不同聲狀態(tài)下嗓音疾病空氣動(dòng)學(xué)研究
發(fā)布時(shí)間：2018-04-11 15:18
本文選題：聲帶 + 室?guī)?/strong> ； 參考：《天津醫(yī)科大學(xué)》2012年碩士論文
【摘要】：目的研究舒適發(fā)聲與響亮發(fā)聲狀態(tài)下,部分臨床常見(jiàn)嗓音疾病患者聲門(mén)下壓、平均氣流率、聲門(mén)阻力和發(fā)聲效率等空氣動(dòng)力學(xué)參數(shù)的變化特點(diǎn),比較不同嗓音疾病間空氣動(dòng)力學(xué)差異,探討聲帶病變對(duì)發(fā)聲中通過(guò)聲門(mén)氣流的影響,以及空氣動(dòng)力學(xué)檢查在嗓音疾病的診斷和評(píng)估中的重要作用。 方法隨機(jī)選取133名受試者,排除受試者呼吸系統(tǒng)、神經(jīng)系統(tǒng)、聽(tīng)力疾病等障礙,根據(jù)病史、體征以及電子喉鏡結(jié)果分為正常對(duì)照組(男25例,女27例),聲帶小結(jié)組(女12例),聲帶息肉組(女17例,男13例),聲帶白斑組(男12例),聲帶瘢痕組(女8例),聲帶Ⅲ型切除術(shù)后雙側(cè)室?guī)Т鷥敯l(fā)聲組(男9例),聲帶Ⅲ～Ⅳ型切除術(shù)后單側(cè)室?guī)Т鷥敯l(fā)聲組(男10例),采用言語(yǔ)發(fā)聲空氣動(dòng)力學(xué)系統(tǒng)6600進(jìn)行空氣動(dòng)力學(xué)測(cè)量,比較分析各組受試者在舒適發(fā)聲、響亮發(fā)聲狀態(tài)下的平均氣流率、聲門(mén)下壓、聲門(mén)阻力和發(fā)聲效率的差異,并通過(guò)ROC曲線(xiàn)和logistic分析明確各種嗓音疾病的特征性空氣動(dòng)力學(xué)參數(shù)。 結(jié)果聲門(mén)下壓：聲帶息肉組男性高于女性(P=0.005)。在聲帶息肉、(男)、聲帶白斑、雙側(cè)室?guī)Оl(fā)聲和聲帶瘢痕情況下升高(P=0.001,P=0.005,P=0.000,P=0,000)。平均氣流率：正常對(duì)照與聲帶息肉組男性高于女性(P=0.000,P=0.005)。在聲帶白斑、雙側(cè)室?guī)Оl(fā)聲、聲帶小結(jié)、聲帶息肉(女)、聲帶瘢痕情況下升高(P=0.000,P=0.000,P=0.003,P=0.001,P=0.008),單側(cè)室?guī)Оl(fā)聲低于正常對(duì)照組(P=0.000)。聲門(mén)阻力：正常對(duì)照與聲帶息肉男性低于女性(P=0.000,P=0.001)。單側(cè)室?guī)Оl(fā)聲聲門(mén)阻力升高(P=0.000),在雙側(cè)室?guī)Оl(fā)聲、聲帶小結(jié)、聲帶息肉(女)、聲帶瘢痕情況下降低(P=0.000,P=0.000,P=0.011,P=0.002)。發(fā)聲效率：在雙側(cè)室?guī)Оl(fā)聲、聲帶小結(jié)、聲帶息肉(女)、聲帶瘢痕情況下降低(P=0.025,P=0.001,P=0.016,P=0.003)。聲門(mén)下壓變化率：?jiǎn)蝹?cè)室?guī)Оl(fā)聲高于正常對(duì)照(P=0.000)。聲帶息肉(女)、聲帶瘢痕較正常對(duì)照小(P=0.001,P=0.005)。平均氣流率變化率：正常對(duì)照與聲帶息肉男、女性受試者相比,男性高于女性(P=0.005,P=0.035)。單側(cè)室?guī)Оl(fā)聲高于正常對(duì)照(P=0.008),聲帶白斑低于正常對(duì)照(P=0.000)。聲門(mén)阻力變化率：正常對(duì)照女性高于男性(P=0.005),聲帶息肉女性低于男性(P=0.023)。聲帶息肉(男)高于正常對(duì)照(P=0.001),在雙側(cè)室?guī)Оl(fā)聲、單側(cè)室?guī)Оl(fā)聲、聲帶息肉(女)、聲帶瘢痕情況下降低(P=0.027,P=0.001,P=0.000,P=0.000)。