摘要目的：探讨气管、支气管狭窄患者气流动力学参数的改变及意义。方法选取2011年1月—2015年12月徐州医学院附属医院40例气管、支气管狭窄患者(观察组)及40名健康体检者(对照组)的临床、影像及肺功能资料进行回顾性分析。依据病变部位不同观察组又分为气管狭窄组、支气管狭窄组各20例；其中恶性狭窄38例,气道狭窄程度>50%者30例,腔外型狭窄为20例,弥漫型狭窄22例,偏心性狭窄37例。应用螺旋CT机采集感兴趣区DICOM数据,利用医学影像3D重建软件建立气道几何模型；将肺功能数据施加到几何模型出入口边界后,应用计算机流体力学分析软件进行气道气流动力学模拟,记录感兴趣区气流动力学截面积、流速、体积流量等参数进行统计学分析,不同参数组内比较采用配对t检验。结果所有研究对象气流动力学研究模型成功建立。气管、支气管狭窄组狭窄处流速分别为(1764±1484) cm/s、(156±57) cm/s,流量分别为(1565±963)mL/s、(310±99)mL/s,均高于同组气管、支气管入口流速及流量(P<0.05或P<0.01)；支气管狭窄组患侧支气管入口流速及流量为(82±35) cm/s及(79±32) mL/s,分别小于健侧支气管入口流速(211±83)cm/s及流量(184±68)mL/s(P值均<0.01)；在15例偏心性气管狭窄患者中,和原发病变同侧支气管入口流速及流量分别为(464±246) cm/s及(526±283) mL/s,高于病变对侧支气管入口流速(308±209)cm/s及流量(359±255)mL/s(P值均<0.05)。对照组气管及双侧支气管入口分别与气管、支气管中段流速及流量比较,差异均无统计学意义(P值均>0.05)。结论气管、支气管狭窄患者气流动力学参数存在着一定的病理性改变。气管狭窄引起狭窄处气体流速、流量增加,且偏心性狭窄影响两侧支气管气流；支气管狭窄则引起患侧进入气流减少。计算机气流动力学参数模拟可以融合多种检查数据,对研究该病呼吸病理生理及病情评估提供了一种新的综合性评价方法。

abstractsObjective To explore the changes and the significance of the aerodynamic parameters in the tracheal and bronchial stenosis. Methods From January 2011 to December 2015, clinical, imaging and pulmonary function data of 40 patients with tracheal and bronchial stenosis ( the stenosis group) and 40 healthy people( the control group) were retrospectively collected in the Affiliated Hospital of Xuzhou Medical College. The stenosis group was further subgrouped as the tracheal stenosis group and the bronchia stenosis group, each subgroup consisted of 20 patients, among which 38 patients with malignant stenosis, 30 patients with a degree of stenosis greater than 50%, 20 patients with extraluminal stenosis, 22 patients with diffuse stenosis and 37 patients with eccentric stenosis. The DICOM data were acquired using the spiral CT machine and the geometric models of airways were established using the three dimensional reconstruction software. The pulmonary function data were imposed on the inlet and outlet of the geometric models. Then the&nbsp;aerodynamics of the airways were simulated using the computational fluid dynamic software. Aerodynamic parameters of the sectional area, velocity and volume flow at the region of interests were recorded and statistically analyzed. Different parameters between two groups were compared using paired t-test. Results The aerodynamic research models were all established. The velocity at the stenotic site of trachea and bronchia was (1 764 ± 1 484) cm/s, (310 ± 99) cm/s and the volume flow was (1 565 ± 963) mL/s, (156 ± 57) mL/s, which was higher than the velocity at the inlet site of trachea and bronchia and the volume flow (P<0. 05 or P<0. 01). In the patients with bronchial stenosis, the velocity and volume flow at the inlet of the affected side of bronchia was (82 ± 35) cm/s and (79 ± 32) mL/s, which was lower than velocity and volume flow at the inlet of the unaffected side of bronchia, that was ( 211 ± 83 ) cm/s and (184 ± 68 ) mL/s. In 15 patients with eccentric stenosis, the velocity and volume flow at the inlet of bronchia on the same side of the primary lesions was (464 ± 246) cm/s, ( 526 ± 283) mL/s, which was higher than velocity and volume flow at the inlet of the bronchia on the contralateral side of the primary lesions, that was (308 ± 209) cm/s and (359 ± 255) mL/s(all P values < 0. 05). Differences in comparison of velocity and volume flow at the site of inlet and middle of tracheal and bronchia in the healthy controls had no statistical significance (all P values>0. 05). Conclusions Pathological changes of the aerodynamic parameters exist in patients with tracheal and bronchial stenosis. Tracheal stenosis caus high velocity and volume flow in the stenotic area, also eccentric tracheal stenosis affected airflow at the two sides of bronchi. While bronchia stenosis causes decreased airflow entering into the affected side. Simulation of computer aerodynamic parameters can integrate a variety of inspection data. It provides a comprehensive evaluation method for breathing pathology and physiology research and illness condition assessment.