本文選題：上氣道　切入點(diǎn)：填充法　出處：《昆明醫(yī)科大學(xué)》2017年碩士論文

【摘要】：[目的]利用正常氣道及困難氣道患者平臥位到仰臥位氣道MRI二維圖像原始數(shù)據(jù)重建上氣道填充三維有限元模型,計(jì)算氣管插管中患者由平臥位到最大仰臥位上氣道形態(tài)學(xué)的改變,分析困難氣道上氣道解剖的特異性。[方法]選取2015年4-12月昆明醫(yī)科大學(xué)第一附屬醫(yī)院手術(shù)麻醉后已經(jīng)評(píng)判定義為正常氣道患者和困難氣道患者各20名,并已經(jīng)課題組重建并驗(yàn)證有效的頭頸部三維有限元模型分別導(dǎo)入Mimics10.01軟件利用填充方法填充正常及困難氣道患者的上氣道三維有限元模型,并標(biāo)示出氣道的準(zhǔn)確位置①門齒點(diǎn)0②咽后壁最高點(diǎn)A③聲門裂中點(diǎn)N/D。并用Mimics10.01自帶軟件精確測(cè)量氣管插管時(shí)患者由平臥位到最大仰臥位由門齒點(diǎn)、咽后壁最高點(diǎn)、聲門裂中點(diǎn)組成的口咽角∠OAN、∠OAN'、∠OAD、∠OAD'、上氣道最小橫截面積(S1、S1'、S2、S2'、S3、S3'、S4、S4')等相關(guān)解剖指標(biāo)數(shù)值。分析正常及困難氣道患者平臥位到最大仰臥位上氣道解剖變化規(guī)律,從而得出困難氣道患者上氣道解剖特異性。[結(jié)果]1、正常氣道及困難氣道口咽角最大仰臥位均較平臥位大;正常氣道口咽角不同體位(平臥位、仰臥位)可活動(dòng)范圍較困難氣道口咽角不同體位(平臥位、仰臥位)大。正常氣道組、困難氣道組之間口咽角存在顯著差異(P0.05),表明口咽角可以作為困難氣道預(yù)測(cè)的有效指標(biāo)。2、氣管插管時(shí)患者由平臥位到仰臥位時(shí),矢狀切上氣道最小橫截面積在增大,且正常氣道較困難氣道變化大;冠狀切上氣道最小橫截面積無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。矢狀切上氣道最小橫截面積正常氣道較困難氣道最小橫截面積大;冠狀切正常氣道及困難氣道上氣道最小橫截面積差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。正常氣道組、困難氣道組之間上氣道矢狀切最小橫截面積存在顯著差異(P0.05),表明上氣道矢狀切最小橫截面積可以作為困難氣道預(yù)測(cè)的有效指標(biāo)。[結(jié)論]應(yīng)用上氣道填充重建三維有限元模型法可有效地從解剖學(xué)方向?qū)щy氣道做出準(zhǔn)確的評(píng)估。正常氣道組、困難氣道組之間口咽角存在顯著差異(P0.05),表明由門齒點(diǎn)、咽后壁最高點(diǎn)、聲門裂中點(diǎn)組成的口咽角可以作為困難氣道預(yù)測(cè)的有效指標(biāo)。正常氣道組、困難氣道組之間矢狀切上氣道最小橫截面積存在顯著差異(P0.05),矢狀切上氣道最小橫截面積可以作為困難氣道預(yù)測(cè)的有效指標(biāo)。
[Abstract]:[objective] to reconstruct the 3D finite element model of upper airway filling with MRI data from normal airway and difficult airway patients in supine position to supine position.The morphologic changes of upper airway in tracheal intubation from supine position to maximum supine position were calculated and the specificity of dissection of difficult upper airway was analyzed.[methods] A total of 20 patients with normal airway and 20 patients with difficult airway were selected from April to December 2015 after anesthesia in the first affiliated Hospital of Kunming Medical University.The effective 3D finite element model of head and neck was imported into Mimics10.01 software to fill the upper airway model of normal and difficult airway patients.The accurate position of the airway was also indicated. The highest point of the posterior pharyngeal wall, the highest point of the posterior pharyngeal wall, the central point of the glottic fissure, was N / D.The patients with tracheal intubation were accurately measured by Mimics10.01 software from supine position to maximum supine position, the highest point of the posterior pharynx wall, and the incisor point in the maximal supine position.The oropharynx angle of glottic fissure, the angle of oropharynx of the glottic fissure, the angle of oropharynx, the distance of OAD, the minimum cross-sectional area of the upper airway, S1, S1, S2, S2, S3, S3, S4, S4, etc., of the glottic fissure, and so on.The anatomic changes of upper airway in normal and difficult airway patients from supine position to maximum supine position were analyzed, and the anatomic specificity of upper airway in patients with difficult airway was obtained.In the normal airway group, there was significant difference in oropharynx angle between the difficult airway group and the difficult airway group (P 0.05), which indicated that the oropharynx angle could be used as an effective index for predicting the difficult airway. During tracheal intubation, the minimum cross-sectional area of the sagittal incised upper airway was increased from supine position to supine position.The change of the normal airway was greater than that of the difficult airway, and the minimum cross sectional area of the upper airway was not statistically significant (P 0.05).The minimum cross sectional area of normal upper airway was larger than that of difficult airway, but there was no significant difference between coronal normal airway and difficult upper airway (P 0.05).There was significant difference between the normal airway group and the difficult airway group in the minimum cross sectional area of the upper airway sagittal incised, indicating that the minimum cross sectional area of the upper airway sagittal cut could be used as an effective index for predicting the difficult airway.[conclusion] the 3D finite element method for reconstruction of upper airway filling can be used to evaluate the difficult airway accurately.There was significant difference in oropharynx angle between the normal airway group and the difficult airway group (P 0.05), indicating that the oropharynx angle composed of the incisor, the highest point of the posterior pharynx wall and the middle point of the glottic fissure could be used as an effective index for predicting the difficult airway.There was significant difference in the minimum cross sectional area of the upper sagittal upper airway between the normal airway group and the difficult airway group. The minimum cross sectional area of the sagittal upper airway could be used as an effective index for predicting the difficult airway.
【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R614

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