本文選題：阻塞性睡眠呼吸暫停　切入點(diǎn)：鼻腔結(jié)構(gòu)矯正術(shù)　出處：《大連醫(yī)科大學(xué)》2011年碩士論文

【摘要】：目的:應(yīng)用多導(dǎo)睡眠呼吸監(jiān)測(polysomnogram,PSG)和三維有限元數(shù)值模擬研究成人阻塞性睡眠呼吸暫停低通氣綜合癥(obstructive sleep apnea-hypopnea syndrome,OSAHS)患者經(jīng)鼻腔結(jié)構(gòu)矯正術(shù)后的療效和鼻、咽腔及軟腭流固耦合數(shù)值模擬的變化特征。 方法:應(yīng)用多導(dǎo)睡眠呼吸監(jiān)測對4例成人OSAHS患者進(jìn)行鼻腔結(jié)構(gòu)矯正術(shù)術(shù)前檢測和術(shù)后3-5個(gè)月的復(fù)查;并對其中3例患者進(jìn)行術(shù)前及術(shù)后5個(gè)月上氣道及周圍組織的CT掃描,將所得的3例患者術(shù)前、術(shù)后的影像學(xué)數(shù)據(jù)導(dǎo)入mimics軟件中建立人上氣道及軟腭的三維模型,應(yīng)用ansys有限元分析軟件建立3例術(shù)前、術(shù)后的三維有限元模型,應(yīng)用流固耦合的方法研究上氣道流場與軟腭運(yùn)動(dòng)的相互作用,分析成人OSAHS患者術(shù)前、術(shù)后上氣道流場和軟腭固體場的變化特征。 結(jié)果: 1.多導(dǎo)睡眠呼吸監(jiān)測(PSG): 病例1、2術(shù)后3-5個(gè)月AHI由術(shù)前的輕-中度轉(zhuǎn)變?yōu)閱渭冃憎Y,術(shù)后睡眠時(shí)呼吸暫停、低通氣等相關(guān)癥狀基本消失,療效為治愈;病例3、4術(shù)后5個(gè)月AHI分別降低了24.7%和9%,OSAHS癥狀均無明顯好轉(zhuǎn),療效為輕度好轉(zhuǎn)。 2.三維重建模型的測量:3例患者術(shù)后鼻腔氣道較術(shù)前明顯增寬。 3.流固耦合數(shù)值模擬結(jié)果: 壓強(qiáng)場:病例1、2術(shù)前在吸氣期兩側(cè)鼻腔壓強(qiáng)分布趨勢不同,前鼻孔至中鼻道前端的壓強(qiáng)差偏曲側(cè)較對側(cè)大且壓強(qiáng)梯度變化較為急劇;病例3在術(shù)前吸氣期兩側(cè)鼻腔的壓強(qiáng)分布趨勢較相似,但不同于正常鼻腔。術(shù)后3例患者兩側(cè)鼻腔壓強(qiáng)分布趨勢和壓強(qiáng)差值均較為相似,且主要的壓強(qiáng)差集中在鼻閾區(qū)附近,前鼻孔至鼻咽部壓強(qiáng)差較術(shù)前減小。 流速場:病例1、2術(shù)后軟腭后區(qū)氣流的最大流速較術(shù)前降低;病例3術(shù)后軟腭后區(qū)的最大流速較術(shù)前有所增大。 壁面剪切力:病例1術(shù)前、術(shù)后在上氣道均出現(xiàn)三個(gè)較高的壁面剪切力區(qū):鼻閾區(qū)附近、腭咽區(qū)附近、聲門區(qū)附近,但術(shù)后壁面剪切力值均較術(shù)前減小,腭咽區(qū)附近壁面剪切力的變化趨勢減緩;術(shù)前兩側(cè)鼻腔壁面剪切力的分布趨勢不同,術(shù)后則較為相似;病例3術(shù)前上氣道出現(xiàn)三個(gè)高壁面剪切力區(qū):鼻閾后至中鼻道前端的區(qū)域、腭咽區(qū)附近、聲門區(qū)附近,最高壁面剪切力出現(xiàn)在腭咽區(qū)附近;術(shù)后僅在腭咽區(qū)附近出現(xiàn)較高的壁面剪切力,且數(shù)值較術(shù)前增大。 軟腭位移場:術(shù)后病例1、2懸雍垂尖部位移較術(shù)前減小;病例3懸雍垂尖部較術(shù)前有所增大。 結(jié)論: 1.經(jīng)本研究,認(rèn)為以鼻腔結(jié)構(gòu)異常為主要阻塞平面的OSAHS病人(包括腺樣體肥大),手術(shù)處理鼻腔阻塞平面,擴(kuò)大鼻腔氣道容積,是去除鼻腔阻塞平面,治療OSAHS的有效方法。 2.對于上氣道存在多個(gè)阻塞平面,即鼻、咽平面、口咽部軟腭區(qū)平面等,類如病例3、4,手術(shù)后鼻腔氣道增寬,在治療鼻阻塞平面是有效的。但根據(jù)氣道空氣流動(dòng)特點(diǎn),鼻腔氣道越“通暢”,有可能更增加軟腭區(qū)壓力差,促使軟腭運(yùn)動(dòng)幅度增大,對治療OSAHS不利,其治療方案還需完善。 3.通過有限元數(shù)值模擬結(jié)合臨床多導(dǎo)睡眠呼吸監(jiān)測的方法來研究OSAHS阻塞平面,并進(jìn)行術(shù)前個(gè)性化評估對其治療方案的選擇和療效評估是必要的;其可以為臨床提供定量的、可分析的平臺,是一種有效的、值得推薦和深入探討的研究方法。因本組病例較少,有待進(jìn)一步擴(kuò)大樣本深入研究,得出更具說服力的結(jié)果。
[Abstract]:Objective: using polysomnography (polysomnogram, PSG) and three dimensional finite element numerical simulation study of adult obstructive sleep apnea hypopnea syndrome (obstructive sleep apnea-hypopnea syndrome, OSAHS) in patients with curative effect and postoperative correction of nasal cavity structure, change characteristics of pharynx cavity and soft palate of FSI numerical simulation.
Methods: using polysomnography in 4 adult patients with OSAHS underwent nasal structure correction of preoperative examination and postoperative 3-5 months; and the CT scan 5 months of upper airway and surrounding tissues in 3 patients before and after surgery, 3 cases of patients were obtained before. After images of the upper airway and the soft palate to establish 3D model data into Mimics software, using ANSYS finite element analysis software to establish 3 cases of preoperative, postoperative three-dimensional finite element model, the interaction method of coupling the upper airway flow and soft palate movement by flow, analysis of adult OSAHS patients after the operation, the upper airway flow and soft palate solid field change characteristics.
Result:
1. polysomnography (PSG):
Case 3-5 months after 1,2 AHI from mild to moderate changes before surgery for simple snoring, postoperative sleep apnea, hypopnea and other related symptoms disappeared, the curative effect to cure cases; 3,4 AHI 5 months after operation were decreased by 24.7% and 9% OSAHS, there is no obvious improvement of symptoms, curative effect is slightly improved.
