Summary 摘要
4-Phase-Rhinomanometry (4PR) Basics and Practice 2010
2010 年 4 相鼻压计 (4PR) 基础与实践
The last comprehensive publications about the theory and practice of rhinomanometry appeared more than 20 years ago. Since the 1980 's, the general progress of sensor techniques, fluid physics and data processing was accompanied by the permanent work of the authors to analyze the errors of rhinomanometry and to create a fundament for a contemporary and practical method that can be used in functional diagnostics of the nasal air stream.
上一本关于鼻测量理论与实践的综合性出版物出版于 20 多年前。自 20 世纪 80 年代以来，伴随着传感器技术、流体物理学和数据处理技术的全面进步，作者们一直致力于分析鼻测量法的误差，并为可用于鼻气流功能诊断的现代实用方法奠定基础。
上一本关于鼻测量理论与实践的综合性出版物出版于 20 多年前。自 20 世纪 80 年代以来，伴随着传感器技术、流体物理学和数据处理技术的全面进步，作者们一直致力于分析鼻测量法的误差，并为可用于鼻气流功能诊断的现代实用方法奠定基础。
In this special document, the objectives and measurement principles, as well as the history of rhinomanometry are described in the first three chapters. It is pointed out, that the key parameters are not only intranasal pressure and flow, but also the factor time. The technical requirements as following from the dynamics of breathing are described.
在这份特别文件的前三章中，介绍了鼻测量仪的目标、测量原理和历史。文件指出，关键参数不仅包括鼻内压和鼻流量，还包括时间因素。此外，还介绍了呼吸动力学的技术要求。
在这份特别文件的前三章中，介绍了鼻测量仪的目标、测量原理和历史。文件指出，关键参数不仅包括鼻内压和鼻流量，还包括时间因素。此外，还介绍了呼吸动力学的技术要求。
The process of averaging of rhinomanometric data lead to a separate and time-dependent analysis of the changes of pressure and flow and implicated the introduction of the 4 breathing phases (ascending and descending curve part in inspiration and expiration) into rhinomanometry and is therefore called 4Phase-Rhinomanometry (4PR). Chapter 4 is containing a comprehensive analysis of the practical errors, which may follow neglecting the 4 breathing phases.
鼻测量数据的平均化过程导致对压力和流量的变化进行单独和随时间变化的分析，并将 4 个呼吸阶段（吸气和呼气时的上升和下降曲线部分）引入鼻测量法，因此被称为 4 阶段鼻测量法（4PR）。第 4 章全面分析了忽视 4 个呼吸阶段可能导致的实际错误。
鼻测量数据的平均化过程导致对压力和流量的变化进行单独和随时间变化的分析，并将 4 个呼吸阶段（吸气和呼气时的上升和下降曲线部分）引入鼻测量法，因此被称为 4 阶段鼻测量法（4PR）。第 4 章全面分析了忽视 4 个呼吸阶段可能导致的实际错误。
The in chapter 5 described mathematical-physical concept of 4PR is based on the introduction of the terms "steady" and "unsteady" flow, in addition to the up to now used terms of laminarity and turbulence. After the derivation of the HOFFRICHTER-equation as explaining the loops around the intersection point of the
第 5 章描述了 4PR 的数学物理概念，除了目前使用的层流和湍流术语外，还引入了 "稳定 "和 "非稳定 "流动术语。在推导出解释
第 5 章描述了 4PR 的数学物理概念，除了目前使用的层流和湍流术语外，还引入了 "稳定 "和 "非稳定 "流动术语。在推导出解释
The precondition for the worldwide introduction of new parameters into the 4PR is a comprehensive statistical analysis. The disadvantages of the present recommended standard values are described in chapter 6. Following previous studies in 5800 cases, the parameters Vertex Resistance (VR), Effective Resistance (Reff) and their logarithmic transformations have been investigated in 1580 rhinograms of different degrees of obstructions, also including the correlations to a VAS. It could be confirmed, that the parameters VR and Reff after logarithmic transformation, have a significant and high correlation to the sensation of obstruction. The new clinical classification of obstruction and conductance of the nose is proposed in Table 1 for Caucasian noses.
在全球范围内将新参数引入 4PR 的先决条件是进行全面的统计分析。第 6 章介绍了目前推荐标准值的缺点。根据之前对 5800 个病例的研究，我们对 1580 张不同阻塞程度的鼻图进行了顶点阻力（VR）、有效阻力（Reff）参数及其对数变换的研究，其中也包括与 VAS 的相关性。结果表明，经过对数变换后的 VR 和 Reff 参数与阻塞感具有显著的高度相关性。表 1 针对白种人鼻子的阻塞和鼻传导性提出了新的临床分类。
在全球范围内将新参数引入 4PR 的先决条件是进行全面的统计分析。第 6 章介绍了目前推荐标准值的缺点。根据之前对 5800 个病例的研究，我们对 1580 张不同阻塞程度的鼻图进行了顶点阻力（VR）、有效阻力（Reff）参数及其对数变换的研究，其中也包括与 VAS 的相关性。结果表明，经过对数变换后的 VR 和 Reff 参数与阻塞感具有显著的高度相关性。表 1 针对白种人鼻子的阻塞和鼻传导性提出了新的临床分类。
Table 1. Clinical classification of obstruction and conductance for Causcasian noses.
表 1.高加索人鼻子阻塞和传导性的临床分类。
表 1.高加索人鼻子阻塞和传导性的临床分类。
| Log10R(VR, REFF) Log10R（VR、REFF） | Obstruction, Resistance 阻碍、阻力 | Conductance 电导 | |
| 1 |
|
very low 非常低 | very high 非常高 |
| 2 |
|
low | high 高 |
| 3 |
|
moderate 温和派 | moderate 温和派 |
| 4 |
|
high 高 | low |
| 5 |
|
very high 非常高 | very low 非常低 |
Chapter 7 is dedicated to the advantages of
第 7 章主要介绍
第 7 章主要介绍
Discussing practical aspects in chapter 8 , the start point of proposals and discussions are the standard recommendations of the ISOANA and the results of its consensus conference in 2003. In particular the calibration processes, hygiene, the correct attachment of the pressure tube at the nostril ("tape method") and the different measurement procedures (AAR, APR), decongestion and provocation tests are extensively described.
第 8 章讨论了实用方面的问题，建议和讨论的出发点是 ISOANA 的标准建议及其 2003 年共识会议的结果。特别是校准过程、卫生、压力管在鼻孔处的正确连接（"胶带法"）、不同的测量程序（AAR、APR）、减充血和激惹试验，都有广泛的描述。
第 8 章讨论了实用方面的问题，建议和讨论的出发点是 ISOANA 的标准建议及其 2003 年共识会议的结果。特别是校准过程、卫生、压力管在鼻孔处的正确连接（"胶带法"）、不同的测量程序（AAR、APR）、减充血和激惹试验，都有广泛的描述。
Both the final chapters are clinical contributions from mainland China, which are of high importance because of the racial differences in nasal respiratory function. In chapter 9 , tests of the assessment of normal nasal airway in adult Chinese by
最后两章都是来自中国大陆的临床研究成果，由于鼻呼吸功能的种族差异，这两章具有非常重要的意义。第 9 章介绍了通过
最后两章都是来自中国大陆的临床研究成果，由于鼻呼吸功能的种族差异，这两章具有非常重要的意义。第 9 章介绍了通过
Chapter 10 is dealing with
第 10 章讨论了鼻中隔偏曲功能评估中的
第 10 章讨论了鼻中隔偏曲功能评估中的
1. The Objective and Measurement Principles of Rhinomanometry
1.鼻测量的目标和测量原理
1-1 Introduction 1-1 引言
The beginnings of functional diagnostic rhinology go back to 1894, when Zwaardemaker
功能诊断鼻科的起源可以追溯到 1894 年，当时 Zwaardemaker
功能诊断鼻科的起源可以追溯到 1894 年，当时 Zwaardemaker
Later, the hygrometric methods described above were replaced by methods characterizing the nasal airflow by its physical parameters of flow and pressure; thus rhinology as well as pneumonology were following methods based on physics and general fluid dynamics. Methods of estimation have now been replaced by measuring and calculation.
后来，上述湿度测量方法被通过流量和压力等物理参数来描述鼻腔气流特征的方法所取代；因此，鼻科和肺科都采用了基于物理学和一般流体动力学的方法。现在，估算方法已被测量和计算方法所取代。
后来，上述湿度测量方法被通过流量和压力等物理参数来描述鼻腔气流特征的方法所取代；因此，鼻科和肺科都采用了基于物理学和一般流体动力学的方法。现在，估算方法已被测量和计算方法所取代。
The goal of rhinomanometry in the past has been either:
过去鼻测量的目标是：
过去鼻测量的目标是：
a. to measure how much pressure is required to move a given volume of air through the nose during respiration, or
a. 测量在呼吸过程中，一定量的空气通过鼻腔所需的压力，或
a. 测量在呼吸过程中，一定量的空气通过鼻腔所需的压力，或
b. to determine the airflow that can pass through the nose at a given pressure.
b. 确定在给定压力下可通过鼻腔的气流。
b. 确定在给定压力下可通过鼻腔的气流。
During the transition from graphical to computerized rhinomanometry it became apparent that the most important parameter is neither the pressure nor the airflow velocity; instead, it is the relation between these two parameters, which allow us to describe more completely the physics of the nasal air stream. The basis of these relations became the accepted standard for evaluating the degree of nasal obstruction in the field of rhinology in
在从图形鼻测量法向计算机鼻测量法过渡的过程中，我们发现最重要的参数既不是压力，也不是气流速度，而是这两个参数之间的关系，它使我们能够更完整地描述鼻腔气流的物理特性。
在从图形鼻测量法向计算机鼻测量法过渡的过程中，我们发现最重要的参数既不是压力，也不是气流速度，而是这两个参数之间的关系，它使我们能够更完整地描述鼻腔气流的物理特性。
During the development of computerized rhinomanometry, it was necessary to consider how pressure and flow vary during a breathing cycle. We had to analyze the dynamics of both measurement channels and to eradicate methodical errors. It became apparent, that another factor played a significant role: this factor was time, which had not been taken into consideration previously. Time is an important physiological factor, because it is essential that the amount of oxygen required by the body reach the lung within a period corresponding to its oxygen needs. In cases of elevated nasal obstruction, this time limit is exceeded and mouth breathing becomes necessary. For example, during vigorous exercise or physical work, this transition is physiologically predetermined. However, when a person at rest feels compelled to breathe through the mouth, this indicates that sufficient amounts of conditioned air cannot flow under those conditions through the nose. Therefore, the pres- sure difference between the nasal opening and the epipharynx has to be maintained for a longer period to allow the transport of sufficient oxygen to the lungs. Therefore, the diagnostic aim of 4-phase-rhinomanometry is to measure the intranasal pressure, flow and time variables necessary for maintaining an adequate oxygen supply through the nose.
在开发计算机鼻测量仪的过程中，有必要考虑呼吸周期中压力和流量的变化情况。我们必须分析两个测量通道的动态变化，并消除方法上的误差。很明显，另一个因素也起着重要作用：这就是以前从未考虑过的时间因素。时间是一个重要的生理因素，因为人体所需的氧气量必须在与肺部氧气需求量相应的时间内到达肺部。在鼻腔阻塞加重的情况下，就会超过这个时间限制，这时就需要用口呼吸。例如，在剧烈运动或体力劳动时，这种转变是生理上预先决定的。然而，当一个人在休息时感到不得不用口呼吸时，这表明在这种情况下，鼻子无法提供足够的调节空气。因此，鼻腔开口和会咽之间的预压差必须保持更长的时间，才能将足够的氧气输送到肺部。因此，四相血压计的诊断目的是测量鼻内压力、流量和时间变量，这些都是通过鼻腔维持充足氧气供应所必需的。
在开发计算机鼻测量仪的过程中，有必要考虑呼吸周期中压力和流量的变化情况。我们必须分析两个测量通道的动态变化，并消除方法上的误差。很明显，另一个因素也起着重要作用：这就是以前从未考虑过的时间因素。时间是一个重要的生理因素，因为人体所需的氧气量必须在与肺部氧气需求量相应的时间内到达肺部。在鼻腔阻塞加重的情况下，就会超过这个时间限制，这时就需要用口呼吸。例如，在剧烈运动或体力劳动时，这种转变是生理上预先决定的。然而，当一个人在休息时感到不得不用口呼吸时，这表明在这种情况下，鼻子无法提供足够的调节空气。因此，鼻腔开口和会咽之间的预压差必须保持更长的时间，才能将足够的氧气输送到肺部。因此，四相血压计的诊断目的是测量鼻内压力、流量和时间变量，这些都是通过鼻腔维持充足氧气供应所必需的。
1-2 Methodology of Rhinomanometry
1-2 鼻测量方法
The principles applied during the past few decades for measuring the relationship between pressure difference and airflow volume through the nose can be described as follows:
在过去几十年中，用于测量压力差与鼻腔气流体积之间关系的原理可描述如下：
在过去几十年中，用于测量压力差与鼻腔气流体积之间关系的原理可描述如下：
1-2-1 External airflow methods (Passive Rhinomanometry)
1-2-1 外部气流测量法（被动式鼻测量法）
External airflow methods consist of pumping a constant, predefined amount of air through a nasal olive into or out of the nose. The resultant pressure difference generated can thus be measured. The basis of this method, so called "passive rhinomanometry", can be traced to Kayser
外部气流法包括通过鼻橄榄将预定量的恒定空气泵入或泵出鼻腔。由此产生的压力差可以被测量出来。这种方法的基础，即所谓的 "被动鼻测量法"，可追溯到 1895 年的 Kayser
外部气流法包括通过鼻橄榄将预定量的恒定空气泵入或泵出鼻腔。由此产生的压力差可以被测量出来。这种方法的基础，即所谓的 "被动鼻测量法"，可追溯到 1895 年的 Kayser
Passive rhinomanometry had been the only available method used to study nasal ventilatory functions until the development of pneumotachography
在气动描记术
在气动描记术
During passive rhinomanometry:
在被动测鼻过程中：
在被动测鼻过程中：
-
The patient must hold his/her breath during the recording
记录时患者必须屏住呼吸 -
The positioning of the soft palate affects airflow resistance significantly and can be deliberately altered only by trained subjects. Airflow from an external source is often reported to cause discomfort and causes reflex movements by the soft palate
软腭的位置对气流阻力有很大影响，只有受过训练的受试者才能有意识地改变软腭的位置。据报道，来自外部的气流通常会引起不适，并导致软腭反射性运动 -
When using alternating airflows, significant differences have been measured between the pumping and suction phases.
在使用交替气流时，测量到抽气和吸气阶段之间存在显著差异。
Passive rhinomanometry is a "one-value" method. It means that the diagnostic information is only one number/value for the pressure at a given flow level and reveals little about the dynamics of nasal airflow. When using nasal olives, the risk exists that at each "breath" the airflow is channelled in a different direction, thereby altering the geometry of the nose and affecting the measurement at each reading. Moreover, the nasal openings, including the nasal valve, cannot be assessed when nasal olives are used. This circumstance further restricts the diagnostic value of passive rhinomanometry.