發(fā)聲效率變化率：正常對(duì)照、聲帶息肉中女性高于男性(P=0.000,P=0.000)。在聲帶白斑、聲帶瘢痕情況下降低(P=0.001,P=0.002),聲帶息肉(女)高于正常對(duì)照(P=0.000) 聲帶息肉(男)：聲門(mén)阻力變化率曲線(xiàn)下面積0.822,數(shù)值為0.55時(shí),靈敏度0.769,特異度0.875,88.4%的患病率。聲帶白斑：發(fā)聲效率變化率曲線(xiàn)下面積0.864,數(shù)值為1.55時(shí),靈敏度0.917,特異度0.842,75.4%的患病率。雙側(cè)室?guī)Оl(fā)聲：平均氣流率、聲門(mén)阻力、發(fā)聲效率曲線(xiàn)下面積均為1.000,當(dāng)數(shù)值分別為0.78L/s、15.21cmH2O/(L/s)、24.88ppm,靈敏度1.000,特異度1.000,患病率為100%。單側(cè)室?guī)Т鷥敯l(fā)聲：聲門(mén)阻力曲線(xiàn)下面積為0.976,數(shù)值為42.16cmH20/(L/s)時(shí),靈敏度1.000,特異度0.932,95.7%的患病率。聲帶小結(jié)：聲門(mén)阻力曲線(xiàn)下面積0.776,數(shù)值為43.09cmH2O/(L/s)時(shí),靈敏度0.917,特異度0.769,患病率為81.3%。聲帶息肉(女)：發(fā)聲效率變化率曲線(xiàn)下面積0.810,數(shù)值為10.94時(shí),靈敏度0.765,特異度0.830,有81.3%的患病率。聲帶瘢痕：發(fā)聲效率變化率曲線(xiàn)下面積1.000,數(shù)值為1.75時(shí),靈敏度1.000,特異度1.000,100%的患病率 結(jié)論正常人群平均氣流率、聲門(mén)阻力存在性別差異,與男、女性喉部解剖結(jié)構(gòu)和聲帶生理特性有關(guān),可能是嗓音疾病女性高發(fā)的原因。在響亮發(fā)聲狀態(tài)下,發(fā)聲效率顯著提升,高發(fā)聲效率與發(fā)聲損傷密切相關(guān),響亮發(fā)聲更易患嗓音疾病。聲帶疾病、室?guī)Оl(fā)聲情況下空氣動(dòng)力學(xué)參數(shù)發(fā)生顯著改變,對(duì)發(fā)聲響度的調(diào)節(jié)能力有不同程度的下降,這與各種病理狀太下聲門(mén)面積、聲帶質(zhì)量、硬度、黏滯度和彈性等因素的改變密切相關(guān)。本次研究涉及的各類(lèi)疾病,各具特征性的空氣動(dòng)力學(xué)參數(shù)改變,空氣動(dòng)力學(xué)檢查在嗓音疾病和聲帶病變的輔助診斷、功能評(píng)估等方面具有一定的意義。
[Abstract]:Objective to study the sound of loud sound and comfortable state, part of patients with common voice disorders subglottic pressure, mean airflow rate, changes of resistance and glottal vocal efficiency of aerodynamic parameters, comparison of different voice aerodynamic differences among the diseases of vocal cord disease, affect the sound through the glottal air flow, and the important role of aerodynamics in the diagnosis and evaluation of voice diseases.
