本文選題：上呼吸道 + 生物力學模型�。� 參考：《大連理工大學》2012年博士論文

【摘要】：睡眠呼吸障礙性疾病與上呼吸道結構性狹窄密切相關,由于發(fā)病率高、危害嚴重,已成為一個突出的醫(yī)療與公共衛(wèi)生問題,其中以阻塞性睡眠呼吸暫停低通氣綜合征(Obstructive sleep apnea/hypopnea syndrome, OSAHS)的危害最大。要深刻認知這類與上呼吸道結構異常相關的疾患,需對氣道解剖結構與功能之間的交互關系進行定量分析。然而,由于患者的個體差異性和上呼吸道結構形態(tài)異常的多樣性,給這方面的研究帶來了困難。本文針對OSAHS的發(fā)病機制和個性化診療等臨床研究中急需解決的問題,基于計算流體動力學(Computational fluid dynamics, CFD)和流固耦合(Fluid structure interaction, FSI)方法,開展上呼吸道系統生物力學模型的研究,并采集臨床觀測數據來驗證分析方法的可行性和結果的可信性,為深入了解與疾病相關的氣道結構與功能的關系,提供了數值量化分析的平臺。主要內容包括： 1.根據健康志愿者多層螺旋CT影像學資料,構造較大樣本的上呼吸道三維模型。研究四種湍流模型對上呼吸道氣流特性的影響,并將得到的計算結果與文獻報道的實驗和數值模擬數據進行比較,驗證本文分析方法的可行性和計算結果的可信性。通過16例健康志愿者上呼吸道氣體動力學特性的分析,總結正常氣道內氣流分布的規(guī)律,為進行結構異常的上呼吸道生物力學特性研究奠定基礎。 2.針對成人和兒童患者幾種典型的手術治療方案,對手術前后上呼吸道內氣流的速度、壓強和氣道阻力的變化進行定量分析。通過與臨床診斷OSAHS的金標準一多導睡眠監(jiān)測儀(Polysomnograph, PSG)和兒童常規(guī)的鼻咽聲反射(Acoustic rhinometryAR)的結果進行對比,驗證了數值模擬的結果對療效評估的可靠性。上呼吸道生物力學特性的數值模擬研究能獲得常規(guī)臨床檢查無法測得的量化參數,為術式的優(yōu)選和療效的評估提供參考依據。 3.對3例伴有鼻阻塞的OSAHS患者行鼻腔結構矯正手術前后上呼吸道的氣流特性與軟腭的運動姿態(tài)進行對比分析,為研究鼻腔結構在OSAHS發(fā)病機制中的作用,以及鼻部手術對OSAHS的治療效果提供定量的依據。數值模擬結果發(fā)現,鼻腔結構的矯正與容積的擴大緩解了兩例輕度患者上呼吸道的阻塞情況。但對另一例重度患者,盡管術后鼻阻塞的情況得以緩解,但整個上呼吸道氣流的速度、壓強降和軟腭的位移均高于術前,尤其是腭咽區(qū)負壓的增大對病情的緩解不利。根據獲得的力學參數對上呼吸道通氣功能進行評估,與PSG的判定和患者的主訴相一致。由于人上呼吸道結構的個體差異性,以及氣道結構與氣流環(huán)境之間復雜的自適應關系,對于不同的上呼吸道結構,鼻阻塞的減輕對整個上呼吸道阻塞情況的影響各不相同。提示臨床醫(yī)生在制定手術方案時,務必對上呼吸道上(鼻腔)、下部分(咽和喉)的一致性和復雜的相關性進行個性化的綜合考量。 4.為全面了解OSAHS的發(fā)病機理及其與呼吸系統疾病的內在聯系,進行異常氣道結構對上呼吸道、氣管和各級支氣管內氣流特性影響的研究。由于OSAHS患者腭咽腔的狹窄,使得氣管和各級支氣管內氣流的速度和壓強降均高于正常氣道。受支氣管結構異常的影響,除氣管和各級支氣管的氣流結構發(fā)生明顯變化之外,上呼吸道的壓強降有所升高,尤其在呼氣相。此外,分析不同呼吸路線(鼻腔呼吸、鼻腔與口腔共同呼吸作用)對氣流結構的影響,揭示張口呼吸加重氣道塌陷和阻塞的原因。大量氣流經由口腔吸入和呼出時,會導致氣道阻力的重新分配,鼻腔阻力大幅降低,而口腔及其以下氣道的阻力反而增大。
[Abstract]:Sleep breathing disorders are closely related to structural stenosis of the upper respiratory tract. Because of the high incidence and severity of the disease, it has become a prominent medical and public health problem, among which Obstructive sleep apnea/hypopnea syndrome (OSAHS) is the most harmful. A quantitative analysis of the interrelationship between the anatomical structure and function of the airway needs a quantitative analysis of the abnormal structure of the upper respiratory tract. However, the diversity of the individual and the abnormal structure of the upper respiratory tract has brought difficulties to this study. This article is aimed at the clinical study of the pathogenesis of OSAHS and the individualized diagnosis and treatment. In urgent need to solve the problem, based on the Computational fluid dynamics (CFD) and the fluid solid coupling (Fluid structure interaction, FSI), the study of the biomechanics model of the upper respiratory system is carried out, and the clinical observation data are collected to verify the feasibility and the credibility of the analytical method, so as to understand the disease and the disease in depth. The relationship between disease related airway structure and function provides a platform for numerical quantitative analysis.
1. based on the multi-slice spiral CT imaging data of healthy volunteers, a three-dimensional model of the upper respiratory tract was constructed. The effects of the four turbulence models on the airflow characteristics of the upper respiratory tract were studied. The results were compared with the experimental and numerical simulation data reported in the literature, and the feasibility and results of the analysis were verified and calculated. By analyzing the aerodynamic characteristics of the upper respiratory tract in 16 healthy volunteers, the distribution of airflow in the normal airway was summarized, which laid the foundation for the study of the biomechanical characteristics of the upper respiratory tract with structural abnormalities.