被动测鼻法是一种 "单值 "方法。这意味着诊断信息只是给定流量下压力的一个数字/数值，对鼻腔气流的动态变化揭示甚少。在使用鼻橄榄时，每次 "呼吸 "时气流都有可能流向不同的方向，从而改变鼻子的几何形状，影响每次读数的测量结果。此外，使用鼻橄榄时，包括鼻瓣在内的鼻腔开口也无法评估。这种情况进一步限制了被动式鼻测量仪的诊断价值。
被动测鼻法是一种 "单值 "方法。这意味着诊断信息只是给定流量下压力的一个数字/数值，对鼻腔气流的动态变化揭示甚少。在使用鼻橄榄时，每次 "呼吸 "时气流都有可能流向不同的方向，从而改变鼻子的几何形状，影响每次读数的测量结果。此外，使用鼻橄榄时，包括鼻瓣在内的鼻腔开口也无法评估。这种情况进一步限制了被动式鼻测量仪的诊断价值。
The oscillatory measurement of nasal resistance assumes a special status and is likewise classified as an external airflow
鼻阻力的振荡测量具有特殊地位，同样被归类为外部气流测量。
procedure
鼻阻力的振荡测量具有特殊地位，同样被归类为外部气流测量。
procedure
With the oscillation method, a reference resistance
在振荡法中，已知大小的基准电阻
在振荡法中，已知大小的基准电阻
and
Resistance in the entire respiratory tract is determined with this method. Nasal resistance can be obtained by subtracting the resistance measured through the mouth from the total resistance. It is a quick and practical method of measurement. However, the oscillation method for assessing nasal airflow resistance is a "one-value" method also, which does not permit further statements to be made about the nasal airflow pattern. No accurate result can be obtained where resistance values exceed
整个呼吸道的阻力都是通过这种方法测定的。从总阻力中减去通过口腔测得的阻力，即可得出鼻腔阻力。这是一种快速实用的测量方法。不过，评估鼻腔气流阻力的振荡法也是一种 "单值 "法，无法进一步说明鼻腔气流模式。如果阻力值超过
整个呼吸道的阻力都是通过这种方法测定的。从总阻力中减去通过口腔测得的阻力，即可得出鼻腔阻力。这是一种快速实用的测量方法。不过，评估鼻腔气流阻力的振荡法也是一种 "单值 "法，无法进一步说明鼻腔气流模式。如果阻力值超过
1-2-2 Spontaneous flow method (Active Rhinomanometry)
1-2-2 自发流量法（主动鼻测量法）
Due to the drawbacks of external flow methods described above, a general consensus has been reached worldwide that the patient's own physiological airflow should be used for assessing nasal ventilatory functions whenever possible. Not only the natural dynamics of nasal breathing can be measured, but nasal symptoms can also be correlated to the pulmonary physiological parameters.
由于上述外部气流方法的缺点，全世界已达成普遍共识，即应尽可能使用患者自身的生理气流来评估鼻通气功能。不仅可以测量鼻腔呼吸的自然动态，还可以将鼻腔症状与肺部生理参数联系起来。
According to Semarak
根据 Semarak
由于上述外部气流方法的缺点，全世界已达成普遍共识，即应尽可能使用患者自身的生理气流来评估鼻通气功能。不仅可以测量鼻腔呼吸的自然动态，还可以将鼻腔症状与肺部生理参数联系起来。
According to Semarak
根据 Semarak
Along with the development of functional nasal surgery in the US, Cottle
随着功能性鼻腔手术在美国的发展，Cottle
随着功能性鼻腔手术在美国的发展，Cottle
Rapid development of microelectronics within last two decades has not only made space flight possible, but it has also ensured that digital measuring technologies, originally possible only using large mainframe computers, have found their way into many areas of everyday life. In rhinomanometry, this particularly pertains to the accurate measurement of very low pressures and flow rates. Thus, new pathways have opened up in rhinology for the implementation of precise and manageable measurement technologies, which can be readapted to suit the needs of practical medicine.
过去二十年来，微电子技术的飞速发展不仅使太空飞行成为可能，而且还确保了原本只能使用大型计算机主机才能实现的数字测量技术进入日常生活的许多领域。在鼻测量领域，这尤其体现在对极低压力和流速的精确测量上。因此，在鼻科领域开辟了新的途径，可以采用精确、易于管理的测量技术，以适应实际医疗的需要。
过去二十年来，微电子技术的飞速发展不仅使太空飞行成为可能，而且还确保了原本只能使用大型计算机主机才能实现的数字测量技术进入日常生活的许多领域。在鼻测量领域，这尤其体现在对极低压力和流速的精确测量上。因此，在鼻科领域开辟了新的途径，可以采用精确、易于管理的测量技术，以适应实际医疗的需要。
Active Rhinomanometry distinguishes in turn between two measurement techniques after deriving the pressure difference between nasal entrance and choanae: the anterior and posterior methods. Active Anterior Rhinomanometry (AAR) involves closing one nostril with a measuring pressure probe, the other nostril thereby serving as an extension of the probe, while Active Posterior Rhinomanometry (APR) measures pressure difference via a tube in the mouth, with or without a mouthpiece, and held by the lips. In order to accurately measure total nasal resistance by APR, the soft palate and the tongue must be relaxed. Since pressure is deflected by the soft palate, the resistance of the anatomical structures between the oropharynx and choanae become effective in addition to the nasal resistance. Thus, rhinomanometric results obtained by AAR and APR are not always comparable. Typical examples for such differences are found in children with enlarged adenoids, in cleft palate patients and patients with nasopharyngeal fibromas or choanal polyps.
在得出鼻腔入口和咽鼓管之间的压力差后，主动鼻腔测量法又分为两种测量技术：前部测量法和后部测量法。前部主动测鼻法（AAR）是用测压探针关闭一个鼻孔，另一个鼻孔作为探针的延伸，而后部主动测鼻法（APR）则是通过口中的一根管子（带或不带吹口管），用嘴唇固定来测量压力差。为了通过 APR 准确测量鼻腔总阻力，软腭和舌头必须放松。由于软腭会使压力发生偏转，因此除了鼻腔阻力外，口咽部和咽喉之间解剖结构的阻力也会产生作用。因此，AAR 和 APR 所获得的测鼻结果并不总是具有可比性。腺样体肥大的儿童、腭裂患者和鼻咽纤维瘤或咽喉息肉患者就是这种差异的典型例子。
在得出鼻腔入口和咽鼓管之间的压力差后，主动鼻腔测量法又分为两种测量技术：前部测量法和后部测量法。前部主动测鼻法（AAR）是用测压探针关闭一个鼻孔，另一个鼻孔作为探针的延伸，而后部主动测鼻法（APR）则是通过口中的一根管子（带或不带吹口管），用嘴唇固定来测量压力差。为了通过 APR 准确测量鼻腔总阻力，软腭和舌头必须放松。由于软腭会使压力发生偏转，因此除了鼻腔阻力外，口咽部和咽喉之间解剖结构的阻力也会产生作用。因此，AAR 和 APR 所获得的测鼻结果并不总是具有可比性。腺样体肥大的儿童、腭裂患者和鼻咽纤维瘤或咽喉息肉患者就是这种差异的典型例子。
2. Technical aspects of rhinomanometry
2.鼻测量技术
2-1 Introduction 2-1 引言
From a technical point of view, rhinomanometry is the simultaneous measurement of the volume flow through the nose and of the differential narinochoanal pressure required for the generation of this airflow and the calculation of relevant physiological parameters. Presently, this task can be completed at different quality levels by several commercially available instruments. Therefore, the following section attempts to present a summary account of currently used measuring technology, which should enable the user to critically assess the quality characteristics of different equipment.
从技术角度看，鼻流量计是同时测量通过鼻腔的气流量和产生该气流量所需的鼻腔咽鼓管压差，并计算相关的生理参数。目前，市场上销售的几种仪器都能以不同的质量水平完成这项任务。因此，下文将对目前使用的测量技术进行简要介绍，以便用户对不同设备的质量特性进行严格评估。
从技术角度看，鼻流量计是同时测量通过鼻腔的气流量和产生该气流量所需的鼻腔咽鼓管压差，并计算相关的生理参数。目前，市场上销售的几种仪器都能以不同的质量水平完成这项任务。因此，下文将对目前使用的测量技术进行简要介绍，以便用户对不同设备的质量特性进行严格评估。
2-2 Measurement of volume flow and differential pressure
2-2 流量和压差测量
Most rhinomanometers in practice have applied the measurement principle of pneumotachography for recording volume flow. This principle requires an introduction of a defined resistance force to the respiratory airflow. The drop in pressure caused by this hindrance is proportional to the flow velocity (Bernoulli's principle). This obstacle is generally referred to as a "spiroceptor", and various technical models of this device exist. Its classic design resembles a so-called "Fleisch' Head" that is comprised of several metal tubes in parallel arrangement. Decrease of pressure occurring in such "heads" is linear within a specific range. Hence, the size of the spiroceptor must correspond to the anticipated flow. In prolonged testing, the spiroceptor must be warmed up to prevent water condensation inside
在实际应用中，大多数鼻毛测量仪都采用气动描记法的测量原理来记录体积流量。这一原理要求在呼吸气流中引入一个确定的阻力。这种阻力造成的压力下降与流速成正比（伯努利原理）。这种障碍物通常被称为 "螺旋受体"，这种装置有各种技术模型。其经典设计类似于所谓的 "弗莱施头"，由多根平行排列的金属管组成。这种 "头 "中发生的压力下降在特定范围内是线性的。因此，螺纹吸附器的尺寸必须与预期流量相符。在长期测试中，必须对螺套进行预热，以防止水在螺套内凝结。
在实际应用中，大多数鼻毛测量仪都采用气动描记法的测量原理来记录体积流量。这一原理要求在呼吸气流中引入一个确定的阻力。这种阻力造成的压力下降与流速成正比（伯努利原理）。这种障碍物通常被称为 "螺旋受体"，这种装置有各种技术模型。其经典设计类似于所谓的 "弗莱施头"，由多根平行排列的金属管组成。这种 "头 "中发生的压力下降在特定范围内是线性的。因此，螺纹吸附器的尺寸必须与预期流量相符。在长期测试中，必须对螺套进行预热，以防止水在螺套内凝结。
So-called "lamellar spiroceptors," consisting of plastic foils arranged in parallel, have a much greater range of linearity
所谓的 "片状螺线管 "由平行排列的塑料薄膜组成，其线性范围更大
所谓的 "片状螺线管 "由平行排列的塑料薄膜组成，其线性范围更大
The critical drawback of this measurement technology is that it possesses a high degree of inaccuracy near zero values (square root of small numbers) and inevitably leads to a distortion of measurement results in this important range.
这种测量技术的主要缺点是在零值（小数的平方根）附近误差较大，不可避免地会导致在这一重要范围内的测量结果失真。
From the hygiene point of view, a common risk involved with the use of all pneumotachographs, and therefore all rhinomanometers based on this principle, is the fact that respiratory flow passing through the lamellae is not filtered for bacteria and appropriate and regular disinfection measures rarely take place. No publications have yet focused on this problem.
从卫生的角度来看，使用所有气压计以及基于此原理的所有鼻流量计的一个共同风险是，通过薄片的呼吸气流没有经过细菌过滤，而且很少采取适当的定期消毒措施。目前还没有任何出版物关注这一问题。
这种测量技术的主要缺点是在零值（小数的平方根）附近误差较大，不可避免地会导致在这一重要范围内的测量结果失真。
From the hygiene point of view, a common risk involved with the use of all pneumotachographs, and therefore all rhinomanometers based on this principle, is the fact that respiratory flow passing through the lamellae is not filtered for bacteria and appropriate and regular disinfection measures rarely take place. No publications have yet focused on this problem.
从卫生的角度来看，使用所有气压计以及基于此原理的所有鼻流量计的一个共同风险是，通过薄片的呼吸气流没有经过细菌过滤，而且很少采取适当的定期消毒措施。目前还没有任何出版物关注这一问题。
2-3 Technical problems following the dynamics of the nasal air flow
2-3 遵循鼻腔气流动态的技术问题
Flow sensors and sensors for measuring differential pressure must meet rigid standard requirements if the primary measurement results are to be accurate. In this respect, the precision of flow and pressure measurements is not the only important criterion. It is just as essential that the speed of the recording is adjusted to time-dependent physiological changes in respiration. The demands placed on measurement technology by the dynamics of respiration have been considered the greatest challenge in the development of rhinomanometry.
流量传感器和压差测量传感器必须满足严格的标准要求，才能保证主要测量结果的准确性。在这方面，流量和压力测量的精度并不是唯一重要的标准。同样重要的是，记录速度必须适应呼吸中随时间变化的生理变化。呼吸动态对测量技术的要求被认为是鼻搏动测量技术发展过程中的最大挑战。
流量传感器和压差测量传感器必须满足严格的标准要求，才能保证主要测量结果的准确性。在这方面，流量和压力测量的精度并不是唯一重要的标准。同样重要的是，记录速度必须适应呼吸中随时间变化的生理变化。呼吸动态对测量技术的要求被认为是鼻搏动测量技术发展过程中的最大挑战。
The most important parameters that can provide information about the dynamic properties of a rhinomanometer are:
能提供鼻压计动态特性信息的最重要参数是
能提供鼻压计动态特性信息的最重要参数是
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resolution 决议
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offset drift 偏移漂移
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gain drift 增益漂移
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cut-off frequency. 截止频率。
In this respect, resolution designates the smallest change of a signal that can still be registered. Above all, the noise level of a sensor puts restrictions on the highest possible resolution. Signal changes within the magnitude of a given noise level cannot be distinguished from general noise. These facts are well known in audiometry and are applied in the same sense in general information technology.
在这方面，分辨率指的是仍能记录的信号的最小变化。最重要的是，传感器的噪音水平会对最高分辨率造成限制。在给定噪声级范围内的信号变化无法与一般噪声区分开来。这些事实在听力测量中众所周知，在一般信息技术中也同样适用。
在这方面，分辨率指的是仍能记录的信号的最小变化。最重要的是，传感器的噪音水平会对最高分辨率造成限制。在给定噪声级范围内的信号变化无法与一般噪声区分开来。这些事实在听力测量中众所周知，在一般信息技术中也同样适用。
Primary signal resolution in digital processing of the measurements is closely related to quantization. For instance, a peak value of
测量数字处理中的主信号分辨率与量化密切相关。例如，
测量数字处理中的主信号分辨率与量化密切相关。例如，
Such a quality, to some extent comparable with CD quality sound in stereo systems, can be attained only by a small number of pressure transducers that register lower range pressures generated by a spiroceptor. The measurement of differential narinochoanal pressure in a pressure range of
这种音质在某种程度上可与立体声系统中的 CD 音质相媲美，但只有通过少量的压力传感器才能实现，这些压力传感器可记录螺旋感受器产生的较低范围的压力。在
这种音质在某种程度上可与立体声系统中的 CD 音质相媲美，但只有通过少量的压力传感器才能实现，这些压力传感器可记录螺旋感受器产生的较低范围的压力。在
Sensor offset drift is a quite disagreeable characteristic, which played a significant role in early pneumotachography technology using valve amplifiers. In spite of the absence of any physiological signal, a measuring device will produce a signal. At each measurement, this offset drift is added on to the signal measured. In this respect, temperature sensitivity of a measurement system is of crucial importance. Stable sensors have an offset drift of
传感器偏移漂移是一个相当令人不快的特性，它在早期使用阀式放大器的气动照相技术中发挥了重要作用。尽管没有任何生理信号，测量设备仍会产生信号。每次测量时，偏移漂移都会加到测量信号上。在这方面，测量系统的温度灵敏度至关重要。稳定的传感器具有
传感器偏移漂移是一个相当令人不快的特性，它在早期使用阀式放大器的气动照相技术中发挥了重要作用。尽管没有任何生理信号，测量设备仍会产生信号。每次测量时，偏移漂移都会加到测量信号上。在这方面，测量系统的温度灵敏度至关重要。稳定的传感器具有
Gain drift, on the contrary, cannot be identified as easily as offset drift. This is a multiplicating error, which can be easily avoided by assessing and correcting the calibration of total measuring channel. Yet, it must first be identified. In modern sensor technology, which is also applied in rhinomanometry, high stability of gain is also generally a prerequisite since it permits the use of the electronic components. Therefore, various factors such as transportation, clogging of a spiroceptor or extreme atmospheric changes implement the necessity of recalibration of the total system.
