| Objective:To explore the dynamic change process and amplitude of central airway diameter and its physiological effect under cough state.To explore the correlation between the diameter of central airway and the range of changes with gender,age,height,weight and body-mass index(BMI)in normal population with cough,so as to provide support for clinical endotracheal intubation,stent design and selection.Materials and methods:A total of 98 patients in the First Affiliated Hospital of Zhengzhou University from November 2019 to December 2020 were selected for DSA examination,including 53 males and 45 females.Height,weight and age of patients were collected and recorded before examination.Then calculating the BMI respectively.During the examination,DSA images were set at 30 frames/second,and then DSA images of trachea were collected from all patients during the coughing process,which were divided into orthopedic,30°oblique and 45° oblique positions.Each cough was completed within 1 second.Select the window width and window level on the PACS workstation to facilitate the measurement of the airway diameter.The upper edge of the first vertebral body,the second vertebral body,the third vertebral body,the fourth vertebral body and the lower edge of the fourth vertebral body were selected as the measurement points,and the plane perpendicular to the tracheal axis was taken as the measurement plane.The airway diameter line values at each point were recorded as T1,T2,T3,T4 and T5 respectively.Calculating the variation range of the gas pipe diameter line at each collection point under different patients’ cough state,which is recorded as T1 range,T2 range,T3 range,T4 range and T5 range respectively.The variation range of tracheal diameter is defined as the difference between the maximum tracheal diameter and the minimum tracheal diameter during cough.The data were independently measured by two physicians.Record the average value of the two measurements.If there is a big difference between the two measurements,the third doctor will retest the data.According to age,they were divided into young group(18≤N ≤45),middle age group(45≤N ≤60)and old group(60≤N≤80).According to BMI,they were divided into the underweight group(BMI≤18 kg/m2),the normal group(18<BMI≤24 kg/m2),the partial reorganization group(24<BMI≤30 kg/m2),and the obese group(BMI≥30 kg/m2).Variance analysis was used to compare the airway diameters of different ages and different BMI,and LSD was used to compare pairwise between groups.The independent sample t test was used to compare the physiological diameter line values and the variation range of the airway between different genders.All statistical results were considered statistically significant when P<0.05.This study was approved by the hospital ethics committee.Results:1.Central airway dimensions and change.The data of airway diameter at each measurement point in the anterional images of 98 subjects:T1(15.42± 1.90)mm,T2(15.20±1.76)mm,T3(15.38±2.08)mm,T4(15.41±2.20)mm,T5(16.48±2.24)mm.The variation amplitude of airway diameter line in cough state was(3.68± 1.26)mm in T1,(3.54± 1.60)mm in T2,(4.48± 1.68)mm in T3,(4.27± 1.61)mm in T4,and(4.76± 1.74)mm in T5.The left anterior inclination of the airway diameter line was measured at 3 0°,T1(15.02± 1.96)mm,T2(15.35±2.41)mm,T3(15.60±2.48)mm,T4(16.12±2.29)mm,T5(17.05±2.62)mm.The variation amplitude of airway diameter line in cough state was(3.23± 1.30)mm in T1,(3.83± 1.57)mm in T2,(4.34± 1.61)mm in T3,(4.74± 1.37)mm in T4,and(4,65±1.45)mm in T5.The measured values of left anterior 45° of the airway diameter line were T1(15.05±2.11)mm,T2(15.51 ±2.28)mm,T3(15.71±2.52)mm,T4(16.31 ±2.54)mm,T5(17.47±2.19)mm.The variation range of airway diameter in cough state was(3.71 ± 1.41)mm in T1,(4.62±2.28)mm in T2,(4.65±2.20)mm in T3,(4.83±2.08)mm in T4,and(5.11 ±2.11)mm in T5.2.The influence of gender,age and BMI on the positive measurement value and the range of change of the airway diameter.In the T1-T3 reference point,the measured value of male airway diameter is larger than that of female,and the difference is statistically significant(P<0.05).There was no statistical difference in the measurement values of airway diameter at T4 and T5 reference points of different genders(P>0.05).There was no statistical difference in the airway diameter changes of different genders(P>0.05).There is no statistical difference in the measured values of T1-T5 airway diameter in different age groups.The change of T4 reference point in the middle-aged group was greater than that of the young group,and the difference was statistically significant.There was no statistical difference between the T4 reference point and the remaining groups;the airway diameter changes at the T1-T3 and T5 reference points had no correlation with age.For different