流体力学分析说话瓣膜对下颌骨缺损重建患者气管切开后功能恢复的影响  

The effect of speaking valve on functional restoration in tracheostomised patients after reconstruction of madibular defects based on the fluid dynamics analysis

作　　者：郑燕娜 梁玉洁[1] 杨乐[1] 卢涣滋 廖贵清[1] Zheng Yanna;Yanna,Liang Yujie;Yang Le;Lu Huanzi;Liao Guiqing(Guanghua School of Stomatology,Hospital of Stomatology,Sun Yat.sen University,Guangdong Provincial Key Laboratory of Stomatology,Guangzhou 510055,China)

机构地区：[1]中山大学光华口腔医学院·附属口腔医院,广东省口腔医学重点实验室,广州510055

出　　处：《中华口腔医学研究杂志（电子版）》2018年第4期227-233,共7页Chinese Journal of Stomatological Research(Electronic Edition)

基　　金：国家自然科学基金(81772894、81672679);中山大学临床医学研究5010计划(20100018);高等学校博士学科点专项科研基金(20130171120125)

摘　　要：目的运用流体力学的方法,研究佩戴说话瓣膜(SV)对围术期气管切开下颌骨缺损重建患者误吸、口腔分泌物、嗅觉及发音的影响。方法根据纳入标准及排除标准入组的8例患者按随机数字表法随机分成瓣膜组及对照组。瓣膜组予术后第2天佩戴SV,对照组不予佩戴SV,观察患者误吸、口腔分泌物、嗅觉、发音情况。吞咽功能采用染色实验,口腔分泌物采用视觉模拟评分法(VAS),患者能正确回答易挥发分子的气味即嗅觉功能阳性,能进行简单的言语交流即发音功能阳性。采用锥形束CT(CBCT)扫描,Mimics和Gambit、Fluent软件,三维重建两组患者气道模型和气道流场,应用SPSS 23.0软件对比分析两组间术前、术后咽腔及声门下腔压力的变化,数据结果以中位数(25%值,75%值)表示。结果两组相比,瓣膜组4例均改善误吸、嗅觉及发音,口腔分泌物明显减少,差异有统计学意义(P<0.05),对照组术前、术后声门下压分别为101 327.00 Pa(101 326.25,101 327.75)、101 270.00 Pa(101 269.25,101 270.75);瓣膜组佩戴SV后恢复声门下气压,术前、术后声门下压均为101 327.00 Pa(101 326.25,101 327.75),差异无统计学意义(P>0.05)。结论围术期气管切开患者佩戴SV能够减少误吸风险,改善嗅觉功能,此外,恢复患者言语交流能力,缓解患者围术期焦虑,有利于患者顺利度过围术期。因此,下颌骨缺损血管化腓骨复合组织瓣修复重建患者气管切开后运用SV值得推广运用。Objective The purpose of the present study was to observe the influence of speaking valve(SV)on aspiration,oral secretions,olfaction,and the phonation in perioperative tracheostomised patients with fibular flap reconstruction of mandibular defects based on fluid dynamics analysis.Methods Eight tracheotomised patients with fibular flap reconstruction of mandibular defects were divided into two groups,the SV group and control group.The SV group were asked to wear SV two days after the tracheostomy while the control group weren′t treated with SV.And the differences were compared between the two groups on aspiration,oral secretion,olfaction and phonation.Dye test was used to assess deglutition functions;visual analog scale(VAS)was adopted to measure oral secretions;patients can correctly answer the odor of volatile molecules were positive function of olfaction;patients can conduct language exchange were positive function of phonation.Two groups were scanned by CBCT before and after the surgery respectively and three-dimensional models were reconstructed with CBCT data by Mimics.The internal flow of upper respiratory tract was simulated by Gambit and Fluent software,and the differences between two groups on the pressure of pharyngeal cavity and infraglottic cavity were compared by SPSS 23.0 software,and the data results are demonstrated with the median(25%,75%).Results There were significant differences between two groups,four patients of SV group had improvement in deglutition,oral secretion,olfaction and phonation(P<0.05).The preoperative and postoperative pressures of infraglottic cavity in control group were 101 327.00 Pa(101 326.25,101 327.75)and 101 270.00 Pa(101 269.25,101 270.75)respectively,while the preoperative and postoperative pressure of infraglottic cavity in SV group were both 101 327.00 Pa(101 326.25,101 327.75),with no statistical significance(P>0.05).Conclusions The application of SV can significantly decrease aspiration and oral secretion,improve olfactory function,and restore the communication a

关 键 词：围手术期医护 气管切开术 流体力学 腓骨瓣修复重建 下颌骨缺损 说话瓣膜 

分 类 号：R782[医药卫生—口腔医学]