相反，增益漂移不像偏移漂移那样容易识别。这是一种倍增误差，可以通过评估和校正总测量通道的校准来轻松避免。但是，必须首先识别它。在现代传感器技术中，增益的高稳定性通常也是一个先决条件，因为它允许使用电子元件。因此，运输、螺线管堵塞或极端的大气变化等各种因素都会导致整个系统需要重新校准。
相反，增益漂移不像偏移漂移那样容易识别。这是一种倍增误差，可以通过评估和校正总测量通道的校准来轻松避免。但是，必须首先识别它。在现代传感器技术中，增益的高稳定性通常也是一个先决条件，因为它允许使用电子元件。因此，运输、螺线管堵塞或极端的大气变化等各种因素都会导致整个系统需要重新校准。
Cut-off-frequency of a sensor or, to be more precise, of the entire measuring section is an exceptionally important factor that is decisive for the quality of rhinomanometric testing. It characterises the dynamic behaviour of a measured section. At the same time, some knowledge of physics is necessary in order to understand it. Depending on the activity level, the normal breathing rate is between 0.3 and
传感器的截止频率，更准确地说，是整个测量截面的截止频率，是一个非常重要的因素，对鼻测量仪的质量起着决定性的作用。它描述了测量截面的动态特性。同时，要理解它还需要一定的物理知识。根据活动水平的不同，正常呼吸频率在 0.3 到
传感器的截止频率，更准确地说，是整个测量截面的截止频率，是一个非常重要的因素，对鼻测量仪的质量起着决定性的作用。它描述了测量截面的动态特性。同时，要理解它还需要一定的物理知识。根据活动水平的不同，正常呼吸频率在 0.3 到
Simulation of human breathing processes to test airflow diagnostic devices can be carried out with a slowly running piston pump with a capacity of
模拟人类呼吸过程以测试气流诊断设备，可以使用一个缓慢运行的活塞泵，其容量为
Highest harmonics of the respiration frequency are found around the phase of changing of the flow direction, because the real breathing curve is more similar to a trapezoid than to a sinusoidal curve. This cannot be measured with a cut-off frequency of
呼吸频率的最高谐波出现在气流方向变化的相位附近，因为真实的呼吸曲线更类似于梯形，而不是正弦曲线。这一点无法用
模拟人类呼吸过程以测试气流诊断设备，可以使用一个缓慢运行的活塞泵，其容量为
Highest harmonics of the respiration frequency are found around the phase of changing of the flow direction, because the real breathing curve is more similar to a trapezoid than to a sinusoidal curve. This cannot be measured with a cut-off frequency of
呼吸频率的最高谐波出现在气流方向变化的相位附近，因为真实的呼吸曲线更类似于梯形，而不是正弦曲线。这一点无法用
In a series of relevant Fourier analysis tests, Mlynski
在一系列相关的傅立叶分析测试中，Mlynski
在一系列相关的傅立叶分析测试中，Mlynski
In this respect, confusion between the terms "respiratory frequency" and "frequency content" in respiratory activity has farreaching consequences. At the time when respiratory frequency itself is predominantly below
在这方面，混淆呼吸活动中的 "呼吸频率 "和 "频率含量 "会产生深远的影响。当呼吸频率本身主要低于
在这方面，混淆呼吸活动中的 "呼吸频率 "和 "频率含量 "会产生深远的影响。当呼吸频率本身主要低于
Today, rhinomanometers based on the measurement principles of pneumotachography should have a cut-off frequency of about
如今，基于气动照相法测量原理的鼻曼仪在流量通道和压力通道中应具有
如今，基于气动照相法测量原理的鼻曼仪在流量通道和压力通道中应具有
The number of possible airflow measurement procedures is far greater. For anemometry, the use of thermistors, or hot wire thermal resistors, is fundamentally practicable; alternatively, airflow measurement can be carried out with Venturi tubes or Pitot tubes as used for aviation purposes. However, all of these methods are either designed for application in areas other than rhinomanometry and cannot satisfy its diagnostic requirements at a reasonable cost.
可能的气流测量程序要多得多。就风速测量而言，使用热敏电阻或热线热敏电阻基本上是可行的；另外，还可以使用文丘里管或用于航空目的的皮托管进行气流测量。然而，所有这些方法要么是为鼻流量计以外的应用而设计的，要么是无法以合理的成本满足鼻流量计的诊断要求。
可能的气流测量程序要多得多。就风速测量而言，使用热敏电阻或热线热敏电阻基本上是可行的；另外，还可以使用文丘里管或用于航空目的的皮托管进行气流测量。然而，所有这些方法要么是为鼻流量计以外的应用而设计的，要么是无法以合理的成本满足鼻流量计的诊断要求。
The evolution of sensor technology brought along by semiconductors has not only been instrumental in developing semiconductor-based pressure sensors but has also produced so-called "mass flow sensors" (Figure 1). These relatively new devices contain all required equipment in a miniature case, which eliminates the need for an extensive tube connecting the nasal cavity with a pressure sensor. The measurement principle consists in the microelectronic evaluation of heat transmission between two thermo-electrical measuring elements.
半导体带来的传感器技术的发展不仅有助于开发基于半导体的压力传感器，而且还产生了所谓的 "质量流量传感器"（图 1）。这些相对较新的设备将所需的所有设备都装在一个微型盒中，因此不需要连接鼻腔和压力传感器的庞大管道。测量原理是对两个热电测量元件之间的热传递进行微电子评估。
半导体带来的传感器技术的发展不仅有助于开发基于半导体的压力传感器，而且还产生了所谓的 "质量流量传感器"（图 1）。这些相对较新的设备将所需的所有设备都装在一个微型盒中，因此不需要连接鼻腔和压力传感器的庞大管道。测量原理是对两个热电测量元件之间的热传递进行微电子评估。
mass: approx.
Figure 1. Mass Airflow Sensor (Datasheet from the Honeywell company).
图 1.质量气流传感器（霍尼韦尔公司数据表）。
图 1.质量气流传感器（霍尼韦尔公司数据表）。
This type of sensors offers high stability performance and compact construction. In combination with laptop computers, these devices provide a high level of mobility and open up entirely new perspectives for rhinological research and practice, especially in allergological and environmental studies. Such miniature measurement technology was first installed in the HRR 2 rhinomanometer (RhinoLab GmbH, Rendsburg, Germany). Earlier hygienic issues have been solved by implementing appropriate filtering elements.
这种传感器稳定性能高，结构紧凑。这些设备与笔记本电脑相结合，具有很高的移动性，为鼻科学研究和实践，特别是过敏症和环境研究开辟了全新的前景。HRR 2 鼻压计（RhinoLab GmbH，德国伦茨堡）首次采用了这种微型测量技术。早期的卫生问题已通过采用适当的过滤元件得到解决。
这种传感器稳定性能高，结构紧凑。这些设备与笔记本电脑相结合，具有很高的移动性，为鼻科学研究和实践，特别是过敏症和环境研究开辟了全新的前景。HRR 2 鼻压计（RhinoLab GmbH，德国伦茨堡）首次采用了这种微型测量技术。早期的卫生问题已通过采用适当的过滤元件得到解决。
As an example (Figure 2), such a device may consist of the following components:
举例来说（图 2），这种装置可由以下部件组成：
举例来说（图 2），这种装置可由以下部件组成：
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sensor case 传感器外壳
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airflow sensor case 气流传感器外壳
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differential pressure sensor
差压传感器 -
diffusor 扩散器
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bacteria and humidity filter
细菌和湿度过滤器 -
hose connections 软管连接
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mask (sterilisable) 面罩（可消毒）
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fixing element for pressure hose
压力软管固定件 -
electronic circuit 电子电路
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computer interface 电脑接口
(B)
Figure 2. Rhinomanometer HRR 3 (RhinoLab, Rendsburg,Germany)*. (A) Schematic picture and (B) in a set with a netbook computer.
图 2.HRR 3 鼻压计（RhinoLab，德国伦茨堡）*。(A) 原理图；(B) 与上网本电脑配套使用。
图 2.HRR 3 鼻压计（RhinoLab，德国伦茨堡）*。(A) 原理图；(B) 与上网本电脑配套使用。
3. Recording technology in rhinomanometry
3.鼻测量仪的记录技术
3-1 Introduction 3-1 引言
The evolution of rhinomanometry into "4-Phaserhinomanometry" is the result of a 20 -year error analysis conducted in rhinomanometric diagnostic technology, both on the side of theoretical research and technical feasibility of the procedure. While fundamental technical approaches as described above have spurred rapid developments in recording possibilities, documentation process of the obtained data and computer data interpretation remain a matter of discussion until today.
从理论研究和技术可行性两方面对鼻测量诊断技术进行了长达 20 年的误差分析，最终将鼻测量演变为 "4-Phaserhinomanometry"。尽管上述基本技术方法推动了记录技术的快速发展，但直到今天，所获数据的记录过程和计算机数据解读仍是一个需要讨论的问题。
从理论研究和技术可行性两方面对鼻测量诊断技术进行了长达 20 年的误差分析，最终将鼻测量演变为 "4-Phaserhinomanometry"。尽管上述基本技术方法推动了记录技术的快速发展，但直到今天，所获数据的记录过程和计算机数据解读仍是一个需要讨论的问题。
3-2 Rhinomanometry devices and set-ups
3-2 鼻测量设备和装置
Earlier pioneers in pneumotachography and rhinomanometry recorded the results of their measurements with a so-called kymograph. Change-sensitive stylus records any deflections on a revolving drum wrapped with a sheet of soot-blackened paper. The founder of functional nasal surgery Cottle
早期的气动测速仪和鼻测量仪先驱使用所谓的气压计记录测量结果。对变化敏感的测针可记录缠有烟灰黑纸的旋转鼓上的任何偏转。功能性鼻腔手术的创始人科特尔 (Cottle)
早期的气动测速仪和鼻测量仪先驱使用所谓的气压计记录测量结果。对变化敏感的测针可记录缠有烟灰黑纸的旋转鼓上的任何偏转。功能性鼻腔手术的创始人科特尔 (Cottle)
Bachmann
巴赫曼
According to Figure 3, the two weakest elements in an analogue recording system were none other than the flow transducer and the
根据图 3，模拟记录系统中最薄弱的两个元件非流量传感器和
巴赫曼
According to Figure 3, the two weakest elements in an analogue recording system were none other than the flow transducer and the
根据图 3，模拟记录系统中最薄弱的两个元件非流量传感器和
Figure 3. Analogue measurement chain in rhinomanometric procedure by Bachmann
图 3.巴赫曼
图 3.巴赫曼
In 1980 with the aid of spacecraft engineering pressure converters and extremely short connecting hoses, a research group at the ENT department of the Charité University Hospital in Berlin, Germany; K. Vogt and team members) managed to attain a cut-off- frequency of
1980 年，借助航天器工程压力转换器和极短的连接软管，德国柏林夏里特大学医院耳鼻喉科的一个研究小组（K. Vogt 和小组成员）成功地在给定的流量测量部分达到了
1980 年，借助航天器工程压力转换器和极短的连接软管，德国柏林夏里特大学医院耳鼻喉科的一个研究小组（K. Vogt 和小组成员）成功地在给定的流量测量部分达到了
Further small-scale experimenting with the aid of piston pump-generated airflow ("artificial nose") has yielded significant findings on how various technical aspects of rhinomanometric measurement - setup can contribute to error generation, i.e., what impact can have hose dimensions, mask size, etc. on cut-off- frequency
借助活塞泵产生的气流（"人工鼻"）进行的进一步小规模实验取得了重要发现，了解了鼻测量的各种技术方面--设置如何导致误差的产生，即软管尺寸、面罩大小等对截止频率
借助活塞泵产生的气流（"人工鼻"）进行的进一步小规模实验取得了重要发现，了解了鼻测量的各种技术方面--设置如何导致误差的产生，即软管尺寸、面罩大小等对截止频率
Figure 4. Rhinomanometric workstation, 1985, HNO-Clinic Charité in Berlin (ENT Department at the Charité University-Hospital). The pressure converters are mounted on a stand. Flow measurement takes place with the aid of a lamellar spiroceptor. Data are recorded using a storage oscilloscope monitor; analogue results are written by an x-y recorder.
图 4.鼻测量工作站，1985 年，柏林 HNO-Clinic Charité（Charité 大学医院耳鼻喉科）。压力转换器安装在支架上。流量测量借助一个片状螺线管进行。数据由存储示波器监视器记录；模拟结果由 x-y 记录器写入。
图 4.鼻测量工作站，1985 年，柏林 HNO-Clinic Charité（Charité 大学医院耳鼻喉科）。压力转换器安装在支架上。流量测量借助一个片状螺线管进行。数据由存储示波器监视器记录；模拟结果由 x-y 记录器写入。
Figure 5. Hybrid system with data digitalisation, an interim stage on the route to computer-assisted rhinomanometry.
图 5.数据数字化混合系统，实现计算机辅助鼻测量的过渡阶段。
图 5.数据数字化混合系统，实现计算机辅助鼻测量的过渡阶段。
In 1982, during the ERS-Congress in Stockholm, the first results of the so-called "computer rhinomanometry" were presented. These were the interpretations of digital curves designed to produce a general mathematical model of curve progression. Similar procedures have been developed independently by research groups in East Berlin, Tbilisi and Rochester (26-28). This development was performed on large workstations typical for that time, where measurement data were recorded in analogue form, digitally stored on magnetic tape and subsequently exported to a computer memory.
1982 年，在斯德哥尔摩召开的 ERS 大会上，首次展示了所谓的 "计算机鼻测量 "成果。这是对数字曲线的解释，旨在建立一个曲线发展的通用数学模型。东柏林、第比利斯和罗切斯特的研究小组也独立开发了类似的程序 (26-28)。这项开发工作是在当时典型的大型工作站上进行的，测量数据以模拟形式记录，以数字形式存储在磁带上，随后输出到计算机存储器中。
The introduction of computer technology into rhinomanometry has brought along some substantial errors attributable to direct importation of calculation methods from other scientific spheres. The initial fundamental error was the calculation of the regression between flow and pressure difference without taking notice of the individual data that arise in the process and, thereon, the analysis of an presumed function instead of the interpretation of actual measurements. On the basis of digital computation technology a new generation of microprocessor rhinomanometers has been developed. Devices of similar construction are still popular today thanks to their user-friendliness.