2. measurement of 3D reconstruction model: 3 cases of patients with postoperative nasal airway significantly widened.
3. FSI numerical simulation results:
The pressure field in 1,2: a case of preoperative inspiratory phase sides nasal cavity pressure distribution trend of different pressure, anterior nostril to the nasal passage in front of the poor than the deviation side changes and pressure gradient on the side sharply; 3 cases in the preoperative inspiratory phase of both sides of the nasal pressure distribution trend is similar, but different from that of normal nasal cavity after operation. 3 cases of patients with nasal cavity pressure distribution trend and the pressure difference are relatively similar, and mainly concentrated in the vicinity of the pressure difference between the nasal valve area, anterior nostril to the nasopharynx pressure difference was decreased.
The velocity field: a case after 1,2 the maximum velocity of soft palate airflow decreased after operation in 3 cases; the maximum velocity of the soft palate than before surgery has increased.
The wall shear stress: 1 cases before surgery, after surgery in the upper airway appeared three high wall shear stress zone near the nasal valve area, near the velopharyngeal area, glottic area nearby, but after the wall shear stress values were decreased, the change trend of slowing down near the velopharyngeal area wall shear stress; distribution of preoperative nasal wall on both sides of shear force, after the operation are similar; 3 cases of preoperative airway appeared on the three high wall shear stress zone: regional front to the nasal meatus threshold, the velopharyngeal area near the glottic region near the maximum wall shear stress in near the velopharyngeal area; postoperative only near the velopharyngeal area high wall shear stress, and the value is increased compared with pre operation.
The displacement field of soft palate: postoperative cases 1,2 uvula apex shift was decreased; 3 cases of the tip of the uvula than before surgery has increased.
Conclusion:
1. by this study, that the abnormal nasal structure as the main obstruction plane of OSAHS patients (including adenoid hypertrophy), surgical treatment of nasal obstruction plane, expanding the volume of nasal airway, removing nasal obstruction plane, effective method for the treatment of OSAHS.
2. for multiple upper airway obstruction plane, nose, throat plane, the velopharyngeal plane, such as case 3,4, postoperative nasal airway is widened, in the treatment of nasal obstruction plane is effective. But according to the characteristics of nasal airway airway air flow, more "smooth", there may be more to increase the area of the soft palate the pressure difference, the movement range of the soft palate increased, the treatment of OSAHS is negative, the treatment needs to improve.
3. numerical simulation by finite element method combined with clinical polysomnography to study OSAHS obstruction plane, and preoperative personalized assessment for the choice of treatment and the curative effect is necessary; it can provide quantitative analysis for clinical, the platform is an effective, worthy of recommendation and research methods further discussion. Because of this group of patients is less, further expand the research sample, draw more convincing results.

【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2011
【分類號】：R766

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相關(guān)期刊論文 前10條

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