2. for several typical surgical treatments for adults and children, quantitative analysis of the changes in velocity, pressure, and airway resistance in the upper respiratory tract before and after the operation. Through the gold standard Polysomnograph (PSG) and children's conventional nasopharyngeal reflex (Acoustic rhinometryAR) through the clinical diagnosis of OSAHS The results are compared to verify the reliability of the results of the numerical simulation. The numerical simulation of the biomechanical characteristics of the upper respiratory tract can obtain the quantitative parameters that can not be measured in the routine clinical examination, and provide a reference for the optimization of the surgical procedure and the evaluation of the curative effect.
3. in 3 cases of OSAHS patients with nasal obstruction, the airflow characteristics of the upper respiratory tract were compared with the motion posture of the soft palate before and after the nasal structure correction, in order to study the role of the nasal cavity in the pathogenesis of OSAHS, and to provide a quantitative basis for the effect of nasal surgery on the treatment of OSAHS. The enlargement of correction and volume relieved the obstruction of the upper respiratory tract in two mild patients. But for another severe patient, although the postoperative nasal obstruction was relieved, the velocity, pressure drop and the displacement of the soft palate were all higher than that before the operation, especially the increase of the negative pressure in the palatyngeal region. The mechanical parameters of the upper respiratory tract were evaluated, consistent with the decision of the PSG and the patients' complaints. Due to the individual differences in the upper respiratory tract structure, and the complex adaptive relationship between the airway structure and the air flow environment, the reduction of the nasal obstruction to the whole upper respiratory tract for the different upper respiratory tract structures The effects are different. It is necessary for clinicians to make an individualized and comprehensive consideration of the consistency and complex correlation of the upper respiratory (nasal cavity) and the lower part (pharynx and larynx) in the formulation of the surgical plan.
4. in order to fully understand the pathogenesis of OSAHS and its internal relationship with respiratory diseases, study the influence of abnormal airway structure on the characteristics of upper airway, trachea and bronchial air flow. Because of the stenosis of the palatopharyngopharynx in OSAHS patients, the velocity and pressure drop of the trachea and all levels of endobronchial air are higher than that of the normal airway. The influence of abnormal airway structure, in addition to the obvious changes in the airflow structure of the trachea and the bronchial tube, the pressure drop of the upper respiratory tract increased, especially in the expiratory phase. In addition, the influence of different breathing routes (nasal respiration, nasal cavity and oral respiration) on the airflow structure was analyzed, and the aggravated airway collapse and obstruction of the mouth breathing were revealed. The cause of the plug. When a large number of airflows are inhaled and exhaled through the mouth, the airway resistance is redistributed, and the resistance of the nasal cavity is greatly reduced, and the resistance of the oral cavity and the following airway is increased.

【學位授予單位】：大連理工大學
【學位級別】：博士
【學位授予年份】：2012
【分類號】：R318.01

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本文編號：1781118