微改变即可明显影响整个气道的阻力,进而影响呼吸功能.对鼻腔的通畅程度进行客观评估具有重要意义.1989年Hilberg等首先提出将声反射技术应用于鼻腔测量,通过声反射法、注水测量法、鼻阻力值测量及CT扫描4种方法对尸头浇铸模型、正常人、鼻中隔偏曲患者和鼻肿瘤患者的鼻腔进行测量,认为鼻声反射测量(acousticrlainometry)作为一种评估鼻腔空间结构的方法具有较高的准确性,为客观评估鼻腔通气状况提供了一种较为理想的方法.     

鼻声反射测定在鼻中隔穿孔中的临床意义

目的 探讨鼻中隔穿孔的鼻声反射特征并指导临床.方法 对18例鼻中隔穿孔患者穿孔术前、术后完全愈合后行鼻声反射检查并同时利用视觉评分系统(visual analogue scale,VAS)对患者的鼻塞症状进行评分,采用SPSS16.0统计软件,对术前术后的数据进行配对t检验,并对VAS评分和鼻腔2～7cm容积(NCV2-7)、双侧鼻腔的最小横截面积( NMCA)进行相关性分析.结果 术前NCV2-7、NMCA和VAS评分分别为(8.25±1.12)cm3、(0.54±0.08)cm2、3.46±1.02,术后分别为(6.45±0.98)cm3、(0.48±0.07)cm2、1.74±0.64,NCV2-7和VAS评分手术前后差异有统计学意义(P＜0.01),NMCA手术前后差异无统计学意义(P＞0.05).术前、术后VAS评分和NMCA相关系数分别为0.762、0.814,VAS评分和NCV2-7的相关系数分别为0.384、0.432,NCV2-7和NMCA的相关系数分别为0.234、0.316,手术前后的VAS评分和NMCA相关性有统计学意义(P＜0.01),VAS评分和NCV2-7相关性无统计学意义,NMCA和NCV2-7亦无统计学意义上的相关性.结论 鼻中隔穿孔患者的鼻声反射图具有典型的特异性改变:对应穿孔部位的双侧鼻腔鼻声反射图呈对称性改变,且显著增高,对称性部分能间接反映穿孔的前后距离,鼻声反射检查对于判断鼻中隔穿孔的位置、大小,司法鉴定,疗效判定,隐匿性穿孔的发现,手术侧别、径路、方案的选择具有一定的指导意义.     

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。     

声反射鼻测量计的临床应用现状

声反射鼻测量计已广泛应用于基础及临床研究，它在测量鼻腔及鼻咽部几何形态方面的可靠性、精确性已得到国外大多数学者的认可。本文就其临床应用现状予以综述。     

鼻声反射测量法评估鼻功能的可重复性的改进

鼻声反射测量法是近年来新的快速、简便、无创的鼻腔呼吸功能检查方式,检查结果的偏差与探头在患者鼻腔的位置有密切关系,日间可重复性低,妨碍了鼻声反射在临床的推广应用。该文作者采用对受试者进行多次测量的方法,改进鼻声反射的可重复性。对10例(经鼻腔收敛的)受试者应用鼻声反射测量最小截面     

鼻声反射应用于鼻塞患者鼻通气功能检查的评价

目的 :评估鼻声反射 (AR)在鼻塞患者鼻通气检查中的应用价值 ,并探讨其参数选择。方法 :对 36例因鼻病引起鼻塞的患者 (鼻病组 )及 2 0例无鼻病健康志愿者 (对照组 )进行AR测试 ,测算鼻腔平均截面积 (MNCA)、最小截面积 (MCA)、鼻腔容积 (NV)和鼻阻力 (NR) ,并进行统计学分析。结果 :对照组中 ,MNCA、MCA、NV、NR性别差异均无统计学意义 (P >0 .0 5 ) ,除NV(P <0 .0 5 )外侧别差异亦无统计学意义 (P >0 .0 5 ) ;鼻病组中鼻塞侧与非鼻塞侧各参数间差异无统计学意义 (P>0 .0 5 ) ;鼻病组中鼻塞侧与对照组比较 ,其中MCA和NR差异有统计学意义 (分别P <0 .0 1和P <0 .0 5 ) ;鼻病组中非鼻塞侧加对照组与鼻病组中鼻塞侧比较 ,其中MCA和NR差异有统计学意义 (分别P <0 .0 1和P <0 .0 5 )。结论 :AR对鼻通气状况有较客观的反映 ,其中MCA和NR对鼻塞状况的反映与患者的主观感受较为一致 ,可作为反映鼻通气状况的敏感指标。     