在鼻测量学中引入计算机技术后，由于直接引进了其他科学领域的计算方法，导致出现了一些重大错误。最初的根本性错误是在计算流量和压差之间的回归时，没有考虑到过程中出现的各种数据，因此分析的是假定函数，而不是对实际测量结果的解释。在数字计算技术的基础上，新一代微处理器鼻压计应运而生。由于使用方便，类似结构的设备至今仍很受欢迎。
1982 年，在斯德哥尔摩召开的 ERS 大会上，首次展示了所谓的 "计算机鼻测量 "成果。这是对数字曲线的解释，旨在建立一个曲线发展的通用数学模型。东柏林、第比利斯和罗切斯特的研究小组也独立开发了类似的程序 (26-28)。这项开发工作是在当时典型的大型工作站上进行的，测量数据以模拟形式记录，以数字形式存储在磁带上，随后输出到计算机存储器中。
The introduction of computer technology into rhinomanometry has brought along some substantial errors attributable to direct importation of calculation methods from other scientific spheres. The initial fundamental error was the calculation of the regression between flow and pressure difference without taking notice of the individual data that arise in the process and, thereon, the analysis of an presumed function instead of the interpretation of actual measurements. On the basis of digital computation technology a new generation of microprocessor rhinomanometers has been developed. Devices of similar construction are still popular today thanks to their user-friendliness.
在鼻测量学中引入计算机技术后，由于直接引进了其他科学领域的计算方法，导致出现了一些重大错误。最初的根本性错误是在计算流量和压差之间的回归时，没有考虑到过程中出现的各种数据，因此分析的是假定函数，而不是对实际测量结果的解释。在数字计算技术的基础上，新一代微处理器鼻压计应运而生。由于使用方便，类似结构的设备至今仍很受欢迎。
In the 1980s, computer technologies have also paved the way for the development of the first commercial software-based rhinomanometers, one of which was produced and released by the research group at HNO-Klinik Charité in Berlin (29). Initially named "Carima", this system was later renamed to "Rhinodat". For over five years, it had been widely used for rhinomanometric measurements in many clinics. Different companies took over this technology after 1990 and many of those systems are still in use.
20 世纪 80 年代，计算机技术也为开发首批基于软件的商业鼻毛测量仪铺平了道路，其中之一就是由柏林 HNO-Klinik Charité 研究小组生产并发布的（29）。该系统最初名为 "Carima"，后更名为 "Rhinodat"。五年多来，该系统在许多诊所广泛用于鼻测量。1990 年后，不同的公司接管了这项技术，其中许多系统仍在使用。
20 世纪 80 年代，计算机技术也为开发首批基于软件的商业鼻毛测量仪铺平了道路，其中之一就是由柏林 HNO-Klinik Charité 研究小组生产并发布的（29）。该系统最初名为 "Carima"，后更名为 "Rhinodat"。五年多来，该系统在许多诊所广泛用于鼻测量。1990 年后，不同的公司接管了这项技术，其中许多系统仍在使用。
Figure 6. Carima System (1989). The first PC-controlled rhinomanometer in the world, produced by Heyer, Bad Ems, Germany. Due to a still existing problem of sensor relocation sensitivity, the case is vertically mounted onto a stand.
图 6.Carima 系统（1989 年）。这是世界上第一台由电脑控制的鼻压计，由德国巴德埃姆斯的 Heyer 公司生产。由于仍存在传感器定位灵敏度的问题，该系统的外壳是垂直安装在支架上的。
图 6.Carima 系统（1989 年）。这是世界上第一台由电脑控制的鼻压计，由德国巴德埃姆斯的 Heyer 公司生产。由于仍存在传感器定位灵敏度的问题，该系统的外壳是垂直安装在支架上的。
Despite continuous improvements in the quality and operational speed of the measurement system, the careful review of the results constantly showed the presence of loops in rhinomanometric curves, an error previously attributed to the deficiencies of the equipment. After ensuring that technical errors were excluded, the loops could only reflect phenomena as characteristic for the nasal airflow physiology. A new basic mathematical and physical concept was needed. The practical conclusion of this concept, as described in Chapter 4, was "High-Resolution Rhinomanometry". In 2003, the "International Standardization Committee on the Objective Assessment of the Nasal Airway" (ISOANA) recommended to rename this term "4-Phase-Rhinomanometry" (30).
尽管测量系统的质量和运行速度不断提高，但在对结果进行仔细审查后发现，鼻气流测量曲线中不断出现回路，而这一误差之前被归咎于设备的缺陷。在确保排除技术误差后，循环只能反映鼻腔气流生理特征的现象。因此需要一个新的基本数学和物理概念。正如第 4 章所述，这一概念的实际结论就是 "高分辨率鼻测量法"。2003 年，"鼻气道客观评估国际标准委员会"（ISOANA）建议将这一术语更名为 "4 相鼻流测量法"（30）。
尽管测量系统的质量和运行速度不断提高，但在对结果进行仔细审查后发现，鼻气流测量曲线中不断出现回路，而这一误差之前被归咎于设备的缺陷。在确保排除技术误差后，循环只能反映鼻腔气流生理特征的现象。因此需要一个新的基本数学和物理概念。正如第 4 章所述，这一概念的实际结论就是 "高分辨率鼻测量法"。2003 年，"鼻气道客观评估国际标准委员会"（ISOANA）建议将这一术语更名为 "4 相鼻流测量法"（30）。
4. Averaging in computerised rhinomanometry the key to 4-Phase-Rhinomanometry
4.计算机鼻测量中的平均值是 4 相鼻测量的关键
4-1 Introduction 4-1 导言
The International Standardization Committee on Objective Assessment of the Nasal Airway (ISOANA) published recommendations of standards for rhinomanometry in
鼻气道客观评估国际标准化组织（ISOANA）在
鼻气道客观评估国际标准化组织（ISOANA）在
After the introduction of computerized rhinomanometry into clinical practice, two different phenomena became visible in determining the shape of the loops:
在临床实践中引入计算机鼻测量技术后，在确定鼻环形状时出现了两种不同的现象：
在临床实践中引入计算机鼻测量技术后，在确定鼻环形状时出现了两种不同的现象：
-
A remarkable number of curves did not pass the intersection of the
-axis and -axis.
许多曲线没有通过轴和 轴的交点。 -
The opening of the loops was frequently observed to be much wider in inspiration than in expiration.
经常观察到吸气时襻的开口比呼气时大很多。
The first observation is caused by the influence of the inertia of the air. The mathematical and physical interpretation will be described in detail in Chapter 5. The theoretical concept has been confirmed by many model experiments using an "artificial nose" and in recent times by Computational Fluid Dynamics (CFD). The second observation is based on the physiological behaviour of the nasal valve (see Chapter 7 for details). nomanometry
第一个观测结果是由空气惯性的影响引起的。第 5 章将详细介绍数学和物理解释。许多使用 "人工鼻 "进行的模型实验以及最近的计算流体动力学（CFD）都证实了这一理论概念。第二个观察结果基于鼻瓣膜的生理行为（详见第 7 章）。
第一个观测结果是由空气惯性的影响引起的。第 5 章将详细介绍数学和物理解释。许多使用 "人工鼻 "进行的模型实验以及最近的计算流体动力学（CFD）都证实了这一理论概念。第二个观察结果基于鼻瓣膜的生理行为（详见第 7 章）。
Figure 7. Averaging of rhinomanometric data by regression lines.
图 7.用回归线平均鼻压计数据。
图 7.用回归线平均鼻压计数据。
The differences between classic rhinomanometry and 4PR originate from the data acquisition process and the method of data averaging. Classic computerized rhinomanometers sequentially collect alternating values for flow and pressure and place the obtained data points in a xy-Cartesian system. Subsequently, a regression line is constructed representing the pressure-flow relationship, which starts at the origin of the axis (Figure 7).
传统鼻压计与 4PR 的区别在于数据采集过程和数据平均方法。传统的计算机鼻压计按顺序交替采集流量和压力值，并将获得的数据点置于 xy-Cartesian 系统中。随后，以轴的原点为起点，构建一条代表压力-流量关系的回归线（图 7）。
传统鼻压计与 4PR 的区别在于数据采集过程和数据平均方法。传统的计算机鼻压计按顺序交替采集流量和压力值，并将获得的数据点置于 xy-Cartesian 系统中。随后，以轴的原点为起点，构建一条代表压力-流量关系的回归线（图 7）。
Two important errors are generated by the above procedure that are not easily recognized by the user of these systems
上述程序会产生两个重要的错误，而这些系统的用户并不容易识别这些错误
上述程序会产生两个重要的错误，而这些系统的用户并不容易识别这些错误
-
The correlation coefficient as a parameter for the reliability of the regression line is not necessarily given in the printouts
作为回归线可靠性参数的相关系数不一定在打印输出中给出 -
The rhinomanometric curve meets always the intersection point of the
-axis and -axis
鼻测量曲线总是与轴和 轴的交点相交。
A better way of acquiring and averaging the data from different breaths is to separately and visually control the uptake of the flow and pressure data and then to construct a "representative breath" as a real-time procedure (Figure 8).
获取和平均不同呼吸数据的更好方法是分别目视控制流量和压力数据的吸收，然后构建 "代表性呼吸 "作为实时程序（图 8）。
获取和平均不同呼吸数据的更好方法是分别目视控制流量和压力数据的吸收，然后构建 "代表性呼吸 "作为实时程序（图 8）。
Breaths differ both in time and in the amplitude of pressure and flow recordings. The uptake process can be followed by both the patient and investigator on the screen. If the differences in length and amplitude between the single breaths are too high, the computer is instructed to discontinue the averaging procedure. The limits of such discrimination can be determined by software. After the recording process, the "representative breath" is constructed by interpolating data points up to
呼吸的时间以及压力和流量记录的振幅都不同。患者和研究人员都可以在屏幕上看到吸气过程。如果单次呼吸在时间和振幅上的差异过大，计算机会被指示停止平均程序。这种辨别的限度可通过软件确定。记录过程结束后，"代表性呼吸 "将通过内插数据点构建，直至
呼吸的时间以及压力和流量记录的振幅都不同。患者和研究人员都可以在屏幕上看到吸气过程。如果单次呼吸在时间和振幅上的差异过大，计算机会被指示停止平均程序。这种辨别的限度可通过软件确定。记录过程结束后，"代表性呼吸 "将通过内插数据点构建，直至
Figure 8. (A) Time-related averaging of rhinomanometric data.
图 8. (A) 鼻测量数据的时间平均值。
图 8. (A) 鼻测量数据的时间平均值。
Step 1: Breaths of different lengths (B1, B2, B3) are "stretched" to a standard length of 2000 data points by spline interpolation (B1',
步骤 1：通过样条插值将不同长度的呼吸（B1、B2、B3）"拉伸 "到 2000 个数据点的标准长度（B1'，
步骤 1：通过样条插值将不同长度的呼吸（B1、B2、B3）"拉伸 "到 2000 个数据点的标准长度（B1'，
Figure 8. (B) Time-related averaging of rhinomanometric data. Step 2: Averaging of the time-standardized breaths.
图 8. (B) 与时间相关的鼻测量数据平均化。步骤 2：对时间标准化的呼吸进行平均。
图 8. (B) 与时间相关的鼻测量数据平均化。步骤 2：对时间标准化的呼吸进行平均。
Figure 8. (C) Time-related averaging of rhinomanometric data.
图 8. (C) 与时间相关的鼻测量数据平均值。
图 8. (C) 与时间相关的鼻测量数据平均值。
Step 3: Transferring of the data for differential pressure and flow in a Cartesian System.
步骤 3：在直角坐标系中传输压差和流量数据。
步骤 3：在直角坐标系中传输压差和流量数据。
a unified length of 2000 points for pressure and flow and a following calculation of the arithmetic means. This time-related standardization preserves the full information of the course of pressure and flow. The pressure and flow curves are saved separately as files along with the patients identification data and
压力和流量的统一长度为 2000 点，然后计算算术平均值。这种与时间相关的标准化保留了压力和流量过程的全部信息。压力和流量曲线与患者身份识别数据和其他数据一起单独保存为文件。
压力和流量的统一长度为 2000 点，然后计算算术平均值。这种与时间相关的标准化保留了压力和流量过程的全部信息。压力和流量曲线与患者身份识别数据和其他数据一起单独保存为文件。
Figure 9. General shape of rhinomanometric graphs in four-phase rhinomanometry (right nasal cavity).
图 9.四相鼻腔测量法中鼻腔测量图的一般形状（右侧鼻腔）。
图 9.四相鼻腔测量法中鼻腔测量图的一般形状（右侧鼻腔）。
can be preserved for later numerical analysis of the pressureflow relationship as well as for statistical analysis.
可以保留下来，以便日后对压力流关系进行数值分析和统计分析。
可以保留下来，以便日后对压力流关系进行数值分析和统计分析。
By using this procedure and transferring the data in a Cartesian system, a double-loop instead of a simple line is generated, which means that the pressure-flow relationship in the increasing airflow is different from the decreasing airflow. The analysis of clinical material below shows the importance of this different behaviour.
通过使用该程序并在笛卡尔系统中传输数据，会产生一个双环而不是简单的线，这意味着气流增加时的压力-流量关系与气流减少时不同。下面的临床材料分析表明了这种不同行为的重要性。
通过使用该程序并在笛卡尔系统中传输数据，会产生一个双环而不是简单的线，这意味着气流增加时的压力-流量关系与气流减少时不同。下面的临床材料分析表明了这种不同行为的重要性。
After transferring these results in a Cartesian system, the shape of Figure 9 appears.
将这些结果转换到直角坐标系后，就出现了图 9 的形状。
将这些结果转换到直角坐标系后，就出现了图 9 的形状。
The four phases depicted in the graph are:
图中描述的四个阶段是
图中描述的四个阶段是
Phase 1: Ascending inspiratory phase. The airflow is accelerated up to the inspiratory peak flow. The airflow in this phase is an exponential function of the pressure. The accelerating flow causes Bernouilli effects, which may reduce the crosssectional area preferably at the nasal entrance by generating so-called "valve effects." Flow is instationary from the starting point of the breathing cycle up to the peak flow, but from the moment of the attained peak flow to the beginning of the decreasing phase, the airflow is stationary and almost turbulent. Under peak flow conditions the relationship between pressure and flow is linear: Depicting the relationship between the pressure-curve and the flow-curve in xt imaging shows parallel curves.
