【摘要】：目的:通過對(duì)60例就診于我科的聲帶息肉患者的臨床資料進(jìn)行回顧性研究,著重探討嗓音障礙指數(shù)量表(the voice handicap index,VHI)、嗓音聲學(xué)分析(acoustic analysis)、音域圖(Voice range profile,VRP)的變化與患者手術(shù)治療前后聲音質(zhì)量變化的趨勢(shì)及相關(guān)性。方法:收集2015年4月~2016年4月因聲帶息肉就診于我科的患者,根據(jù)《臨床診療指南-耳鼻喉科分冊(cè)》(中華醫(yī)學(xué)會(huì)編著名,人民衛(wèi)生出版社),《臨床技術(shù)操作規(guī)范-耳鼻喉科分冊(cè)》(中華醫(yī)學(xué)會(huì)編著,人民軍醫(yī)出版社)制定診斷標(biāo)準(zhǔn),將符合以下條件者納入研究:1.主訴:聲音嘶啞;2.體征:內(nèi)鏡檢查可見單側(cè)或雙側(cè)聲帶帶蒂或廣基的息肉樣增生物。共60例患者納入研究,在首診時(shí)均完善嗓音障礙指數(shù)量表、頻閃喉鏡、嗓音聲學(xué)分析及音域圖檢查。所有患者均無其他基礎(chǔ)疾病,所有患者均由同一耳鼻喉科醫(yī)師及麻醉科醫(yī)師在相同設(shè)備下完成顯微支撐喉鏡手術(shù)。所有患者于術(shù)后1周、4周均再次回院隨訪,完善嗓音障礙指數(shù)量表、頻閃喉鏡、嗓音聲學(xué)分析及音域圖檢查,并與首診時(shí)各項(xiàng)結(jié)果比較。所有患者于隨訪期間避免連續(xù)、高強(qiáng)度用聲。所有術(shù)前及術(shù)后檢查均由同一醫(yī)師完成。所有統(tǒng)計(jì)均應(yīng)用SPSS19.0軟件完成。結(jié)果:1.VHI:患者術(shù)后VHI結(jié)果明顯優(yōu)于術(shù)前水平,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。由于術(shù)后1周術(shù)區(qū)仍有輕微腫脹,且患者精神較緊張,故術(shù)后4周VHI改善最明顯,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。2.嗓音聲學(xué)分析:(1)基頻微擾(Jitter)方面,患者術(shù)后1周、4周Jitter值均低于術(shù)前Jitter值,差異具有統(tǒng)計(jì)學(xué)意義(P0.05);術(shù)后4周Jitter值較術(shù)后1周更低,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。(2)振幅微擾(Shimmer)方面,術(shù)后1周、4周Shimmer值較術(shù)前小,差異具有統(tǒng)計(jì)學(xué)意義(P0.05);術(shù)后4周Shimmer值較術(shù)后1周更低,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。(3)標(biāo)準(zhǔn)化噪聲能量(normalized noise energy,NNE)方面,術(shù)后1周、4周NNE絕對(duì)值均高于患者術(shù)前水平,差異具有統(tǒng)計(jì)學(xué)意義(P0.05);術(shù)后4周NNE絕對(duì)值高于術(shù)后1周水平,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。(4)噪諧比(Harmonica-noise ratio,NHR)方面,術(shù)后1周、4周NHR均有不同程度的下降,其中術(shù)后4周NNE值低于術(shù)后1周NNE值,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。3.VRP:(1)在頻率方面,患者術(shù)后1周最大頻率、最小頻率、頻率范圍較術(shù)前無明顯差別(P0.05);患者術(shù)后4周最大頻率較手術(shù)前有所升高,最小頻率較術(shù)前有所降低,頻率范圍也較手術(shù)前顯著擴(kuò)大,差別有統(tǒng)計(jì)學(xué)意義(P0.05)。(2)就強(qiáng)度而言,患者手術(shù)后1周與術(shù)前在最大聲強(qiáng)、最小聲強(qiáng)、強(qiáng)度范圍無明顯差別(P0.05);而患者術(shù)后4周最大聲強(qiáng)、最小聲強(qiáng)值較手術(shù)前降低,而平均聲強(qiáng)范圍比擴(kuò)大,差別有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:通過比較患者手術(shù)前、手術(shù)后的VHI、嗓音聲學(xué)分析及VRP相關(guān)參數(shù)指標(biāo)之間的差異,我們認(rèn)為VHI、嗓音聲學(xué)分析及VRP具有嗓音量化評(píng)定功能,能有效對(duì)聲帶息肉手術(shù)進(jìn)行療效評(píng)估,是嗓音功能檢測(cè)的重要手段。
[Abstract]:Objective: to study retrospectively the clinical data of 60 patients with vocal cord polyps in our department, and to discuss the voice disturbance index scale (the voice handicap index,VHI) and voice acoustic analysis of (acoustic analysis), range map (Voice range profile,). The change of VRP and the change trend and correlation of sound quality before and after operation. Methods: patients with vocal cord polyps were collected from April 2015 to April 2016. According to the guidelines for Clinical diagnosis and treatment-Otorhinolaryngology, (the name of the Chinese Medical Association, people's Health Publishing House), (Chinese Medical Association, the people's military Medical Publishing House) to formulate diagnostic criteria, the following conditions will be included in the study: 1. Complaint: hoarseness; 2. Signs: endoscopic examination of unilateral or bilateral vocal cord pedicle or wide-base polyp-like hyperplasia. A total of 60 patients were included in the study. At the first visit, the voice disorder index scale, stroboscopic laryngoscope, voice acoustic analysis and phonogram were all improved. All patients had no other underlying diseases, and all patients underwent microscopical laryngoscope surgery with the same otolaryngologist and anesthesiologist under the same equipment. All the