本文選題：懸雍垂腭咽成形術(shù)　切入點：嗓音　出處：《天津醫(yī)科大學(xué)》2012年碩士論文

【摘要】：目的： 懸雍垂腭咽成形術(shù)(uvulopalatopharyngoplasty, UPPP)對阻塞性睡眠呼吸暫停低通氣綜合征(Obstructive Sleep Apnea Hypopnea Syndrome, OSAHS)患者手術(shù)前后的嗓音影響研究。通過多維嗓音分析軟件(Multi-Dimensional Voice Program, MDVP)、線性預(yù)測譜(Linear Prediction Coding, LPC)、鼻流計(Nasometer)檢測等方法,對OSAHS成年男性患者行UPPP手術(shù)前后的嗓音進行客觀評價和分析,探討手術(shù)前后咽腔的改變對患者發(fā)聲功能和口鼻共鳴功能的影響,從而為選擇UPPP手術(shù)人群提供參考、建立更合理OSAHS的管理和治療手段提供依據(jù)。 方法： 對30例確診為OSAHS的成年男性患者行UPPP,并分別在術(shù)前、術(shù)后一周及術(shù)后三月時通過多維嗓音分析軟件、線性預(yù)測譜、鼻流計檢測等方法,對元音/a/的基頻(Average Fundamental Frequency, FO),頻率微擾(Jitter)、振幅微擾(Shimmer),諧噪比(Noise-to-Harmonic Ratio, NHR)進行測量以客觀評價其發(fā)聲功能；對元音/a/i/u/的第一共振峰(Formant1, F1)、第二共振峰(Formant2,F2)進行測量以客觀評價其口腔共鳴功能；對非鼻音句、口鼻音句、鼻音句的鼻音率進行測量以客觀評價其鼻腔共鳴功能,繼而對患者手術(shù)前后各參數(shù)結(jié)果進行統(tǒng)計學(xué)分析比較。 結(jié)果： 1.多維嗓音分析軟件顯示,手術(shù)前后F0、Jitter、Shimmer、NHR均無顯著性差異(P0.05)。 2.線性預(yù)測譜分析顯示,術(shù)后一周時元音/a/、/i/、/u/的F1、F2較術(shù)前無顯著性差異(P0.05)；術(shù)后三月時元音/i/的F1、F2及元音/u/的F1較術(shù)前差異仍無統(tǒng)計學(xué)意義(P0.05),但元音/a/的F1、F2及元音/u/的F2較術(shù)前升高(P0.05)。 3.鼻流計分析顯示,術(shù)后一周時非鼻音句、口鼻音句、鼻音句的鼻音率較術(shù)前無明顯差異(P0.05)；術(shù)后三月時非鼻音句、口鼻音句的鼻音率較術(shù)前仍無明顯差異(P0.05),但鼻音句的鼻音率較術(shù)前則略有升高(P0.05)。提示手術(shù)對患者的發(fā)聲功能無明顯影響,對聲道共鳴功能有一定影響。 結(jié)論： 1. UPPP對OSAHS患者嗓音影響較小,對其發(fā)聲功能無明顯影響,但對口鼻共鳴功能產(chǎn)生輕微影響。 2.鑒于UPPP對口鼻共鳴功能產(chǎn)生輕微影響,對專業(yè)歌唱、戲曲及播音主持等職業(yè)用聲者行UPPP時還需要慎重,并且一定要對其告知手術(shù)對嗓音改變的可能性。
[Abstract]:Objective:. The effect of uvulopalatopharyngoplasty on voice of patients with obstructive Sleep Apnea Hypopnea Syndrome (OSAHS) before and after operation. Nasometerometer, etc., Objective evaluation and analysis of voice of adult male patients with OSAHS before and after UPPP operation were carried out to explore the influence of changes of pharynx cavity on vocal function and oral and nasal resonance function of patients before and after UPPP operation. To establish more reasonable management and treatment of OSAHS to provide the basis. Methods:. Thirty adult male patients with OSAHS were treated with UPP, and were analyzed by multi-dimensional voice analysis software, linear predictive spectrum and nasal flow meter before operation, one week after operation and three months after operation. The fundamental frequency of vowel / / is measured by measuring the fundamental frequency of vowel / Fundamental frequency frequency, frequency perturbation, amplitude perturbation, amplitude perturbation and harmonic noise ratio Noise-to-Harmonic Ratio (NHRs) in order to objectively evaluate the vocal function of the vowel / a / a / /, the first resonance peak of vowel / a / r / F _ (1), F _ (1), F _ (2) is measured to evaluate objectively its oral resonance function; the first resonance peak of the vowel / / / is Formant _ 1, F _ (1), and the second resonance peak (F _ (2)) is measured to evaluate its oral resonance function objectively. The nasal rate of non-nasal, oral and nasal sentences was measured in order to evaluate the nasal resonance function objectively, and then the results of the parameters before and after operation were statistically analyzed and compared. Results:. 1.Multidimensional voice analysis software showed that there was no significant difference in NHR between F0 and Jitteror Shimmerin before and after operation (P 0.05). 2. Linear predictive spectrum analysis shows that, At one week after operation, there was no significant difference in the vowel / a / r / u / F 1 / F 2 compared with that before operation (P 0.05); the vowel / I / F 1 and vowel / F 1 at 3 months after operation were still not significantly different from those before operation (P 0.05), but the vowel / a / F 1 F 1 / F 2 and the vowel r / u / F 2 were significantly higher than those before operation (P 0.05). 3. Nasal flow analysis showed that there was no significant difference in the nasal rate of non-nasal, oral, nasal and nasal sentences one week after operation compared with that before operation (P 0.05), and at 3 months after operation, there was no significant difference in the rate of nasal sounds in non-nasal sentences, and in the third month after operation, there was no significant difference between the two groups. There was no significant difference in nasal sound rate between before and after operation, but the nasal sound rate of nasal sentence was slightly higher than that before operation (P 0.05). It suggested that the operation had no obvious effect on the vocal function of patients, but had certain influence on the vocal resonance function of the patients. Conclusion:. 1. UPPP had little effect on the voice of OSAHS patients, but had little effect on the vocal function of OSAHS patients, but had a slight effect on the resonance function of mouth and nose. 2. In view of the slight influence of UPPP on the oral and nasal resonance function, it is necessary to be cautious in performing UPPP for professional speakers such as singing, opera and broadcasting hosts, and to inform them of the possibility of voice change.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2012
【分類號】：R766

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