第 1 阶段：上升吸气阶段。气流加速至吸气峰值流量。该阶段的气流是压力的指数函数。加速的气流会产生伯努利效应，通过产生所谓的 "阀门效应"，缩小鼻腔入口处的横截面积。从呼吸周期的起点到峰值流量，气流都是静止的，但从达到峰值流量的时刻到下降阶段的开始，气流是静止的，几乎是湍流。在峰值流量条件下，压力与流量之间呈线性关系：在 xt 成像中，压力曲线和流量曲线之间的关系显示为平行曲线。
第 1 阶段：上升吸气阶段。气流加速至吸气峰值流量。该阶段的气流是压力的指数函数。加速的气流会产生伯努利效应，通过产生所谓的 "阀门效应"，缩小鼻腔入口处的横截面积。从呼吸周期的起点到峰值流量，气流都是静止的，但从达到峰值流量的时刻到下降阶段的开始，气流是静止的，几乎是湍流。在峰值流量条件下，压力与流量之间呈线性关系：在 xt 成像中，压力曲线和流量曲线之间的关系显示为平行曲线。
Phase 2: Descending inspiratory phase. The second phase is the phase from the highest inspiratory flow to the end of the inspiration. The pressure-flow relationship depends on the course of the pressure drop due to the exponential function between pressure and flow, the whirling of the airflow and the causative anatomical conditions, and on the mechanical properties of the elastic compartments determining the behaviour of the nasal entrance. When the pressure difference is zero (0), airflow may still occur if the kinetic energy of the streaming
第二阶段：下降吸气阶段。第二阶段是从最高吸气流量到吸气结束的阶段。压力-流量关系取决于压力和流量之间的指数函数所导致的压力下降过程、气流的旋涡和解剖条件，以及决定鼻腔入口行为的弹性区块的机械特性。当压差为零（0）时，如果气流的动能为 0，则气流仍会发生。
volume is sufficient. This is the case if the shape of the nasal channel approximates a tube instead of a diaphragm. At the same pressure level as in the first phase, the flow is lower than in the ascending phase. This important fact determines the subjective feeling of obstruction.
体积就足够了。如果鼻腔通道的形状近似于管道而不是隔膜，就会出现这种情况。在与第一阶段相同的压力水平下，流量低于上升阶段。这一重要事实决定了主观上的阻塞感。
第二阶段：下降吸气阶段。第二阶段是从最高吸气流量到吸气结束的阶段。压力-流量关系取决于压力和流量之间的指数函数所导致的压力下降过程、气流的旋涡和解剖条件，以及决定鼻腔入口行为的弹性区块的机械特性。当压差为零（0）时，如果气流的动能为 0，则气流仍会发生。
volume is sufficient. This is the case if the shape of the nasal channel approximates a tube instead of a diaphragm. At the same pressure level as in the first phase, the flow is lower than in the ascending phase. This important fact determines the subjective feeling of obstruction.
体积就足够了。如果鼻腔通道的形状近似于管道而不是隔膜，就会出现这种情况。在与第一阶段相同的压力水平下，流量低于上升阶段。这一重要事实决定了主观上的阻塞感。
Phase 3: Ascending expiratory phase. After the air flow changes its direction, the instationary airflow accelerates up to the peak expiratory flow. The relationship between pressure and flow is again exponential. The increasing expiratory airflow widens the flow channel to a small extent. During the short period of the expiratory peak flow, the pressure-flowrelation is again found to be linear. The variability of the pressure-flow relationship is higher than in Phase 4.
第 3 阶段：呼气上升阶段。气流改变方向后，吸入气流加速达到呼气峰值。压力和流量之间的关系再次呈指数关系。呼气气流的增加在很小程度上拓宽了气流通道。在呼气峰值流量的短时间内，压力-流量关系再次呈线性。压力-流量关系的变异性高于第 4 阶段。
第 3 阶段：呼气上升阶段。气流改变方向后，吸入气流加速达到呼气峰值。压力和流量之间的关系再次呈指数关系。呼气气流的增加在很小程度上拓宽了气流通道。在呼气峰值流量的短时间内，压力-流量关系再次呈线性。压力-流量关系的变异性高于第 4 阶段。
Phase 4: Descending expiratory phase. The last phase of the nasal breathing cycle is characterized by the return to resting conditions. Under physiological conditions it is followed by an expiratory break. This pause is not reproducible under the conditions of rhinomanometry.
第四阶段：呼气下降阶段。鼻呼吸周期最后一个阶段的特点是恢复到静息状态。在生理条件下，这之后是呼气暂停。在鼻测量仪的条件下，这一停顿无法重现。
第四阶段：呼气下降阶段。鼻呼吸周期最后一个阶段的特点是恢复到静息状态。在生理条件下，这之后是呼气暂停。在鼻测量仪的条件下，这一停顿无法重现。
The flow is higher than in the first expiratory phase when comparing the respective pressure levels.
比较各自的压力水平，流量要高于第一呼气阶段。
比较各自的压力水平，流量要高于第一呼气阶段。
Figure 10. Incorrect averaging and depicting of results in a graph leads to severe diagnostic errors in particular in elastic deformations of the nasal air channel
图 10.在图表中对结果进行不正确的平均和描述会导致严重的诊断错误，尤其是在鼻腔气道的弹性变形方面
图 10.在图表中对结果进行不正确的平均和描述会导致严重的诊断错误，尤其是在鼻腔气道的弹性变形方面
Phase 1 and Phase 4 are determined preferably by the anatomical structures of the nose. The parameters in Phase 2 and
第 1 和第 4 阶段最好由鼻子的解剖结构决定。第 2 和第 4 阶段的参数
Phase 3 depend to a great extent on the generated flow.
第 3 阶段在很大程度上取决于所产生的流量。
第 1 和第 4 阶段最好由鼻子的解剖结构决定。第 2 和第 4 阶段的参数
Phase 3 depend to a great extent on the generated flow.
第 3 阶段在很大程度上取决于所产生的流量。
During one nasal breathing cycle, the relationship changes between the causative narinochoanal pressure and the resulting flow. That is the reason why it is impossible to calculate or define a single pressure-flow relationship with one equation. Furthermore, the variability of the pressure-flow relationship is different within the four phases of nasal breathing.
在一个鼻呼吸周期中，引起鼻腔回声的压力和由此产生的流量之间的关系会发生变化。这就是为什么不可能用一个等式来计算或定义单一的压力-流量关系。此外，在鼻腔呼吸的四个阶段中，压力-流量关系的变化也各不相同。
在一个鼻呼吸周期中，引起鼻腔回声的压力和由此产生的流量之间的关系会发生变化。这就是为什么不可能用一个等式来计算或定义单一的压力-流量关系。此外，在鼻腔呼吸的四个阶段中，压力-流量关系的变化也各不相同。
4-3 The clinical impact of loops in rhinomanometry
4-3 环路对鼻测量的临床影响
Presently, users of rhinomanometry use the flow at different pressure levels as parameters of clinical importance. This is also the procedure recommended by the international standard of ISOANA. The flow at a differential pressure of
目前，鼻测量仪的使用者将不同压力水平下的流量作为临床重要参数。这也是 ISOANA 国际标准推荐的程序。
目前，鼻测量仪的使用者将不同压力水平下的流量作为临床重要参数。这也是 ISOANA 国际标准推荐的程序。
If the resolution of the breathing cycle in four phases is accepted as being correct and representing the fluid dynamics of the nasal airflow, the question arises as to whether the separate analysis of the ascending and descending phases of inspiration and expiration is really of clinical importance, or whether or not averaging of the flow values for the same pressure level of the ascending and descending curve parts can be accepted for clinical purposes.
如果认为将呼吸周期分为四个阶段是正确的，并代表了鼻腔气流的流体动力学，那么问题就来了，对吸气和呼气的上升和下降阶段进行单独分析是否真的具有临床意义，或者是否可以将上升和下降曲线部分同一压力水平的流量值平均用于临床目的。
如果认为将呼吸周期分为四个阶段是正确的，并代表了鼻腔气流的流体动力学，那么问题就来了，对吸气和呼气的上升和下降阶段进行单独分析是否真的具有临床意义，或者是否可以将上升和下降曲线部分同一压力水平的流量值平均用于临床目的。
To arrive at an answer to these questions, a statistical analysis of 1377 non-classified rhinomanometric measurements of patients who visited the author (KV) because of different rhinologic problems was conducted. The material consisted of measurements of all possible degrees of nasal obstruction. A bilateral active anterior rhinomanometry before and after decongestion with xylometazoline was carried out in any case observed. The differences between the flow values at clinically important pressure levels were calculated. The mean values are noted in Table 1.
为了回答这些问题，我们对作者（KV）因不同鼻病就诊的 1377 名患者的非分类鼻测量数据进行了统计分析。材料包括所有可能的鼻阻塞程度的测量值。在使用甲氧甲唑啉减充血前后，对观察到的任何病例都进行了双侧主动前鼻测量。计算了在临床重要压力水平下流量值之间的差异。平均值见表 1。
为了回答这些问题，我们对作者（KV）因不同鼻病就诊的 1377 名患者的非分类鼻测量数据进行了统计分析。材料包括所有可能的鼻阻塞程度的测量值。在使用甲氧甲唑啉减充血前后，对观察到的任何病例都进行了双侧主动前鼻测量。计算了在临床重要压力水平下流量值之间的差异。平均值见表 1。
Table 1. Mean values of flow in each of the 4 breathing phases at different pressure levels.
表 1.不同压力水平下 4 个呼吸阶段中每个阶段的流量平均值。
表 1.不同压力水平下 4 个呼吸阶段中每个阶段的流量平均值。
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-300 | -250 | -200 | -150 | -100 | -75 | -50 | 0 | 50 | 75 | 100 | 150 | 200 | 250 | 300 |
| Before decongestion 减员前 | |||||||||||||||
| Inspiration 1 灵感 1 | 119 | 165 | 201 | 256 | 297 | 323 | 344 | ||||||||
| Inspiration 2 灵感 2 | 99 | 136 | 169 | 224 | 268 | 298 | 323 | ||||||||
| Difference
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16.8 | 17.6 | 15.9 | 12.5 | 9.8 | 7.7 | 6.1 | ||||||||
| Expiration 1 有效期 1 | -330 | -305 | -273 | -228 | -169 | -133 | -68 | ||||||||
| Expiration 2 有效期 2 | -345 | -324 | -296 | -259 | -211 | -180 | -144 | ||||||||
| Difference
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4.3 | 5.9 | 7.8 | 12.0 | 19.9 | 26.1 | 52.8 | ||||||||
| After decongestion 解除充血后 | |||||||||||||||
| Inspiration 1 灵感 1 | - | 157 | 223 | 275 | 354 | 411 | 452 | 469 | |||||||
| Inspiration 2 灵感 2 | 136 | 190 | 239 | 319 | 381 | 425 | 446 | ||||||||
| Difference
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13.4 | 14.8 | 13.1 | 9.9 | 7.3 | 6.0 | 4.9 | ||||||||
| Expiration 1 有效期 1 | -455 | -434 | -392 | -327 | -238 | -185 | -102 | ||||||||
| Expiration 2 有效期 2 | -485 | -455 | -419 | -365 | -292 | -274 | -195 | ||||||||
| Difference
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6.2 | 4.6 | 6.4 | 10.4 | 18.5 | 32.5 | 47.7 | ||||||||
Table 2. Relationship between pressure level and the number of unacceptable rhinomanometric measurements obtained by averaging the ascending and descending curve parts.
表 2.压力水平与通过平均上升和下降曲线部分获得的不可接受的鼻测量次数之间的关系。
表 2.压力水平与通过平均上升和下降曲线部分获得的不可接受的鼻测量次数之间的关系。
| Before decongestion 减员前 | After decongestion 解除充血后 | |||
| Inspiration 灵感 | Expiration 到期 | Inspiration 灵感 | Expiration 到期 | |
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The values in Table 1 and 2 show that the greatest differences between the ascending and descending phases are found at low pressure levels and that they are smaller at higher pressures. When one considers only the mean values, it could lead to the wrong conclusion. For example, a statistical mean difference of
表 1 和表 2 中的数值表明，升压阶段和降压阶段的差异在低压水平时最大，而在高压水平时则较小。如果只考虑平均值，可能会得出错误的结论。例如，第一阶段和第二阶段在
表 1 和表 2 中的数值表明，升压阶段和降压阶段的差异在低压水平时最大，而在高压水平时则较小。如果只考虑平均值，可能会得出错误的结论。例如，第一阶段和第二阶段在
Figure 12. Relationship between pressure level and resistance values in
图 12.图 12 中压力水平与电阻值之间的关系
图 12.图 12 中压力水平与电阻值之间的关系
750 measurements in which a pressure level of
750 次测量，其中获得
Figure 11. Relationship between pressure level and the number of unacceptable rhinomanometric measurements obtained by averaging the ascending and descending curve parts.
图 11.压力水平与通过平均上升和下降曲线部分获得的不可接受的鼻测量次数之间的关系。
750 次测量，其中获得
Figure 11. Relationship between pressure level and the number of unacceptable rhinomanometric measurements obtained by averaging the ascending and descending curve parts.
图 11.压力水平与通过平均上升和下降曲线部分获得的不可接受的鼻测量次数之间的关系。
such measurements. Therefore, much more important is the information obtained by histograms showing the statistical distribution of the differences in the entire data set. The histogram in Figure 11 shows the distribution of flow differences between the ascending and descending inspiratory curve parts at a differential pressure level of
因此，显示整个数据集差异统计分布的直方图所获得的信息要重要得多。因此，通过直方图显示整个数据集中差异的统计分布所获得的信息要重要得多。图 11 中的直方图显示了在
Considering the pressure levels of clinical interest, the large number of measurements can be seen in which the averaging of the curve parts would produce unacceptable errors. It again becomes obvious that the greatest numbers of unacceptable results occur within the lower pressure levels.
考虑到临床关注的压力水平，可以看到大量的测量结果，其中曲线部分的平均值会产生不可接受的误差。同样明显的是，在较低的压力水平下，不可接受的结果数量最多。
考虑到临床关注的压力水平，可以看到大量的测量结果，其中曲线部分的平均值会产生不可接受的误差。同样明显的是，在较低的压力水平下，不可接受的结果数量最多。
Another disadvantage of the currently used pressure-related linear resistance is the fact that the linear resistances increase with the pressure level. It follows that a resistance given at 150
目前使用的与压力相关的线性电阻的另一个缺点是，线性电阻会随着压力水平的增加而增加。因此，如果在第二次比较测量中无法达到
The main conclusion of the dependency of the linear resistance on the pressure level concerns the Polar Coordinate Model by Broms
关于线性阻力与压力水平关系的主要结论涉及 Broms 的极坐标模型
目前使用的与压力相关的线性电阻的另一个缺点是，线性电阻会随着压力水平的增加而增加。因此，如果在第二次比较测量中无法达到
The main conclusion of the dependency of the linear resistance on the pressure level concerns the Polar Coordinate Model by Broms
关于线性阻力与压力水平关系的主要结论涉及 Broms 的极坐标模型
Summarizing the statistical data presented here, it must be concluded that neglecting the resolution of the human breath in four different phases leads to severe errors of clinical importance. The application of graphical methods for evaluating rhinomanometric curves in the modern computerized analysis of nasal breathing becomes obsolete. However, a physically and mathematically correct interpretation of the complete respiratory cycle leads to a remarkable increase in the diagnostic information, which can be derived.
综合本文提供的统计数据，必须得出这样的结论：忽视人体呼吸在四个不同阶段的分辨率会导致严重的临床误差。在现代鼻呼吸计算机分析中，应用图形方法评估鼻测量曲线已经过时。然而，从物理和数学角度正确解释完整的呼吸周期可显著增加诊断信息。
综合本文提供的统计数据，必须得出这样的结论：忽视人体呼吸在四个不同阶段的分辨率会导致严重的临床误差。在现代鼻呼吸计算机分析中，应用图形方法评估鼻测量曲线已经过时。然而，从物理和数学角度正确解释完整的呼吸周期可显著增加诊断信息。
5. The mathematical-physical concept of 4-phase-rhinomanometry
5.四相血压计的数学物理概念
5-1 Introduction 5-1 导言
After introducing the averaging procedure, described in chapter 4 , which resulted in the observation of loops as the common form of the rhinomanometrical xy-curve, it became evident that it was necessary to reconsider the existing physical and mathematical concepts of rhinomanometry and the underlying flow phenomena within the nose.
