主客观评估在功能性鼻整形术中的应用

目的探讨主客观评估方法在功能性鼻整形术中的应用。方法选择2017年1月至2018年10月在重庆医科大学附属第一医院耳鼻咽喉科接受功能性鼻整形术的患者64例,其中男性32例,女性32例,年龄18~45岁。在术前及术后6个月,分别应用视觉模拟量表(VAS)、鼻阻塞症状评估量表(NOSE)、鼻声反射、鼻阻力检测等评估鼻通气功能,应用VAS、鼻整形结果评估量表(ROE)、外鼻亚单位测量等评估鼻外形情况,应用情感平衡量表及Rosenberg自尊量表评估心理状态,最后行综合满意度分析及各指标间的相关性分析。采用SPSS 23.0软件进行统计学分析。结果与术前相比,术后患者鼻塞VAS、NOSE评分、鼻腔总阻力及鼻腔阻力差异比均显著下降(1.62±0.85)分比(7.56±1.44)分,(22.62±3.54)分比(69.75±7.85)分,(0.16±0.08)Pa·s/ml比(0.31±0.43)Pa·s/ml,0.33±0.28比0.71±0.32,P值均<0.05];术后患者鼻外形VAS及ROE评分均显著升高(11.20±3.66)分比(2.70±0.97)分,(17.80±2.71)分比(7.50±1.12)分,P值均<0.05];外鼻亚单位测量示术后鼻背坡长、鼻面角、鼻额角及鼻翼角明显缩小(29.33±4.26)mm比(33.61±5.24)mm,(135.11±3.81)°比(139.91±6.30)°,(130.63±2.88)°比(136.74±5.72)°,(99.71±4.02)°比(106.27±5.60)°,P值均<0.05];术后情感平衡量表、Rosenberg自尊量表评分明显增高(5.88±1.54)分比(4.31±1.85)分,(28.31±2.64)分比(22.13±2.77)分,P值均<0.05]。Pearson相关性分析显示,患者满意度与鼻通气主观评分(VAS、NOSE)、鼻外形主观评分(VAS、ROE)、情感平衡量表评分呈正相关,与鼻阻力测值呈负相关,与外鼻亚单位测值无相关性。鼻通气主观评分与鼻阻力测值呈显著正相关,但鼻外形主观评分与外鼻亚单位测值无相关性。结论用主客观结合的方式从鼻通气功能、鼻外观美学、心理状态多角度整体综合评估,可有效评价功能性鼻整形术的疗效。

Application of the subjective and objective evaluation in functional rhinoplasty

Objective To explore the subjective and objective evaluation methods in functional rhinoplasty.Methods Sixty-four patients who underwent rhinoplasty in the Department of Otorhinolaryngology,the First Affiliated Hospital of Chongqing Medical University were included in this study from January 2017 to October 2018.There were 32 males and 32 females,with the age ranging from 18 to 45 years old.Before and 6 months after operation,nasal ventilation function was evaluated by Visual Analogue Scale(VAS),Nasal Obstruction Symptom Evaluation(NOSE),nasal acoustic reflex and nasal resistance.Satisfaction with nasal appearance was evaluated by VAS,Rhinoplasty Outcome Evaluation(ROE)and facial proportions evaluation.Psychological state was assessed by Emotional Balance Scale and Rosenberg Self-esteem Scale.Finally,the Pearson correlation analysis of patient satisfaction was performed.SPSS 23.0 software was used for statistical analysis.Results Compared with pre-operation,nasal obstruction VAS,NOSE scores,total nasal resistance and difference ratio of nasal resistance showed significantly decline after surgery(1.62±0.85 vs 7.56±1.44,22.62±3.54 vs 69.75±7.85,(0.16±0.08)Pa·s/ml vs(0.31±0.43)Pa·s/ml,0.33±0.28 vs 0.71±0.32,all P<0.05).VAS of appearance and ROE scores showed an increase after surgery(11.20±3.66 vs 2.70±0.97,17.80±2.71 vs 7.50±1.12,all P<0.05).The measurement of the external nasal subunits showed that the length of the dorsum of the nose,the angle of the face to the nose,the angle of the frontal and the angle of the alar of the nose were obviously reduced((29.33±4.26)mm vs(33.61±5.24)mm,(135.11±3.81)°vs(139.91±6.30)°,(130.63±2.88)°vs(136.74±5.72)°,(99.71±4.02)°vs(106.27±5.60)°,all P<0.05).The scores of postoperative Emotional Balance Scale and Rosenberg Self-esteem Scale increased significantly(5.88±1.54 vs 4.31±1.85,28.31±2.64 vs 22.13±2.77,all P<0.05).The Pearson correlation analysis showed that patients′satisfaction was positively correlated with subjective score of nasal ventilation(VAS,NOSE),subjective score of nasal appearance(VAS,ROE)and emotional balance scale,while negatively correlated with nasal resistance,and not correlated with the measurement of external nasal subunit.There was a significant positive correlation between the subjective score of nasal ventilation and the measurement of nasal resistance,but there was no significant correlation between the subjective score of nasal appearance and the measurement of external nasal subunit.Conclusion The subjective and objective evaluation of nasal ventilation function,aesthetics of nasal appearance and psychological state can evaluate the effect of functional rhinoplasty effectively.