CAJ | 학술논문

目的：通过分析鼻腔扩容术前后鼻腔和咽腔相关空气动力学指标的变化，探讨鼻腔扩容术对上气道流场特征变化影响，为研究鼻腔扩容术的临床意义，提供计算流体力学（computational fluid dynamics，CFD）的依据。方法选取30例成年阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apnea hypopnea syndrome，OSAHS）患者进行鼻腔扩容术，随访至少3月，建立鼻腔扩容术前后上气道三维模型，应用CFD方法，数值模拟分析鼻腔扩容术前、后上气道空气动力学特征变化。结果鼻腔扩容术后数值模拟鼻腔压力云图提示术后压力梯度变化趋于平缓，鼻腔速度云图提示上气道气流速度梯度变化较术前变小；鼻咽腔和腭咽腔云图同一截面的平均气流速度降低，分布相对于术前变得均匀对称；平均压力相对于术前显著降低。上气道流场特征值结果显示：鼻腔有效通气容积较术前显著增大（t=4.025，P<0.01），鼻腔压力差较术前显著下降（t=-2.065，P<0.01），上气道总阻力较术前下降（t=-2.659，P<0.01），但有5例患者的上气道总阻力较术前增高。结论鼻腔扩容术显著降低OSAHS患者的鼻腔总阻力，增大患者有效通气容积；降低患者咽腔气流速度，减小气流运动对咽壁产生的负压，降低咽腔塌陷性；鼻腔扩容术能降低OSAHS患者上气道总阻力，在于上游鼻腔通气程度的改善能否对下游咽腔产生有益的影响。上气道的CFD数值模拟分析可以评估鼻腔扩容术后上气道流场特征改变。
목적：통과분석비강확용술전후비강화인강상관공기동역학지표적변화，탐토비강확용술대상기도류장특정변화영향，위연구비강확용술적림상의의，제공계산류체역학（computational fluid dynamics，CFD）적의거。방법선취30례성년조새성수면호흡잠정저통기종합정（obstructive sleep apnea hypopnea syndrome，OSAHS）환자진행비강확용술，수방지소3월，건립비강확용술전후상기도삼유모형，응용CFD방법，수치모의분석비강확용술전、후상기도공기동역학특정변화。결과비강확용술후수치모의비강압력운도제시술후압력제도변화추우평완，비강속도운도제시상기도기류속도제도변화교술전변소；비인강화악인강운도동일절면적평균기류속도강저，분포상대우술전변득균균대칭；평균압력상대우술전현저강저。상기도류장특정치결과현시：비강유효통기용적교술전현저증대（t=4.025，P<0.01），비강압력차교술전현저하강（t=-2.065，P<0.01），상기도총조력교술전하강（t=-2.659，P<0.01），단유5례환자적상기도총조력교술전증고。결론비강확용술현저강저OSAHS환자적비강총조력，증대환자유효통기용적；강저환자인강기류속도，감소기류운동대인벽산생적부압，강저인강탑함성；비강확용술능강저OSAHS환자상기도총조력，재우상유비강통기정도적개선능부대하유인강산생유익적영향。상기도적CFD수치모의분석가이평고비강확용술후상기도류장특정개변。
[ABSTRACT]OBJECTIVETo compare the aerodynamic differences before and after nasal cavity ventilation expansion techniques in patients with OSAHS. METHODSA total of 30 adult patients with OSAHS were included in this study. Pre-operative upper airway CT of each subject was acquired. Each subject underwent surgery. Postoperative upper airway CT was obtained at least 3 months later. By means of CFD simulation method, numerical simulation was performed to calculate the airflow dynamic indexes of the upper airway. The pre-and post-operative aerodynamic characteristics were compared. RESULTSAfter operation, post-operative negative pressure nephogram of the nasal cavity indicated more smooth variation of pressure gradient, post-operative velocity nephogram of nasal cavity indicated slower airflow velocity. Proper values of flow field indicated the volume of nasal cavity increased significantly (t=4.025,P<0.01), the total nasal airway resistance decreased significantly (t=-2.065,P<0.01). The total negative pressure of the upper airway decreased significantly (t=-2.659,P<0.01) after operation. However, the proper values of flow field increased in 5 patients. CONCLUSIONNasal cavity ventilation expansion effectively increase the volumes of nasal cavity, improve the nasal ventilation, and reduce the air flow velocity of both nasal cavity and pharynx in OSAHS patients, those reduce the pharyngeal negative pressure and the pharyngeal collapse. However, for patients with its narrowest segment at the velopharyngeal level, operation cannot do anything or even aggravate the pharyngeal collapse. Operation should be performed individually.