在引入第 4 章所述的平均程序后，观察到环形是鼻测量 xy 曲线的常见形式，显然有必要重新考虑鼻测量的现有物理和数学概念以及鼻内的基本流动现象。
在引入第 4 章所述的平均程序后，观察到环形是鼻测量 xy 曲线的常见形式，显然有必要重新考虑鼻测量的现有物理和数学概念以及鼻内的基本流动现象。
The diagnostic intention of rhinomanometry is to obtain an impartial measure of the energy expended or the work performed during breathing to generate the flow of air through the nose as it is conditioned for the lungs. Except for the region of the anatomic structures of the "nasal valve", nasal breathing is about alternating ventilation of air in both directions through an irregular cavity with a narrowing at both ends. Rhinomanometry ostensibly measures changes in the physical parameters transnasal pressure and transnasal flow during the ventilation of the entire nasal cavity. The fluid-dynamics interpretation of several parts of this cavity by comparing it with streamed cavities within the technology becomes interesting only if one attempts to interpret an at first sight unexpected rhinomanometrical result anatomically. Previous comparisons of the nose with flow-bodies and using technical terminology that does not consider the alternate breathing through the nose may be of limited practical value.
鼻息量测定法的诊断目的是公正地测量呼吸过程中所消耗的能量或所做的工作，以产生经鼻进入肺部的气流。除 "鼻瓣膜 "解剖结构区域外，鼻腔呼吸是通过一个两端狭窄的不规则腔体向两个方向交替通气。从表面上看，鼻测量仪测量的是整个鼻腔通气过程中跨鼻压力和跨鼻流量的物理参数变化。只有当我们试图从解剖学角度解释一个乍看之下出乎意料的鼻腔测量结果时，通过与技术中的流腔进行比较对该腔的几个部分进行流体动力学解释才会变得有趣。以往将鼻腔与流体进行比较，以及使用未考虑通过鼻腔交替呼吸的技术术语，其实用价值可能有限。
鼻息量测定法的诊断目的是公正地测量呼吸过程中所消耗的能量或所做的工作，以产生经鼻进入肺部的气流。除 "鼻瓣膜 "解剖结构区域外，鼻腔呼吸是通过一个两端狭窄的不规则腔体向两个方向交替通气。从表面上看，鼻测量仪测量的是整个鼻腔通气过程中跨鼻压力和跨鼻流量的物理参数变化。只有当我们试图从解剖学角度解释一个乍看之下出乎意料的鼻腔测量结果时，通过与技术中的流腔进行比较对该腔的几个部分进行流体动力学解释才会变得有趣。以往将鼻腔与流体进行比较，以及使用未考虑通过鼻腔交替呼吸的技术术语，其实用价值可能有限。
5-2 Fluid Physics 5-2 流体物理学
From the standpoint of fluid physics the definitions, that are a standard element of the foundation of fluid mechanics, have so far not found their way into the fluid physiology of the nose.
从流体物理学的角度来看，这些定义是流体力学基础的标准要素，但迄今为止，这些定义还没有进入鼻子的流体生理学。
从流体物理学的角度来看，这些定义是流体力学基础的标准要素，但迄今为止，这些定义还没有进入鼻子的流体生理学。
When one considers the fluid dynamics, one initially distinguishes between laminar and turbulent flow. The type of flow is characterised by the Reynolds number Re, which describes the relationship between inertial and frictional forces. For Reynolds numbers up to 2300 , there is normally laminar flow within a pipe. In laminar flow, there is minimal if any momentum change perpendicular to the main direction of flow. The flow is very steady and since the frictional forces are relatively high, any disturbances that occur due to obstacles encountered quickly die out. In laminar flow, the generation of detachments and eddies may also occur. If the velocity is measured at a point in the flow for an extended period, the quantity is nearly constant. The calculation of the flow rate,
在考虑流体动力学时，我们首先要区分层流和湍流。流动类型以雷诺数 Re 为特征，它描述了惯性力和摩擦力之间的关系。雷诺数不超过 2300 时，管道内通常为层流。在层流中，垂直于主要流动方向的动量变化极小。流动非常稳定，由于摩擦力相对较大，遇到障碍物时产生的任何扰动都会很快消失。在层流中，还可能产生支流和涡流。如果长时间在水流中的某一点测量流速，则流速几乎是恒定的。通过管道的流速
在考虑流体动力学时，我们首先要区分层流和湍流。流动类型以雷诺数 Re 为特征，它描述了惯性力和摩擦力之间的关系。雷诺数不超过 2300 时，管道内通常为层流。在层流中，垂直于主要流动方向的动量变化极小。流动非常稳定，由于摩擦力相对较大，遇到障碍物时产生的任何扰动都会很快消失。在层流中，还可能产生支流和涡流。如果长时间在水流中的某一点测量流速，则流速几乎是恒定的。通过管道的流速
For Reynolds numbers above 2300 in a pipe, there is normally turbulent flow and the Hagen-Poiseuille-Law loses its validity. When again measuring the velocity at a point in the flow, there are irregular, random velocity fluctuations, because the momentum develops strongly perpendicular to the main flow direction, even though the propulsive pressure force is constant. The pressure decrease no longer relates to flow in a linear fashion but rather with the flow squared:
当管道中的雷诺数超过 2300 时，通常会出现湍流，哈根-普瓦耶定律也就失去了作用。当再次测量流动中某一点的速度时，会出现不规则的随机速度波动，这是因为尽管推动压力保持不变，但动量的发展方向与主要流动方向高度垂直。压力下降不再与流量成线性关系，而是与流量的平方成线性关系：
当管道中的雷诺数超过 2300 时，通常会出现湍流，哈根-普瓦耶定律也就失去了作用。当再次测量流动中某一点的速度时，会出现不规则的随机速度波动，这是因为尽管推动压力保持不变，但动量的发展方向与主要流动方向高度垂直。压力下降不再与流量成线性关系，而是与流量的平方成线性关系：
The pressure decrease for turbulent flows in pipes is considerably higher than for laminar flows at the same velocity. The flow through the nose goes through an irregular cavity in which there can be detachments and eddies, etc., causing yet further pressure decreases compared to the flow in a pipe. Therefore, flow in the nose can only be simulated to a limited extent using the model of flow in a pipe. Special note should be made that unlike the flow in a pipe, the flow of air in the nose is unsteady. This means that the volume of flow per unit time (volume flow rate) and the pressure difference per unit time are also a function of time, t. Bernouilli's equation, often used for the calculation of steady flows, has to be expanded to include an unsteady element:
在相同速度下，管道中湍流的压力下降幅度远远高于层流。流经鼻腔的气流会通过一个不规则的空腔，其中可能会出现脱离和漩涡等现象，从而导致压力比管道中的气流进一步降低。因此，鼻腔内的流动只能在有限的范围内使用管道内的流动模型进行模拟。需要特别注意的是，与管道中的气流不同，鼻腔中的气流是不稳定的。这意味着单位时间内的流量（体积流量）和单位时间内的压力差也是时间 t 的函数：
在相同速度下，管道中湍流的压力下降幅度远远高于层流。流经鼻腔的气流会通过一个不规则的空腔，其中可能会出现脱离和漩涡等现象，从而导致压力比管道中的气流进一步降低。因此，鼻腔内的流动只能在有限的范围内使用管道内的流动模型进行模拟。需要特别注意的是，与管道中的气流不同，鼻腔中的气流是不稳定的。这意味着单位时间内的流量（体积流量）和单位时间内的压力差也是时间 t 的函数：
The contribution of the unsteady element depends on the amount of acceleration or deceleration over
非稳态元素的贡献取决于
非稳态元素的贡献取决于
The measurement of the flow volume rate in incompressible and steady flows is based on the principles of Bernouilli's equation for stationary flows:
不可压缩稳定流的流速测量是基于静止流的伯努利方程原理：
不可压缩稳定流的流速测量是基于静止流的伯努利方程原理：
For unsteady flows the relation according to the above mentioned is:
对于非稳定流，上述关系式为
对于非稳定流，上述关系式为
At steady flows, the amount of differential pressure
在稳定流中，压差
在稳定流中，压差
-
the acceleration or deceleration
whose variation depends strongly on the nasal flow
加速度或减速度，其变化在很大程度上取决于鼻流 -
and the length,
, of the pipe, connected upstream of the measuring system, so that an emerging trend in the flow profile may be revealed.
以及连接到测量系统上游的管道长度，从而揭示流量曲线的新趋势。
The measuring systems and analysis algorithms that have been used commonly up to the present are only appropriate for steady flows. There are no known easy measuring systems for unsteady flows. Therefore, one must initially rely on the common measuring systems when measuring the unsteady flows. However, for an exact and correct measurement, the analysis algorithm has to be modified, e.g. using a method that incorporates a correction of the results obtained from the steady state analysis. The correction factor must depend on the current acceleration or deceleration and the length
目前常用的测量系统和分析算法只适用于稳定流。目前还没有已知的适用于非稳态流的简易测量系统。因此，在测量非稳态流时，人们最初必须依靠常用的测量系统。然而，为了获得精确和正确的测量结果，必须对分析算法进行修改，例如采用一种对稳态分析结果进行修正的方法。修正系数必须取决于当前的加速度或减速度以及测量系统的长度
目前常用的测量系统和分析算法只适用于稳定流。目前还没有已知的适用于非稳态流的简易测量系统。因此，在测量非稳态流时，人们最初必须依靠常用的测量系统。然而，为了获得精确和正确的测量结果，必须对分析算法进行修改，例如采用一种对稳态分析结果进行修正的方法。修正系数必须取决于当前的加速度或减速度以及测量系统的长度
The differences between steady and unsteady flow have not yet attracted any attention in rhinology, but for those experienced in fluid mechanics they are eminently important. A mathematical model, integrating the unsteady flow rate, was first described by Hoffrichter
稳定流与非稳定性流之间的差异尚未引起鼻科学界的注意，但对于那些有流体力学经验的人来说，它们是非常重要的。1993 年，霍夫里希特
稳定流与非稳定性流之间的差异尚未引起鼻科学界的注意，但对于那些有流体力学经验的人来说，它们是非常重要的。1993 年，霍夫里希特
Figure 13. Breathing curve in xt-chart.
图 13.xt-图表中的呼吸曲线。
图 13.xt-图表中的呼吸曲线。
The plot of the changes in pressure and flow through the nose against time (Figure 13) - in the course of breathing in and out - shows that after a rapid increase in pressure and flow, a plateau typically occurs. The initial sharp increase-section and the transition from breathing in to breathing out are the sections of steepest acceleration, and thus are the sections with the highest frequency content. Because of the steeper temporal gradient, these sections have the highest risks of introducing errors in measurement of the flow. This questions the applicability of the current choice of measuring points in the standardised system of ISOANA. When examining these curves, which are made up of corresponding pressure and flow points for each time unit, it becomes evident that the rate of change of the pressure and the rate of change of the corresponding flow points are different particularly in the increasing and decreasing phase of the curve. Therefore, when these pressure and flow changes are plotted against each other in an xy-diagram, the result is not a simple line, but rather a loop. The
在吸气和呼气过程中，通过鼻腔的压力和流量随时间的变化曲线图（图 13）显示，在压力和流量快速增加之后，通常会出现一个高原。最初的急剧增加段和从吸气到呼气的过渡段是加速度最陡峭的段落，因此也是频率含量最高的段落。由于时间梯度较陡，这些部分在测量流量时引入误差的风险最高。这就对目前 ISOANA 标准化系统中选择测量点的适用性提出了质疑。这些曲线由每个时间单位的相应压力点和流量点组成，在研究这些曲线时，可以明显看出，压力的变化率和相应流量点的变化率是不同的，尤其是在曲线的上升和下降阶段。因此，当这些压力和流量的变化在 xy 图中相互映衬时，结果就不是一条简单的直线，而是一个循环。
在吸气和呼气过程中，通过鼻腔的压力和流量随时间的变化曲线图（图 13）显示，在压力和流量快速增加之后，通常会出现一个高原。最初的急剧增加段和从吸气到呼气的过渡段是加速度最陡峭的段落，因此也是频率含量最高的段落。由于时间梯度较陡，这些部分在测量流量时引入误差的风险最高。这就对目前 ISOANA 标准化系统中选择测量点的适用性提出了质疑。这些曲线由每个时间单位的相应压力点和流量点组成，在研究这些曲线时，可以明显看出，压力的变化率和相应流量点的变化率是不同的，尤其是在曲线的上升和下降阶段。因此，当这些压力和流量的变化在 xy 图中相互映衬时，结果就不是一条简单的直线，而是一个循环。
5-3 Under appropriate measuring conditions, the hysteresis curves represent a part of the flow physiology of the nose
5-3 在适当的测量条件下，滞后曲线代表了鼻腔的部分流动生理特征
The previously described method of averaging, introduced to rhinomanometry by Vogt and Wernecke
Vogt 和 Wernecke
Vogt 和 Wernecke
When previous devices were used for rhinomanometry and loops were seen, various causes for the loop generation were proposed:
在使用以前的设备进行鼻畸形测量时，如果发现有环路，就会提出产生环路的各种原因：
在使用以前的设备进行鼻畸形测量时，如果发现有环路，就会提出产生环路的各种原因：
-
Different dynamic behaviour of the pressure transducer used for flow compared with the pressure transducer used to measure differential pressure.
用于测量流量的压力传感器与用于测量压差的压力传感器的动态特性不同。 -
Different dynamic behaviour of the actuator for the x-axis compared to the actuator for the
-axis on the -recorder (before computer printouts).
与记录仪上 轴的执行机构相比， 记录仪上 轴的执行机构的动态表现不同（在电脑打印之前）。 -
Inadequate seal of the mask.
面罩密封不严。 -
Inappropriate dimensions of the connecting tubes between mask and flow detector or pressure transducer.
掩膜与流量检测器或压力传感器之间的连接管尺寸不当。 -
Contaminated tubing connecting the parts of the system.
连接系统各部分的管道受到污染。
Today, dynamic high-quality pressure transducers and nearly inertia less recording technology in the form of computer screens are available. But the loops in the rhinomanometrical curves still exist. Some veteran rhinomanometer users felt that
如今，已经有了高质量的动态压力传感器和几乎没有惯性的计算机屏幕记录技术。但鼻压计曲线中的回路依然存在。一些经验丰富的鼻压计使用者认为
the appearance of loops meant an artefact that might be related to inferior performance by the equipment. Most equipment manufacturers have used the microprocessor technology of their product to generate an averaged function curve from the loop, which passes through the zero origin of the xy-plot. This overlooked the possibility that the loop generation reflected a physiologic phenomenon and might contain diagnostic information. It can be shown that some rhinomanometers, which display an averaged curve instead of a loop or which always display the pressure-flow curve passing through the origin, have done some manipulation of the true measured pressure and flow data and thus are not accurately displaying the changes in flow.
