本文選題：鼻阻塞 + 鼻聲反射��； 參考：《鄭州大學(xué)》2013年碩士論文

【摘要】：背景和目的 鼻阻塞(nasal obstruction)是耳鼻咽喉科學(xué)臨床工作中的常見(jiàn)疾病,引起鼻阻塞的原因很多,成人和嬰幼兒及兒童的病因各不相同。臨床上對(duì)鼻阻塞程度的評(píng)估主要根據(jù)患者的主觀感覺(jué),治療的主要手段之一是行手術(shù)治療,對(duì)患者術(shù)后鼻塞改善的程度也主要依靠其自身的主觀感覺(jué),故對(duì)鼻阻塞程度及術(shù)后療效評(píng)估缺乏客觀的參考依據(jù)和指標(biāo)。鼻功能診斷系統(tǒng)包括鼻(咽)聲反射儀、鼻阻力儀及鼻呼吸量?jī)x,近年來(lái)已廣泛應(yīng)用于耳鼻喉科臨床工作中,它能從客觀上反映鼻腔阻塞程度、部位及性質(zhì),并具有術(shù)前術(shù)后療效對(duì)比功能,客觀反映手術(shù)效果,很大程度上能克服臨床工作中患者主訴與實(shí)際不符的難題,有效避免醫(yī)患矛盾。 本文總結(jié)我科2011年11月～2012年12月收治的150例鼻阻塞患者(分別為腺樣體肥大組60例,鼻中隔偏曲組、慢性鼻竇炎組及鼻腔鼻竇占位性病變組各30例)資料,分別根據(jù)患者具體情況行鼻內(nèi)窺鏡手術(shù)治療,同時(shí)對(duì)患者術(shù)前及術(shù)后行鼻功能檢查,并將各組數(shù)據(jù)進(jìn)行統(tǒng)計(jì)學(xué)分析,同時(shí)選正常成人對(duì)照組和正常兒童對(duì)照組各30例并行鼻功能檢測(cè),將鼻阻塞各組與之對(duì)比分析,探討鼻功能診斷系統(tǒng)在鼻阻塞患者行鼻內(nèi)窺鏡手術(shù)效果中的臨床應(yīng)用價(jià)值。 方法 將150例鼻阻塞患者分為4組,即腺樣體肥大組(A組,其中單純腺樣體肥大患者30例即a組、腺樣體伴扁桃體肥大患者30例即b組)、鼻中隔偏曲組(B組)、慢性鼻竇炎組(C組)和鼻腔鼻竇占位性病變組(D組),分別行術(shù)前及術(shù)后鼻功能檢測(cè),分析各組臨床資料；正常成人對(duì)照組30例即E組和正常兒童對(duì)照組30例即F組分別行鼻功能檢測(cè),并進(jìn)行統(tǒng)計(jì)學(xué)分析。 結(jié)果 E組正常成人對(duì)照組雙側(cè)NMCA1.48±0.12cm2,雙側(cè)NCV18.67±1.49cm3,雙側(cè)NAR0.182±0.017kPa·s/L,雙側(cè)VT8.194±0.312L；單側(cè)NMCA0.72±0.06cm2,單側(cè)NCV10.16±0.51cm3,單側(cè)NAR0.341±0.030kPa·s/L,單側(cè)VT4.014-0.306L。F組正常兒童對(duì)照組雙側(cè)NMCA0.70±0.12cm2,雙側(cè)NPV19.05±1.62cm3,雙側(cè)NAR0.225±0.052kPa·s/L,雙側(cè)VT6.321±0.615L。 A組(腺樣體肥大組)患者術(shù)前NMCA0.65±0.12cm2,NPV12.20±2.16cm3, NAR0.301±0.040kPa-s/L, VT3.444±0.344L;術(shù)后3月復(fù)查鼻功能, NMCA0.72±0.10cm2, NPV19.60±1.78cm3, NAR0.239±0.043kPa·s/L, VT6.429±0.535L,術(shù)后較術(shù)前相比,NMCA、NPV、VT增大,NAR減小,差異有統(tǒng)計(jì)學(xué)意義(P0.05),與正常兒童對(duì)照組各檢測(cè)指標(biāo)相比無(wú)明顯差異(P0.05)。B組(鼻中隔偏曲組)患者術(shù)前NMCA0.59±0.17cm2, NCV8.13±1.24cm3, NAR0.421±0.031kPa-s/L, VT5.024±0.521L;術(shù)后3月復(fù)查鼻功能,NMCA1.57±0.19cm2, NCV19.04±2.43cm3, NAR0.176±0.029kPa·s/L, VT8.212±0.461L,術(shù)后較術(shù)前相比,NMCA、NCV、VT增大,NAR減小,差異有統(tǒng)計(jì)學(xué)意義(P0.05),與正常成人對(duì)照組雙側(cè)鼻腔各檢測(cè)指標(biāo)相比無(wú)明顯差異(P0.05)。