Comparison of perceptional nasal obstruction with rhinomanometric and acoustic rhinometric assessment

Perception of nasal stuffiness, together with rhinomanometric and acoustic rhinometric assessments were evaluated before and after nasal and/or sinus surgery in ¶50 Japanese adult patients. Nasal resistance on both expiration and inspiration correlated well with the patients’ perceptions (P<0.05). Nasal volumes (0–4 cm and 0–7 cm) obtained from acoustic rhinometry measurements also correlated well with perception (P<0.05). No significant relationships were found between rhinomanometric and acoustic rhinometric results. Perceptional nasal obstruction, rhinomanometric and acoustic rhinometric results (except for the sectional areas at the I-notch) improved significantly after the operations. Rhinomanometry and acoustic rhinometry are valuable methods for assessing nasal stuffiness, but we must take account of the differences between the two methods.     

Intersession repeatability of acoustic rhinometry measurements in healthy volunteers

Objectives

Acoustic rhinometry is a rapid, reliable and non-invasive technique for the evaluation of conditions associated with impaired nasal patency. This study aimed to examine the intersession repeatability of acoustic rhinometry measurements of unilateral and combined nasal parameters in a group of healthy volunteers.

Methods

Twenty healthy volunteers were studied. In each subject, acoustic rhinometry measurements were performed on five consecutive days, with multiple recordings. Five clinically relevant parameters were measured in each session and the intersession repeatability of these measurements was expressed in terms of mean coefficient of variation, intraclass correlation coefficient and inter-item correlations.

Results

Intraclass correlation coefficients showed a high, and greater repeatability over time for all the combined (mean) values compared to the unilateral values. All intraclass correlations for combined values were ≥0.80 confirming almost perfect agreement. All intraclass correlations and inter-item correlations were associated with P<0.001. The mean coefficient of variation was low (<10%) for all but the proximal minimum cross sectional area (MCA1) measurements.

Conclusion

Acoustic rhinometry provides highly repeatable measurements of nasal patency, which is best for combined (mean) nasal parameters. This property makes it suitable for use in the diagnosis and follow-up of conditions associated with nasal obstruction, either structural or functional.     

鼻声反射在学龄前儿童鼻腔容积测定中的应用

目的:使用鼻声反射技术检测学龄前儿童鼻腔容积,提出检测方法、结果分析方法以及相关正常参考值。方法:①在最小横截面积相同但容积不同的模拟鼻腔,通过鼻声反射仪和通气阻力检测仪测量管腔容积和通气阻力,比较最小横截面积和管腔容积在反映通气阻力变化时的敏感性。②使用鼻声反射仪测量97例4岁儿童和137例5岁儿童的鼻腔容积。结果:①在模拟鼻腔最小横截面积不变的情况下,通气阻力随鼻腔容积增加而减小。②学龄前儿童平均双侧鼻腔容积为(2.03±0.4)ml。不同年龄和不同性别学龄前儿童鼻腔容积差异均无统计学意义(均P>0.05)。结论:分析鼻声反射检测结果时,鼻腔容积变化比最小横截面积更能反映鼻腔通气阻力变化。本次研究提出鼻声反射检测结果评估方法和学龄前儿童鼻腔容积正常参考值。     

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。     

Proposed diagnostic standard using visual analogue scale and acoustic rhinometry in nasal provocation test in allergic patients

Objective

The authors aimed to analyze symptom change after nasal provocation and acoustic rhinometry results of a larger number of allergic rhinitis patients and also aimed to propose a new diagnostic threshold by investigating the difference between patients with allergic and non-allergic perennial rhinitis.