环路的出现意味着一种假象，可能与设备性能较差有关。大多数设备制造商利用其产品的微处理器技术从循环中生成一条平均函数曲线，该曲线穿过 xy 图的零原点。这就忽略了环路生成反映生理现象并可能包含诊断信息的可能性。事实证明，有些鼻流量计显示的是平均曲线而不是环路，或者始终显示的是通过原点的压力-流量曲线，这些鼻流量计对真实测量的压力和流量数据做了一些处理，因此不能准确显示流量的变化。
如今，已经有了高质量的动态压力传感器和几乎没有惯性的计算机屏幕记录技术。但鼻压计曲线中的回路依然存在。一些经验丰富的鼻压计使用者认为
the appearance of loops meant an artefact that might be related to inferior performance by the equipment. Most equipment manufacturers have used the microprocessor technology of their product to generate an averaged function curve from the loop, which passes through the zero origin of the xy-plot. This overlooked the possibility that the loop generation reflected a physiologic phenomenon and might contain diagnostic information. It can be shown that some rhinomanometers, which display an averaged curve instead of a loop or which always display the pressure-flow curve passing through the origin, have done some manipulation of the true measured pressure and flow data and thus are not accurately displaying the changes in flow.
环路的出现意味着一种假象，可能与设备性能较差有关。大多数设备制造商利用其产品的微处理器技术从循环中生成一条平均函数曲线，该曲线穿过 xy 图的零原点。这就忽略了环路生成反映生理现象并可能包含诊断信息的可能性。事实证明，有些鼻流量计显示的是平均曲线而不是环路，或者始终显示的是通过原点的压力-流量曲线，这些鼻流量计对真实测量的压力和流量数据做了一些处理，因此不能准确显示流量的变化。
The many proposed models for fitting the data in the pressureflow curve have been summarized by Pallanch
Pallanch
Pallanch
5-4 Recalculation of the relationship of transnasal pressure and flow during nasal breathing
5-4 重新计算鼻呼吸时跨鼻压力和流量的关系
These equations will be presented for breathing through an even pipe with length 1 and cross section A. There initially is non-moving air with a very low mass
这些方程将用于通过长度为 1、横截面为 A 的偶数管道进行呼吸。管道中最初存在质量很小的非流动空气
这些方程将用于通过长度为 1、横截面为 A 的偶数管道进行呼吸。管道中最初存在质量很小的非流动空气
First, this pressure force pushes on the air in the entire pipe cross section and the air inside is accelerated. The first period of acceleration is
首先，该压力力推动整个管道横截面内的空气，管道内的空气被加速。第一个加速期为
首先，该压力力推动整个管道横截面内的空气，管道内的空气被加速。第一个加速期为
Accordant to the principle of linear momentum of mechanics this equation applies:
根据力学的线性动量原理，这个等式是适用的：
根据力学的线性动量原理，这个等式是适用的：
Applying this equation to our example, when the pressure force
将该方程应用到我们的例子中，当压力
将该方程应用到我们的例子中，当压力
While the air is now accelerating through the pipe, new air rushes in and accelerates to the speed v1. But the momentum necessary for this part of the process is just
但这部分过程所需的动量仅为
但这部分过程所需的动量仅为
This initial step in the depiction of the flow is represented by the equation:
这个描绘水流的初始步骤用等式表示：
这个描绘水流的初始步骤用等式表示：
The air mass
现在，气团
现在，气团
And if one puts
如果把
如果把
Now imagine the time course of the breath, being divided into an infinite sequence of momenta. The number of time slices,
现在想象一下，呼吸的时间过程被划分为一个无限的时刻序列。时间片的数量
现在想象一下，呼吸的时间过程被划分为一个无限的时刻序列。时间片的数量
Now imagine that the initial momentum of air has passed out of the pipe and only the momentum
现在想象一下，空气的初始动量已从管道中流出，只有动量
现在想象一下，空气的初始动量已从管道中流出，只有动量
After addition of all of these equations one gets:
将所有这些等式相加，就得到了
将所有这些等式相加，就得到了
If
如果设置
如果设置
with 与
This differential equation may be rewritten with
这个微分方程可以改写为
这个微分方程可以改写为
and
to
The graphical representation of this relationship is shown in Figure 14. A sinusoidal flow course with an amplitude of 15
这种关系的图示如图 14 所示。在长度为
这种关系的图示如图 14 所示。在长度为
Figure 14. Flow, Pressure and Energy curve through a pipe (the scale for the Energy curve is strongly magnified).
图 14.通过管道的流量、压力和能量曲线（能量曲线的刻度被大幅放大）。
图 14.通过管道的流量、压力和能量曲线（能量曲线的刻度被大幅放大）。
The graphical representation of the same flow course through a pipe with steady state flow is shown in Figure 15. In this case, the unsteady part in equation (5) has been set to zero so that a steady flow results. Mathematically it can be said that the pipe length 1 tends to zero. It is clearly recognizable that now the phase shift is zero.
图 15 显示了流经管道的相同稳态流动过程。在这种情况下，方程 (5) 中的非稳态部分被设为零，从而形成稳态流。数学上可以说，管道长度 1 趋于零。可以清楚地看到，现在相移为零。
图 15 显示了流经管道的相同稳态流动过程。在这种情况下，方程 (5) 中的非稳态部分被设为零，从而形成稳态流。数学上可以说，管道长度 1 趋于零。可以清楚地看到，现在相移为零。
Figure 15. Flow- and Pressure curve through a pipe with steady flow.
图 15稳定流通过管道时的流量和压力曲线。
图 15稳定流通过管道时的流量和压力曲线。
If the pressure and flow from the time plots in Figure 14 are plotted against each other in an xy-plot, one gets Figure 16. In a similar manner, Figure 17 is obtained from the pressure and flow data in Figure 15. The graphs are numerical solutions of the differential equation (5).
如果将图 14 中时间图中的压力和流量相对应地绘制成 xy 图，就会得到图 16。同样，根据图 15 中的压力和流量数据也可以得到图 17。这些图都是微分方程 (5) 的数值解。
如果将图 14 中时间图中的压力和流量相对应地绘制成 xy 图，就会得到图 16。同样，根据图 15 中的压力和流量数据也可以得到图 17。这些图都是微分方程 (5) 的数值解。
Figure 16. xy-chart of Flow and Pressure curve through a pipe of
图 16. 通过长度为
图 16. 通过长度为
Figure 17. xy-chart of Flow and Pressure curve through a pipe of
图 17. 通过长度为
图 17. 通过长度为
Since breathing through the nose cannot be modeled with a pipe of "length zero" but rather needs a pipe of a certain length and specific, but different, resistances for inspiration and expiration, phase shifts between pressure and volume flow rate are to be expected in a real nasal airway.
由于通过鼻腔呼吸不能用 "长度为零 "的管道来模拟，而是需要一定长度的管道以及特定但不同的吸气和呼气阻力，因此在真实的鼻腔气道中，压力和体积流量之间的相位变化是意料之中的。
由于通过鼻腔呼吸不能用 "长度为零 "的管道来模拟，而是需要一定长度的管道以及特定但不同的吸气和呼气阻力，因此在真实的鼻腔气道中，压力和体积流量之间的相位变化是意料之中的。
The above differential equation (6) is of the so-called Riccatical type. Therefore, solutions may only be obtained by performing a numerical simulation. The effects are interesting. Equation (5) says that the flow in the nose not only depends on the current transnasal pressure but also on its "previous history", the preceding transnasal pressures. There is a phase shift, dependent on the volume of the nose channel, between the pressure signal and the flow signal, in which the flow consistently lags behind the pressure signal. Loops do appear in the xy-plots because of this phase shift. The term
上述微分方程 (6) 属于所谓的 Riccatical 类型。因此，只有通过数值模拟才能求解。其效果非常有趣。方程（5）表明，鼻腔中的气流不仅取决于当前的跨鼻压力，还取决于其 "前史"，即之前的跨鼻压力。压力信号和流量信号之间存在相位偏移，这取决于鼻通道的容积，其中流量始终落后于压力信号。由于这种相位偏移，在 xy 图中确实出现了环路。
上述微分方程 (6) 属于所谓的 Riccatical 类型。因此，只有通过数值模拟才能求解。其效果非常有趣。方程（5）表明，鼻腔中的气流不仅取决于当前的跨鼻压力，还取决于其 "前史"，即之前的跨鼻压力。压力信号和流量信号之间存在相位偏移，这取决于鼻通道的容积，其中流量始终落后于压力信号。由于这种相位偏移，在 xy 图中确实出现了环路。
C. Hirsch, during the consensus conference in Brussels 2003
C.赫希在 2003 年布鲁塞尔
C.赫希在 2003 年布鲁塞尔
with the respiratory pulsation
与呼吸脉动
与呼吸脉动
With a respiratory frequency of
当呼吸频率为
当呼吸频率为
The combined effects of flow resistance (viscosity), inertia and elasticity can be expressed by an electrical analogy, through an impedance
流动阻力（粘度）、惯性和弹性的综合效应可以通过电学类比，即阻抗
流动阻力（粘度）、惯性和弹性的综合效应可以通过电学类比，即阻抗
where
其中
其中
The contribution of the inertia is expressed through the inductance
惯性的贡献由电感
惯性的贡献由电感
and
和
和
It is important, that this impedance has also to be applied to the elastic compartments of the measuring system, which has been already discussed in the chapters above.
重要的是，这一阻抗也必须应用于测量系统的弹性区域，这一点已在上述章节中讨论过。
重要的是，这一阻抗也必须应用于测量系统的弹性区域，这一点已在上述章节中讨论过。
In 2002, A. Grzanka (personal communication) did confirm the presence of the loops at the ISANA meeting in the occasion of the conference of the European Rhinological Society in Ulm, Germany.
2002 年，A. Grzanka（个人通信）证实，在德国乌尔姆举行的欧洲鼻科学会会议期间，该环路参加了 ISANA 会议。
2002 年，A. Grzanka（个人通信）证实，在德国乌尔姆举行的欧洲鼻科学会会议期间，该环路参加了 ISANA 会议。
5-5 Graphical representation of pressure-flow relationship during alternating breathing
5-5 交替呼吸时的压力-流量关系图示
From these theoretical considerations as well as the results of experiments on models, it is apparent that phase shifts and loop generations are always to be expected in the rhinomanometrical result if, because of the need to create sufficient gradients to overcome an airway obstruction, a large volume of air has to be accelerated or decelerated in a short period. This is naturally the case at the transition from inspiration to expiration and vice-versa. It can also occur with fitful respiratory movements that anxious patients sometimes perform during testing with rhinomanometry. Also, a narrowing of the nasal airway e.g. caused by an anatomic convexity, can significantly increase the unsteady term in equation (5), resulting in increased loop generation.
从这些理论考虑和模型实验结果中可以明显看出，如果由于需要产生足够的梯度来克服气道阻塞，大量空气必须在短时间内加速或减速，那么鼻毛测量结果中就会出现相位偏移和环路产生。从吸气到呼气的转换过程中自然会出现这种情况，反之亦然。焦虑的患者在鼻测量仪测试过程中有时会做一些不规则的呼吸运动，也会出现这种情况。此外，鼻腔气道的狭窄（如解剖凸度造成的狭窄）也会显著增加公式 (5) 中的不稳定项，从而增加环路的产生。
从这些理论考虑和模型实验结果中可以明显看出，如果由于需要产生足够的梯度来克服气道阻塞，大量空气必须在短时间内加速或减速，那么鼻毛测量结果中就会出现相位偏移和环路产生。从吸气到呼气的转换过程中自然会出现这种情况，反之亦然。焦虑的患者在鼻测量仪测试过程中有时会做一些不规则的呼吸运动，也会出现这种情况。此外，鼻腔气道的狭窄（如解剖凸度造成的狭窄）也会显著增加公式 (5) 中的不稳定项，从而增加环路的产生。
The time sequence of the transition from one respiratory phase to the other will be presented again graphically. Figure 18 shows the time sequence of the flow in the pipe after entry of air from a much bigger reservoir. For the nose, this is equivalent to either the airspace around the external nose or the nasopharynx. At the time T0, there exists a flow caused by the lower pressure in the nasopharynx. If the pressure difference is zero at time
从一个呼吸阶段过渡到另一个呼吸阶段的时间顺序将再次用图表表示。图 18 显示了空气从一个更大的储气罐进入管道后的流动时序。对于鼻子来说，这相当于外鼻周围的空气空间或鼻咽部。在 T0 时，由于鼻咽部的压力较低，因此存在一个气流。如果在
从一个呼吸阶段过渡到另一个呼吸阶段的时间顺序将再次用图表表示。图 18 显示了空气从一个更大的储气罐进入管道后的流动时序。对于鼻子来说，这相当于外鼻周围的空气空间或鼻咽部。在 T0 时，由于鼻咽部的压力较低，因此存在一个气流。如果在
Figure 18. Fluid characteristics in a pipe at reversal of pressure direction.
图 18.压力方向逆转时管道内的流体特征。
图 18.压力方向逆转时管道内的流体特征。
What happens - with reduced viscosity and speed - is similar to the wake of a ship, still moving for a long time in a semicircular path opposite to the running direction of the ship, even when the ship is far away. In addition, the inertia of the moving air in breathing keeps it moving away from the nose after exhalation keeping us from choking on or re-breathing our own air
在粘度和速度降低的情况下，会发生类似于轮船尾流的情况，即使轮船已经远离，尾流仍然会以与轮船运行方向相反的半圆形轨迹运动很长时间。此外，呼吸时流动空气的惯性使其在呼气后远离鼻腔，使我们不会被自己的空气呛到或再次呼吸。
在粘度和速度降低的情况下，会发生类似于轮船尾流的情况，即使轮船已经远离，尾流仍然会以与轮船运行方向相反的半圆形轨迹运动很长时间。此外，呼吸时流动空气的惯性使其在呼气后远离鼻腔，使我们不会被自己的空气呛到或再次呼吸。
The described theoretical considerations may be summarized as follows:
所述理论考虑可归纳如下：
所述理论考虑可归纳如下：
The generation of loops in the display of the curve data from rhinomanometry measurements is more easily seen with 4phases- rhinomanometry than with previous rhinomanometers. The loops are due to the shape of the nasal air channel that is being measured and the alternating acceleration and deceleration of the nasal airflow.