C組(慢性鼻竇炎組)患者術(shù)前NMCA0.67±0.13cm2, NCV8.03±1.68cm3, NAR0.407±0.055kPa·s/L, VT4.926±0.615L;術(shù)后3月復(fù)查鼻功能,NMCA1.46±0.27cm2, NCV19.14±3.50cm3, NAR0.179±0.035kPa·s/L, VT8.013±0.660L,術(shù)后較術(shù)前相比,NMCA、NCV、VT增大,NAR減小,差異有統(tǒng)計(jì)學(xué)意義(P0.05),與正常成人對(duì)照組雙側(cè)鼻腔各檢測(cè)指標(biāo)相比無(wú)明顯差異(P0.05)。D組(鼻腔鼻竇占位性病變組)患者術(shù)前NMCA0.26±0.08cm2, NCV5.09±1.27cm3, NAR1.605±0.409kPa·s/L, VT0.936±0.320L;術(shù)后3月復(fù)查鼻功能,NMCA0.58±0.07cm2, NCV10.33±1.75cm3, NAR0.323±0.076kPa·s/L, VT3.909±0.830L,術(shù)后較術(shù)前相比,NMCA、NCV、VT增大,NAR減小,差異有統(tǒng)計(jì)學(xué)意義(P0.05),與正常成人對(duì)照組單側(cè)鼻腔各檢測(cè)指標(biāo)相比,NMCA差異有統(tǒng)計(jì)學(xué)意義(P0.05), NCV、VT、NAR無(wú)明顯差異(P0.05)。 結(jié)論 術(shù)前對(duì)鼻阻塞患者行鼻功能檢測(cè),可對(duì)患者鼻阻塞部位、程度進(jìn)行精確判斷,可幫助手術(shù)方案的選擇和手術(shù)操作的進(jìn)行;術(shù)后再次行該檢測(cè)并與術(shù)前進(jìn)行對(duì)比,可客觀、直接、有效的呈現(xiàn)手術(shù)效果。鼻功能診斷系統(tǒng)能客觀、準(zhǔn)確的反映鼻腔的通氣狀況,所以在一定程度上鼻功能診斷系統(tǒng)可作為評(píng)價(jià)鼻阻塞程度及鼻阻塞患者行鼻內(nèi)窺鏡手術(shù)效果的客觀評(píng)價(jià)指標(biāo)。
[Abstract]:Background and purpose
Nasal obstruction (nasal obstruction) is a common disease in the scientific clinical work of otorhinolaryngology. There are many causes of nasal obstruction. The causes of adults and infants and children are different. The evaluation of the degree of nasal obstruction mainly depends on the subjective feeling of the patients. One of the main means of treatment is the operation treatment, and the patient's nasal congestion. The degree of improvement mainly depends on its own subjective feeling, so it lacks objective reference and index for the degree of nasal obstruction and the evaluation of postoperative effect. The nasal function diagnosis system includes the nasal (pharynx) acoustic reflexometer, the nose resistance instrument and the nasal breathing apparatus. In recent years, it has been widely used in the clinical work in the Department of ENT. It can reflect the nasal cavity objectively. The degree, location and nature of obstruction, and the effect of preoperative and postoperative effect comparison, objectively reflect the effect of the operation, to a great extent, to overcome the difficult problems of the patients' complaints and practice in clinical work, and to effectively avoid the contradiction between doctors and patients.
