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研究生:李哲瑋
研究生(外文):Che-Wei Lee
論文名稱:病患自覺鼻塞嚴重程度與鼻阻力測量及聲波鼻腔測量檢查之相關性研究
論文名稱(外文):Relationship between Self-perception and Objective Findings obtained using Rhinomanometry and Acoustic Rhinometry for Patients with Nasal Obstruction
指導教授:陳永福陳永福引用關係
學位類別:碩士
校院名稱:中國醫藥大學
系所名稱:醫務管理學研究所碩士班
學門:商業及管理學門
學類:醫管學類
論文出版年:2010
畢業學年度:98
語文別:中文
論文頁數:62
中文關鍵詞:鼻塞鼻阻力測量聲波鼻腔測量
外文關鍵詞:Nasal obstructionRhinomanometryAcoustic Rhinometry
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許多病患主訴鼻塞,但目前的鼻阻力測量及聲波鼻腔測量檢查卻無法呈現出來。本研究之目的是探討病患自覺鼻塞嚴重程度與鼻阻力測量及聲波鼻腔測量檢查之相關性,且透過國內病人數據分析後,調整一組使用鼻阻力計量測國人鼻腔構造之參數。
本研究樣本取自中部某醫學中心耳鼻喉科,2008年11月至2010年3月間,15歲至69歲191位主訴鼻塞經診斷為鼻中隔彎曲合併肥厚性鼻炎之病患資料進行分析,若鼻阻力測量或聲波鼻腔測量檢查數據中出現「呼吸次數=0」者,會自動剔除該筆資料。病患利用問卷先自我評估左、右兩側自覺鼻塞嚴重程度,分數從0分(沒有鼻塞)至5分(完全鼻塞),再以鼻阻力測量與聲波鼻腔測量檢查測得左、右兩側吸氣及吐氣之阻力、各定點之截面積、最小截面積及其位置、各段空間容積。將病患自覺嚴重程度分為輕度(0分)、中度(1、2、3分)及重度(4、5分),以變異數分析法討論各組間之差異,並以複迴歸分析法分析左、右側之主、客觀鼻塞之相關性。
變異數分析之結果顯示,左側自覺嚴重程度在左側吸氣阻力及鼻腔3.3cm2達顯著差異(P<0.05);右側自覺嚴重程度在右側吸氣阻力、呼氣阻力及鼻腔3.3cm處達顯著差異(P<0.05)。透過複迴歸分析結果,左、右兩側之吸氣阻力及鼻腔3.3cm,與自覺鼻塞嚴重程度皆呈顯著正相關 (R2=0.131)。新增樣本之變異數分析法結果得知,左側自覺嚴重程度在左側2.8-3.3 cm達顯著差異(P<0.05);右側自覺嚴重程度(P<0.05)在右側容積2.8-3.3 cm達顯著差異(P<0.05)。
  本研究結果得知,左、右兩側吸氣阻力影響病患的自覺鼻塞嚴重程度較大。舊樣本複迴歸分析結果顯示在鼻腔3.3cm處顯著負相關的預測效果(R2=0.131),新樣本根據舊樣本的分析結果找出新切點,顯示在鼻腔左、右兩側2.8-3.3cm與病患自覺嚴重程度有顯著差異(P<0.05),所以本研究建議耳鼻喉科醫師量測病人的鼻腔2.8-3.3cm區段之間的容積,做為診斷鼻塞嚴重程度之參考。

Objective:
Some patients complain that they feel uncomfortable because of nasal obstruction, although clinical measurements using flow meter and acoustic instrumentation show no obvious sign of severe obstruction. In this study, we intend to find the measured parameters which directly correlate to patient perception.
Methods:
Parameters including standard inspiration/expiration resistance, local cross-sectional area and volume, and minimum cross-sectional area and its corresponding position of the nostril tube were acquired by using flow meter and acoustic instrumentation. After the measurements, patients were asked to fill a questionaire to evaluate perception of nostril obstruction based on the percentage of perceived obstruction. The degree of obstruction for both left and right nostrils was divided into 3 levels, including mild (<20%), moderate (20%-40%), and severe (>60%). A total of 191 patients who had nasal problem were recruited for this study. Sixty-two patients with recorded breathing number of 0 were excluded, therefore only data of 129 patients were used for further analysis. Analysis of variance (ANOVA) was used to observe which parameters are correlated to self-perception of nasal obstruction. In addition, multiple regression analysis was applied to observe the correlation between perceived obstruction and objective obstruction (quantified by measured parameters) for either right or left nostril.
Result:
It was found that both the inspiration resistances for three groups are significant different (ANOVA, p<0.001) at both left and right nostrils. However, only the inspiration resistances is correlated (Multiple Regression, p<0.01) to perceived obstruction for both left and right nostrils. Furthermore, The position of minimum cross-sectional area situated mostly at 2.8-3.3 cm in the nostril tube.
Conclusion:
Inspiration resistances might be used to evaluate the degree of perceived nasal obstruction.


摘要 i
Abstract iii
致謝 iv
目錄 v
表目錄 ix
圖目錄 xi
第一章 緒論 1
一、研究背景與動機 1
1.鼻腔的構造 1
2.造成鼻塞原因 2
3.鼻阻力測量(Rhinomanometry) 3
4.聲波鼻腔測量(Acoustic rhinometry) 3
二、研究目的 4
第二章 文獻探討 5
一、鼻塞形成原因 5
二、鼻阻力測量及聲波鼻腔測量 6
第三章 研究設計與方法 11
一、研究流程 11
二、研究架構 13
三、研究對象 13
四、研究工具 14
1.鼻塞自我評估表 14
2.鼻阻力測量儀器 15
3.聲波鼻腔測量儀器 16
4.儀器測量步驟 17
5.統計軟體 18
五、分析方法 18
第四章 資料分析與結果 19
一、鼻阻力測量之統計分析 19
1.兩側阻力之描述性統計 19
2.兩側阻力之同質性檢定 20
3.兩側阻力之變異數單因子分析 21
4.兩側阻力之事後檢定 22
二、聲波鼻腔測量之統計分析 24
1.兩側區段容積及單點截面積之描述性統計 24
2.兩側區段容積及單點截面積之同質性檢定 26
3.兩側區段容積及單點截面積之單因子變異數分析 28
4.兩側區段容積及單點截面積之事後檢定 29
三、鼻阻力測量及聲波鼻腔測量之複迴歸分析 33
四、聲波鼻腔測量新增樣本之統計分析 35
1.兩側新區段容積之描述性統計 35
2.兩側新區段容積之同質性檢定 37
3.兩側新區段容積之單因子變異數分析 39
4.兩側新區段容積之事後檢定 40
五、兩側鼻腔合併之統計分析 42
1.舊資料合併之描述性統計 42
2.舊資料合併之同質性檢定 43
3.舊資料合併之單因子變異數分析 44
4.舊資料合併之事後檢定 45
六、臨床測試分析 49
1.臨床測試之描述性統計 49
2.臨床測試之同質性檢定 49
3.臨床測試之單因子變異數分析 50
4.臨床測試之事後檢定 50
第五章 討論 52
一、鼻阻力測量 52
二、聲波鼻腔測量 53
三、複迴歸分析 56
四、臨床測試之驗證 56
第六章 結論與建議 58
參考文獻 59

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