patients were followed up again at 1 week and 4 weeks after operation to perfect the voice disorder index scale, stroboscopic laryngoscope, voice acoustic analysis and phonogram examination, and to compare the results with those of the first visit. All patients were followed up to avoid continuous, high-intensity sound use. All preoperative and postoperative examinations were performed by the same physician. All statistics were completed by SPSS19.0 software. VHI: postoperative VHI results were significantly better than the preoperative level, the difference was statistically significant (P0.05). 2. Because there was still slight swelling in the operation area at 1 week after operation, and the patients were nervous, the improvement of VHI at 4 weeks after operation was the most obvious, the difference was statistically significant (P0.05). Voice acoustic analysis: (1) fundamental frequency perturbation (Jitter), patients 1 week, 4 weeks after the Jitter values were lower than the preoperative Jitter value, the difference was statistically significant (P0.05); The Jitter value at 4 weeks after operation was lower than that at 1 week after operation, the difference was statistically significant (P0.05). (2) in terms of amplitude perturbation (Shimmer), and the Shimmer value at 1 week and 4 weeks after operation was smaller than that before operation (P0.05). The Shimmer value at 4 weeks after operation was lower than that at 1 week after operation, and the difference was statistically significant (P0.05). (3) standardized noise energy (normalized noise energy,NNE. The absolute values of NNE at 1 week and 4 weeks after operation were higher than those before operation. The difference was statistically significant (P0.05). The absolute value of NNE at 4 weeks after operation was higher than that at 1 week after operation, and the difference was statistically significant (P0.05). (4) the ratio of noise to harmonic (Harmonica-noise ratio,NHR) was significantly lower than that at 1 week and 4 weeks after operation, and the NHR decreased to some extent at 1 week and 4 weeks after operation. The NNE value at 4 weeks after operation was lower than that at 1 week after operation, and the difference was statistically significant (P0.05). 3. VRP: (1) in terms of frequency, the maximum frequency and minimum frequency of 1 week after operation were found in the patients. The frequency range was not significantly different from that before operation (P0.05). The maximum frequency of 4 weeks after operation was higher than that before operation, the minimum frequency was lower than that before operation, and the frequency range was significantly larger than that before operation. The difference was statistically significant (P0.05). (2) in terms of intensity. There was no significant difference in the range of maximum intensity and minimum intensity between one week and one week after operation (P0.05). The maximum sound intensity and the minimum sound intensity were lower than those before operation, but the mean range of sound intensity was enlarged, the difference was statistically significant (P0.05). Conclusion: by comparing the differences between VHI, voice acoustic analysis and VRP parameters before and after operation, we believe that VHI, voice acoustic analysis and VRP have the function of quantitative voice evaluation. It is an important method to evaluate the effect of vocal polyp surgery.
【學(xué)位授予單位】：西南醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R767.91

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