150 cases of nasal obstruction admitted from November 2011 to December 2012 (60 cases of adenoid hypertrophy group, nasal septum deviation group, chronic sinusitis group and 30 cases of nasal sinus paranasal sinus space occupying lesion group) were reviewed in our department. Nasal endoscopic hand surgery was performed on the basis of the patient's specific conditions, and the nasal function examination was performed before and after the operation. At the same time, the data of each group were statistically analyzed, and 30 cases of normal adult control group and normal control group were selected for the parallel nasal function test, and the nasal obstruction groups were compared and analyzed to explore the clinical value of nasal function diagnosis system in the effect of nasal endoscopic surgery in nasal obstruction patients.
Method
150 cases of nasal obstruction were divided into 4 groups, namely, adenoid hypertrophy group (group A, 30 patients with adenoid hypertrophy, 30 cases of adenoid hypertrophy patients, group B), nasal septum deviation group (group B), chronic sinusitis group (group C) and nasal sinus paranasal space occupying venereal disease group (Group D), respectively, before and after the operation of nasal function test. Data from the normal adult control group, 30 cases, namely E group and normal child control group, 30 cases, namely F group, were examined by nasal function and analyzed statistically.
Result
In the normal adult control group, bilateral NMCA1.48 + 0.12cm2, bilateral NCV18.67 + 1.49cm3, bilateral NAR0.182 + 0.017kPa s/L, bilateral VT8.194 + 0.312L, unilateral NMCA0.72 + 0.06cm2, unilateral 0.12cm2 + s/L, unilateral and normal children control group were bilateral. Bilateral NAR0.225 + 0.052kPa? S/L, bilateral VT6.321 + 0.615L.
The patients in group A (adenoid hypertrophy group) were NMCA0.65 0.12cm2, NPV12.20 + 2.16cm3, NAR0.301 + 0.040kPa-s/L, VT3.444 + 0.344L. After the operation, the nasal function was reviewed in March, NMCA0.72 + 0.10cm2. Compared with the normal control group, there was no significant difference (P0.05) in group.B (nasal septum deviation group) before operation NMCA0.59 + 0.17cm2, NCV8.13 + 1.24cm3, NAR0.421 + 0.031kPa-s/L, VT5.024 + 0.521L. After the operation, the nasal function was reviewed in March. Compared with the preoperative NMCA, NCV, VT and NAR, the difference was statistically significant (P0.05). There was no significant difference between the normal adult control group and the control group (P0.05).C group (P0.05).C (chronic nasosinusitis group) before operation NMCA0.67 + 0.13cm2, NCV8.03 +. 46 + 0.27cm2, NCV19.14 + 3.50cm3, NAR0.179 + 0.035kPa s/L, VT8.013 + 0.660L, compared with pre operation, NMCA, NCV, VT increased, NAR decreased, and the difference was statistically significant. There was no significant difference between the normal adult control group and the bilateral nasal sinus space occupying lesion group. 2, NCV5.09 + 1.27cm3, NAR1.605 + 0.409kPa s/L, VT0.936 + 0.320L. After the operation, the nasal function was reviewed in March, NMCA0.58 + 0.07cm2, NCV10.33 + 1.75cm3. The difference of NMCA was statistically significant (P0.05), but there was no significant difference in NCV, VT and NAR (P0.05).
conclusion
The nasal obstruction of the patients before operation can be detected by the nasal function, which can accurately judge the location of the nasal obstruction. It can help the choice of the operation plan and the operation of the operation. After the operation, the examination and comparison with the preoperative can be used to objectively, directly and effectively show the effect of the operation. The nasal function diagnosis system can objectively and accurately reflect the nasal cavity. To a certain extent, the nasal function diagnosis system can be used as an objective evaluation index for evaluating the degree of nasal obstruction and the effect of nasal endoscopic surgery for patients with nasal obstruction.

【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：R765.9

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本文編號(hào)：1826542