与以前的鼻毛测量仪相比，4 相鼻毛测量仪在显示鼻毛测量的曲线数据时更容易看到循环。产生循环的原因是被测鼻腔气道的形状以及鼻腔气流的交替加速和减速。
与以前的鼻毛测量仪相比，4 相鼻毛测量仪在显示鼻毛测量的曲线数据时更容易看到循环。产生循环的原因是被测鼻腔气道的形状以及鼻腔气流的交替加速和减速。
5-6 Description of the model demonstrating the dependence of the rhinomanometric curve shape on the anatomical configuration of the flow channel
5-6 模型说明：鼻测量曲线的形状取决于流道的解剖结构
5-6 模型说明：鼻测量曲线的形状取决于流道的解剖结构
We have observed, when considering the effect of anatomical form on the nasal airway during experiments with models and in the course of our clinical examinations done with 2 different 4PR-rhinomanometers over the period of more than 10 years, that one may discern 3 different anatomical types and corresponding curve shapes, of which the two first merge fluently, but the third warrants special consideration. These types have been classified by Vogt and Hoffrichter
10 多年来，我们在使用模型进行实验以及使用 2 种不同的 4PR 鼻压计进行临床检查的过程中，考虑到解剖形态对鼻腔气道的影响，我们发现有 3 种不同的解剖类型和相应的曲线形状，其中前两种可以流畅地融合，但第三种需要特别考虑。Vogt 和 Hoffrichter 将这些类型分为以下几种
10 多年来，我们在使用模型进行实验以及使用 2 种不同的 4PR 鼻压计进行临床检查的过程中，考虑到解剖形态对鼻腔气道的影响，我们发现有 3 种不同的解剖类型和相应的曲线形状，其中前两种可以流畅地融合，但第三种需要特别考虑。Vogt 和 Hoffrichter 将这些类型分为以下几种
Figure 19. Clinical classification of the results of 4-PhaseRhinomanometry after Vogt and Hoffrichter
图 19.Vogt 和 Hoffrichter
图 19.Vogt 和 Hoffrichter
Type A - the diaphragm type
A 型--隔膜式
In a decongested state, the nose presents the lowest resistance to the air; i.e. the airflow from the lungs or the surroundings arrives without any major pressure losses and has a certain speed. The narrowing of the flow passage at the nasal entrance - whether from the inspiratory or expiratory direction - causes an acceleration of the airflow as it passes into the enlarged space of the next part of the airway. The unsteady component of respiration has its principle effect in the area of narrowing. Due to the short length 1 of this narrowness, the unsteady term in equation 6 becomes quite minimal. Consequently, only a slight phase shift between pressure and flow is expected: the curves are closed and virtually go through zero.
在鼻腔不充血的状态下，鼻腔对空气的阻力最小；也就是说，气流从肺部或周围到达鼻腔时不会有任何重大的压力损失，并具有一定的速度。无论是从吸气还是呼气方向，鼻腔入口处的气流通道变窄都会导致气流加速进入气道下一部分的扩大空间。呼吸的不稳定成分主要作用于狭窄区域。由于狭窄区域的长度 1 很短，等式 6 中的不稳定项变得非常小。因此，预计压力和流量之间只有轻微的相位变化：曲线是闭合的，几乎归零。
在鼻腔不充血的状态下，鼻腔对空气的阻力最小；也就是说，气流从肺部或周围到达鼻腔时不会有任何重大的压力损失，并具有一定的速度。无论是从吸气还是呼气方向，鼻腔入口处的气流通道变窄都会导致气流加速进入气道下一部分的扩大空间。呼吸的不稳定成分主要作用于狭窄区域。由于狭窄区域的长度 1 很短，等式 6 中的不稳定项变得非常小。因此，预计压力和流量之间只有轻微的相位变化：曲线是闭合的，几乎归零。
Type B - the pipe type
B 型 - 管道类型
If the nose is swollen, there generates a pipe-like cavity with several parallel connected cavities in the remaining cavity generally at the lower und middle nasal passage. The air in these pipes is accelerated considerably stronger than at type A, since the flow diameter available is reduced. Therefore, the unsteady term in equation 5 is considerably higher than at type A, so that measurable phase shifts are generated. If the energy supply stops, the accelerated air mass flows on for a short period until its energy is used up by friction. The nose acts as an air pump for a while (Figure 18). A time delay emerges between difference pressure and volume flow rate. This implies a phase shift. As a consequence, the curves are not allowed to go through zero at this point. Due to the pipe system, i. e. at a mucomembraneous-induced mostly blocked nose, the resistance is considerably higher, so that the generating loops, and especially at a very flat curve shape with high resistance values are sparsely bended.
如果鼻腔肿胀，一般在下鼻道和中鼻道的剩余空腔中会产生一个管状空腔，空腔内有几个平行相连的空腔。与 A 型相比，这些管道中的空气加速度要大得多，因为可用的气流直径减小了。因此，等式 5 中的不稳定项比 A 型要高得多，从而产生了可测量的相移。如果能量供应停止，加速的气团会在短时间内继续流动，直到其能量被摩擦耗尽。鼻子会暂时充当气泵（图 18）。差压和体积流量之间出现时间延迟。这意味着相移。因此，在这一点上，曲线不允许通过零点。由于管道系统的原因，即在粘膜引起的大部分堵塞的鼻孔处，阻力要大得多，因此产生的环路，特别是在阻力值较高的非常平坦的曲线形状处，弯曲稀疏。
如果鼻腔肿胀，一般在下鼻道和中鼻道的剩余空腔中会产生一个管状空腔，空腔内有几个平行相连的空腔。与 A 型相比，这些管道中的空气加速度要大得多，因为可用的气流直径减小了。因此，等式 5 中的不稳定项比 A 型要高得多，从而产生了可测量的相移。如果能量供应停止，加速的气团会在短时间内继续流动，直到其能量被摩擦耗尽。鼻子会暂时充当气泵（图 18）。差压和体积流量之间出现时间延迟。这意味着相移。因此，在这一点上，曲线不允许通过零点。由于管道系统的原因，即在粘膜引起的大部分堵塞的鼻孔处，阻力要大得多，因此产生的环路，特别是在阻力值较高的非常平坦的曲线形状处，弯曲稀疏。
Type C - the elastic type
C 型--弹性型
On the supposition that the classical rhinomanometers do measure qualitatively correct, which should be assumed for most offered rhinomanometers, it should be expected that under the condition of an inflexible nose the displays of the curves in expiration and inspiration are approximately rotationally symmetric. This is not necessarily always the case, because each the increasing and decreasing sides of expiration and inspiration are not congruent. The reason is that the nose is subject to elastically effects, especially at inspiration, which can easily be observed when looking in the nose from below during a powerful inspiration. During inspiration the wing of the nose is contracted and when the flow reduces, the nose opens again still during inspiration, because the aspirated wing of the nose returns to its resting position. Similar mechanisms do occur in a considerably smaller extent in the sector of the turbinates or if there are other mobile structures like polyps in the nose.
假定传统鼻压计的测量结果在质量上是正确的（大多数提供的鼻压计都是如此），那么在鼻子不灵活的条件下，呼气和吸气时的曲线显示应该是近似旋转对称的。但情况并不一定总是如此，因为呼气和吸气时的增大侧和减小侧并不完全一致。原因是鼻子会受到弹性的影响，尤其是在吸气时。在吸气时，鼻翼收缩，当气流减少时，鼻翼会再次张开，因为吸入的鼻翼会回到静止位置。在鼻甲部位或鼻腔内有息肉等其他活动结构时，类似的机制也会发生，但发生的程度要小得多。
假定传统鼻压计的测量结果在质量上是正确的（大多数提供的鼻压计都是如此），那么在鼻子不灵活的条件下，呼气和吸气时的曲线显示应该是近似旋转对称的。但情况并不一定总是如此，因为呼气和吸气时的增大侧和减小侧并不完全一致。原因是鼻子会受到弹性的影响，尤其是在吸气时。在吸气时，鼻翼收缩，当气流减少时，鼻翼会再次张开，因为吸入的鼻翼会回到静止位置。在鼻甲部位或鼻腔内有息肉等其他活动结构时，类似的机制也会发生，但发生的程度要小得多。
For the analysis, there now is the problem that the air stream to measure changes its diameter under the influence of the generated flow.
在分析过程中，需要测量的气流会在产生的气流影响下改变直径。
在分析过程中，需要测量的气流会在产生的气流影响下改变直径。
The result is a curve type corresponding to a club whose "hand grip" lies in the expiratory quadrants. This commonly observed result, mainly occurring at modest obstructions of the nose, thus in the clinical most important area of therapy determining diagnostics, has been the reason for numerous errors or misinterpretations up to most recent times. Its definition requires the certain exclusion of cut-off frequency determined construction poverty at the rhinomanometer. But in our judgement the
其结果是曲线类型与 "手柄 "位于呼气象限的球杆相对应。这种常见的结果主要发生在鼻腔有轻微阻塞的情况下，因此在临床最重要的治疗诊断领域，直到最近才出现了许多错误或曲解。它的定义要求一定要排除在鼻压计上确定的贫困建设的截止频率。但我们认为
elastically type is the type at which already the "first view diagnosis" allows essential conclusions on the nose physiology, especially under the aspect of nasal valve surgery and diagnostics of valve dysfunction.
弹性型是指通过 "第一视角诊断 "就能对鼻子的生理结构得出基本结论的类型，尤其是在鼻瓣膜手术和鼻瓣膜功能障碍诊断方面。
其结果是曲线类型与 "手柄 "位于呼气象限的球杆相对应。这种常见的结果主要发生在鼻腔有轻微阻塞的情况下，因此在临床最重要的治疗诊断领域，直到最近才出现了许多错误或曲解。它的定义要求一定要排除在鼻压计上确定的贫困建设的截止频率。但我们认为
elastically type is the type at which already the "first view diagnosis" allows essential conclusions on the nose physiology, especially under the aspect of nasal valve surgery and diagnostics of valve dysfunction.
弹性型是指通过 "第一视角诊断 "就能对鼻子的生理结构得出基本结论的类型，尤其是在鼻瓣膜手术和鼻瓣膜功能障碍诊断方面。
The graphical consideration of rhinomanometrical results in the scope of "first-view- diagnostics" conveys an entirely new impression of the real procedures in the nose to the observer, but above all it immediately reveals in what extend the printed numerical results of the "classical default values" are falsified by the drift apart of the loops.
在 "第一视角诊断 "的范围内，对鼻腔测量结果进行图形化分析，可以向观察者传达鼻腔真实过程的全新印象，但最重要的是，它可以立即揭示 "经典默认值 "的印刷数字结果在多大程度上被环路的偏离所伪造。
在 "第一视角诊断 "的范围内，对鼻腔测量结果进行图形化分析，可以向观察者传达鼻腔真实过程的全新印象，但最重要的是，它可以立即揭示 "经典默认值 "的印刷数字结果在多大程度上被环路的偏离所伪造。
For the practical diagnostics by the help of 4-phaserhinomanometry, it is important to know that the curve type does not only depend on the geometrical form of the flow channel but above all on the unsteady progresses of the flow. In practice can often be found curves, which as hybrids, cannot be referred to only one single curve type.
对于借助 4-phaserhinomanometry 进行实际诊断而言，重要的是要知道曲线类型不仅取决于流道的几何形状，更重要的是取决于流动的非稳态进展。在实际应用中，经常会发现一些混合曲线，它们不能只归属于一种单一的曲线类型。
对于借助 4-phaserhinomanometry 进行实际诊断而言，重要的是要知道曲线类型不仅取决于流道的几何形状，更重要的是取决于流动的非稳态进展。在实际应用中，经常会发现一些混合曲线，它们不能只归属于一种单一的曲线类型。
5-7 Physical Model of Nose Respiration
5-7 鼻呼吸物理模型
Clinical observations and false conclusions from literature studies result in reviewing the mathematical coherence between pressure and air stream. It now became necessary to verify the coherence found in the physical experiment and at the same time to evaluate the influence on the practice of rhinomanometry. For this purpose, different respiratory simulators have been set up ("Artificial Noses"). These consist of a pump, accordant to the lungs, with alternating streamed resistors. A respiratory pump otherwise used in anaesthesiology (Draegerwerke, Luebeck, Germany) had been connected to a stepper motor via a linear gear. This is to be controlled with a special program (Maxon Motor Control) via a PC in a way that trapezoidal respiratory curves will be generated with different respiratory curves, which do thus simulate the conditions of alternate breathing with a quick transition between inspiration and respiration. The rhinomanometric measurements in this model have been carried out by the 4-phase-rhinomanometer HRR 2 (RhinoLab GmbH, Rendsburg, Germany)
临床观察和文献研究得出的错误结论导致了对压力和气流之间数学一致性的审查。现在有必要验证物理实验中发现的一致性，同时评估其对鼻测量实践的影响。为此，我们建立了不同的呼吸模拟器（"人工鼻"）。这些模拟器由一个与肺部相吻合的泵和交替流电阻组成。麻醉科使用的呼吸泵（Draegerwerke，德国吕贝克）通过线性齿轮与步进电机相连。步进电机由一个特殊的程序（Maxon 电机控制）通过个人电脑进行控制，以产生梯形呼吸曲线和不同的呼吸曲线，从而模拟吸气和呼吸之间快速转换的交替呼吸条件。该模型的鼻压测量由 4 相鼻压计 HRR 2（RhinoLab GmbH，德国伦茨堡）完成。
临床观察和文献研究得出的错误结论导致了对压力和气流之间数学一致性的审查。现在有必要验证物理实验中发现的一致性，同时评估其对鼻测量实践的影响。为此，我们建立了不同的呼吸模拟器（"人工鼻"）。这些模拟器由一个与肺部相吻合的泵和交替流电阻组成。麻醉科使用的呼吸泵（Draegerwerke，德国吕贝克）通过线性齿轮与步进电机相连。步进电机由一个特殊的程序（Maxon 电机控制）通过个人电脑进行控制，以产生梯形呼吸曲线和不同的呼吸曲线，从而模拟吸气和呼吸之间快速转换的交替呼吸条件。该模型的鼻压测量由 4 相鼻压计 HRR 2（RhinoLab GmbH，德国伦茨堡）完成。
The following resistors have been examined at this
在此检查了以下电阻器
在此检查了以下电阻器
-
Diaphragm shaped resistors with a diameter from 3 to
直径为 3 至的膜片形电阻器 -
A short pipe with a length of
and a diameter of
长度为、直径为 的短管道 -
A pipe with a length of
and a diameter of
长度为、直径为 的管道
Figure 20. Model resistors
图 20.模型电阻器
图 20.模型电阻器
(A)
Figure 21. (A) Respiratory simulator "ARNO 1" and (B) generated respiratory curves with rhinomanometer HRR 2.
图 21.(A) 呼吸模拟器 "ARNO 1 "和 (B) 使用 HRR 2 鼻压计生成的呼吸曲线。
图 21.(A) 呼吸模拟器 "ARNO 1 "和 (B) 使用 HRR 2 鼻压计生成的呼吸曲线。
Figure 22. Rhinogram of a diaphragm resistor (quadrant
图 22.隔膜电阻器（
图 22.隔膜电阻器（
An air stream with a frequency of 12 (quadrant 1 to 3 ) and 24 (quadrant 2-4) breathes per minute was lead through both resistors. Not any changes occurred at the diaphragm model, when the respiratory frequency increased. At the pipe model a loop demonstrating hysteresis around the zero appeared, which was considerably wider after doubling the respiratory frequency. The remaining flow at a pressure of
每分钟 12 次（第 1 至第 3 象限）和 24 次（第 2 至第 4 象限）呼吸频率的气流通过两个电阻器。当呼吸频率增加时，隔膜模型没有发生任何变化。在管道模型中，零点附近出现了一个滞后环，呼吸频率增加一倍后，滞后环的范围明显增大。在呼吸频率为
每分钟 12 次（第 1 至第 3 象限）和 24 次（第 2 至第 4 象限）呼吸频率的气流通过两个电阻器。当呼吸频率增加时，隔膜模型没有发生任何变化。在管道模型中，零点附近出现了一个滞后环，呼吸频率增加一倍后，滞后环的范围明显增大。在呼吸频率为
Therewith, the accuracy of the mathematical coherences at the test may be considered confirmed.
因此，可以认为测试中数学一致性的准确性已得到确认。
因此，可以认为测试中数学一致性的准确性已得到确认。
A last confirmation of the 4-phase-rhinomanometry as measur-
最后一次确认四相血压计可用于测量
最后一次确认四相血压计可用于测量