BMI,T1-T5 airway diameter measurements have no statistical difference.The change of the T3 reference point in the obese group was greater than that of the thin group,the normal group,and the overweight group.The difference in the change of the T3 reference point was greater than that of the thin group.There was no statistical difference between the T3 reference points and the remaining groups;there was no correlation between T1-T2 and T4-T5 reference points and BMI.3.The influence of gender,age and BMI on the measured value and the range of change of the 30°left anterior oblique of the airway diameter.At each reference point of the airway,the measured values of the male airway diameter are larger than those of the female,and the difference is statistically significant.The airway changes at the T3 reference point in males were larger than females,and the difference was statistically significant.There was no statistically significant difference in the airway diameter changes at the T1-T2 and T4-T5 reference points in different genders.There was no significant difference in the measured values of 30°left anterior oblique airway diameter at each reference point for different ages.The airway diameter at the T5 reference point in the middle-aged group was larger than that in the elderly group,and the difference was statistically significant.There was no significant correlation between the airway diameter at the other reference point and age.The airway diameter at T3 reference point in normal group was larger than that in obese group,and the difference was statistically significant.There was no significant correlation between the airway diameter at the remaining reference points and BMI.With different BMI,there is no significant difference in the change range of airway diameter at each reference point.4.The influence of gender,age and BMI on the measured value and change range of the left anterior oblique 45° of the airway diameter.At each reference point of the airway,the measured values of the male airway diameter are larger than those of the female,and the difference is statistically significant.The airway changes at the T2 and T3 reference points in men were larger than females,and the difference was statistically significant.There was no statistical difference in the airway diameter changes at the T1 and T4-T5 reference points for different genders.There was no significant difference in the measured values of 45° left anterior inclination of the airway diameter at each reference point for different ages.The airway diameter at the T2 reference point in the middle-aged group was larger than that in the young group,and the difference was statistically significant.The airway diameter at the other reference point had no significant correlation with age.There were no significant differences in the measured values of the airway diameters and the range of changes at each reference point between different BMI groups.5.Comparison of the percentage change of airway diameter line from different angles.In the positive position,the percentage change of airway diameter line in T1 was less than that in T3 and T5.The percentage change of airway diameter at T2 was less than that at T3,T4 and T5,and the difference was statistically significant There was no significant difference in the percentage change of airway diameter between the other groups.When the left anterior inclination is 30,the change percentage of airway diameter line in T1 was less than that in T3,T4 and T5.The percentage change of airway diameter at T2 was less than that at T4,and the difference was statistically significant.There was no significant difference in the percentage change of airway diameter between the other groups.When the left anterior oblique angle is 45,the percentage change of airway diameter line in T1 was less than that in T2 and T4,and the difference is statistically significant.There was no significant difference in the percentage change of airway diameter between the other groups.Conclusion:1、DSA can be used as a tool for measuring dynamically changing tracheal diameter.2、The diameter of male airway is larger than that of female,and there is no obvious correlation with age and BMI.During cough,different positions of the trachea and different angles of the trachea varied in different ranges.Age and BMI were the main influencing factors in the orthotopic position.In oblique position,it is mainly related to sex and age.When coughing,the lower part of the trachea has greater mobility than the upper part of the trachea.3、The measurement of airway diameter and the range of airway changes can provide the basis for stent design,and provide reference for the selection of airway stents for patients with different genders,ages and BMI. |
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