Methods

The authors checked symptom change and performed acoustic rhinometry before and after nasal provocation in 208 patients (114 males and 94 females, 19-58 years old) with allergic rhinitis and 222 patients (116 males and 106 females, 20-74 years old) clinically diagnosed with non-allergic perennial rhinitis (control group). Then the authors compared VAS (visual analogue scale), TNV (total nasal volume), MCA (minimal cross-sectional area), length of MCA and change of these values between allergic patients group and control group, to propose the new diagnostic standard.

Results

The change of symptom score and number of sneezing after nasal provocation were significantly different between allergic patient and control group. The basal TNV, MCA, length of MCA, and changes of these values were also significantly different. By drawing the ROC (receiver operator characteristic) curve and evaluating the sensitivity and specificity for each criteria, we could set the diagnostic criteria as follows: (1) symptom change: more than 2 points in the case of nasal obstruction and more than 1 point for the case of rhinorrhea or itching, (2) more than 24.5% change of the TNV, and (3) more than 20% change of the MCA.

Conclusion

VAS change and acoustic rhinometry in nasal provocation test could be a valuable tool in diagnosing allergic rhinitis with high sensitivity and specificity.     

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。     

Value of acoustic rhinometry for measuring nasal valve area

OBJECTIVE: To assess the validity of acoustic rhinometry for measuring nasal valve area in human subjects. STUDY DESIGN: A comprehensive study that compared acoustic rhinometry data with computed tomography findings from scans obtained perpendicular to the acoustic axis and perpendicular to the floor of the nose. METHODS: Fifty nasal passages of 25 healthy adults with no nasal disease were examined by acoustic rhinometry and computed tomography. In each case, the area of the nasal valve as measured by acoustic rhinometry was compared with the area calculations from computed tomography sections taken in two different coronal planes, one perpendicular to the acoustic axis and one perpendicular to the floor of the nose. Computed tomography slices perpendicular to the floor of the nose were obtained at two different locations, a specific distance from the tip of the nose and a specific distance from the anterior nasal spine. RESULTS: There was a significant correlation between the nasal valve areas determined by acoustic rhinometry and computed tomography when imaging was obtained perpendicular to the acoustic axis. In contrast, when scanning was obtained perpendicular to the straight axis of the floor of the nose, the correlations between the acoustic rhinometry and computed tomography data were weak. CONCLUSIONS: When any type of imaging is used for comparison with nasal valve areas determined by acoustic rhinometry, the cross-sections should be perpendicular to the acoustic pathway. The results of the study show that acoustic rhinometry is a valuable method for measuring nasal valve area.     

症状、CT和鼻声反射在慢性鼻窦炎组织重构诊断中的意义

目的探讨鼻塞症状、CT扫描Lund-Mackay评分和鼻声反射测量鼻黏膜充血指数与慢性鼻及鼻窦炎(chronic rhinosinusitis,CRS)组织重构程度之间的相关性,探讨三者在CRS组织重构诊断中的意义。方法选取CRS患者43例,应用视觉模拟评分(visual analogous scale,VAS)系统评价鼻塞症状;Lund- Mackay平分系统评价鼻窦CT扫描结果;鼻声反射测量获取鼻黏膜充血指数;钩突黏膜组织标本行鼻黏膜纤维化程度评分。应用统计学方法对其相关性进行分析。结果鼻塞症状严重程度与鼻黏膜纤维化程度之间无明显相关性(r=-0.046,P=0.77);CT评分与黏膜组织纤维化评分之间无相关性(r=0.132,P=0.40);鼻黏膜纤维化程度与鼻黏膜充血指数之间呈负相关(r=-0.348, P=0.022)。结论鼻黏膜充血指数能够反映病变黏膜的组织重构程度,辅助症状与CT检查指导CRS治疗策略。