单侧鼻阻塞对中度OSAHS患者咽腔压力的影响  

The Influence of rhinostegnosis on the pressure of upper airway in medium obstructive sleep apnea patients

作　　者：陆立彦[1] 张宇宁[2] 郭宇峰[3] 刘树红[4] 陈广[1] 卢晓峰[1] 朱敏[1] 

机构地区：[1]上海交通大学医学院附属第九人民医院口腔颌面外科,上海市口腔医学重点实验室,上海市口腔医学研究所,200011 [2]华威大学工程学院 [3]上海交通大学医学院附属瑞金医院耳鼻喉科 [4]清华大学热能工程系,清华大学水沙科学与水利水电工程国家重点实验室

出　　处：《实用口腔医学杂志》2010年第4期523-528,共6页Journal of Practical Stomatology

基　　金：上海科学技术委员会资助(编号:08DZ2271100)

摘　　要：目的:研究通过计算机流体力学(computational fluid dynamics,CFD)模型模拟平静呼吸下阻塞型睡眠呼吸暂停低通气综合征(OSAHS)患者咽腔形态及内部流动,并模拟单侧鼻腔阻塞情况下平静呼吸时患者的咽腔流体流场,进行对比分析。方法:对志愿者(中度OSAHS患者)的咽腔行CT扫描,通过Amira 4.0建立上气道三维模型,同时通过计算机模拟建立单侧鼻腔阻塞的上气道三维模型,利用Gambit2.3.16网格划分后,用Fluent6.3.2模拟不同情况、不同流量下的咽腔内部流体力学。将CFD测量结果进行比较。结果:该患者上气道最狭窄处位于软腭后区,最小截面积大小为1.349×10-4m3,与临床检查相符合;在此区域,出现上气道最大流速(14.39 m/s)、最大压降(总压降40.60%);在模拟单侧鼻阻塞情况下,该模型管腔内各截面流速平均加快0.25 m/s,各截面压力平均增大2.90 Pa,但是流速、压力变化趋势不发生改变。结论:本研究建立的CFD模型能准确地反映患者上气道实际情况;单侧鼻腔阻塞情况时,患者的管腔内负压增大,更易产生上气道塌陷,但是不改变患者原有的上气道气流分布规律,是促进因子而非始动因子。Objective： To reconstruct a 3D model of human upper airway,and simulate the situation of one nostril with rhinostegnosis to investigate the influence on the airflow in the model.Methods： One female with the moderated obstructive sleep apnea hypopnea syndrome（OSAHS） accepted CT scan.CFD model was built by CT scans through Amira 4.0 and Gambit 2.3.16.Fluent 6.3.26 stimulated the airflow in breathing rates of 190 ml/s.Then by numerical simulation,the situation of one nostril obstruction was obtained,and the same procedures were done.The data were analyzed to discuss the change between the situations with and without rhinostegnosis.Results： 1） The minimum cross section area（1.349×10-4 m 3） of upper air way was obtained by CFD model,which matched well with the clinical examination,and maximum air velocity（14.39 m/s） in 190 ml flow and maximum pressure change（40.60%） were observed.2） With rhinostegnosis,the average air velocity increased 0.25 m/s and the average pressure dropped 2.90 Pa in 190 ml flow.However,the flow pattern in UA did not change under such circumstance.Conclusion： CFD model based on CT data enhances the understanding of the mechanism of OSAHS.It suggests that the rhinostegnosis is not a initiation factor but a promoter.

关 键 词：阻塞性睡眠暂停低通气综合征 计算机流体力学 三维重建 咽腔 鼻阻塞 

分 类 号：R766.3[医药卫生—耳鼻咽喉科]