Methods 133 subjects were randomly selected, excluding subjects with respiratory system, nervous system, hearing disorders, diseases based on history, signs and results of electronic laryngoscope were randomly divided into normal control group (male 25 cases, female 27 cases), a small group of vocal cord (12 women), polyps (17 females. 13 cases were male), vocal cord leukoplakia group (12 male), vocal scar group (8 women), vocal cord type III after resection of bilateral vocal chamber with compensatory group (9 men), vocal cord type III ~ IV after resection of unilateral vocal chamber with compensatory group (10 men), with the sounds of speech the aerodynamic system 6600 aerodynamic measurement, comparison and analysis of each group of subjects in a comfortable voice, loud sound average flow rate, subglottic pressure difference, glottal resistance and phonatory efficiency, and through the ROC curve and logistic parameter analysis of aerodynamic characteristics of various clear voice diseases.
The subglottic pressure: vocal polyp group was higher in male than in female (P=0.005). In the vocal cord polyp, (male), bilateral vocal cord leukoplakia, chamber with vocal and vocal scar cases increased (P=0.001, P=0.005, P=0.000, P=0000). The average flow rate: normal control and vocal polyp group of male sex than women (P=0.000, P=0.005). In vocal leukoplakia, vocal, chamber with bilateral vocal nodules and vocal cord polyp (female), vocal scar cases increased (P=0.000, P=0.000, P=0.003, P=0.001, P=0.008), unilateral vocal chamber with lower than the normal control group (P=0.000). Glottal resistance: normal control and vocal cord polyps lower in males than in females (P=0.000, P=0.001). Unilateral vocal chamber with glottal resistance increased (P=0.000), in the room with bilateral vocal, vocal nodules and vocal cord polyp (female), vocal scar cases reduced (P=0.000, P=0.000, P= 0.011, P=0.002). The sound efficiency: in the room with bilateral vocal, vocal nodules and vocal cord polyp (female), vocal scar cases (P=0.025, P=0.001, P=0.016 decreased, P=0.003). The rate of pressure change: unilateral vocal subglottic chamber with higher than normal control (P=0.000). The vocal cord polyp of vocal scar (female), compared to the normal control of small (P=0.001, P=0.005). The average flow rate and the rate of change: normal control polyp of vocal cord compared to male, female subjects, men than women (P=0.005, P=0.035). Unilateral vocal chamber with higher than normal control (P=0.008), leukoplakia is lower than that of normal control (P=0.000). The rate of change of glottal resistance: normal control women than men (P=0.005), vocal cord polyp femaleunderthe male vocal cord (P=0.023). Polyp (male) was higher than that of normal control (P=0.001), in the room with bilateral vocal, vocal chamber with unilateral vocal polyp, vocal scar (female), lower (P=0.027, P=0.001, P=0.000, P=0.000). The sound efficiency rate of change: the normal female vocal cord polyp than males (P=0. 000, P=0.000). Lower (P=0.001, P=0.002) and vocal cord polyps (P=0.000) in vocal cords leukoplakia and soundscars.
Vocal cord polyp (male): glottal resistance change rate of the area under the curve of 0.822, value of 0.55, sensitivity of 0.769, specificity of 0.875,88.4%. The prevalence of vocal cord leukoplakia: vocal efficiency change rate of the area under the curve of 0.864, value of 1.55, sensitivity of 0.917, specificity of 0.842,75.4%. The prevalence of bilateral ventricular band sound: mean flow rate, glottal resistance, sound efficiency of the area under the curve was 1, when the values are 0.78L/s and 15.21cmH2O/ (L/s), 24.88ppm, sensitivity 1, specificity was 1, the prevalence rate was 100%. with unilateral ventricular compensatory sound: glottal resistance area under the curve is 0.976, the value for the 42.16cmH20/ (L/s), the sensitivity of 1 the specificity of 0.932,95.7%. The prevalence of vocal nodules: glottal resistance area under the curve of 0.776, the value for the 43.09cmH2O/ (L/s), the sensitivity was 0.917, specificity was 0.769, the prevalence of 81.3%. with polyps (female): Acoustic sounding efficiency curves When the area is 0.810, the value is 10.94, the sensitivity is 0.765, the specificity is 0.830, and there is a 81.3% prevalence rate. The scar area of the vocal cord: the area under the curve of the efficiency of voice efficiency is 1. When the value is 1.75, the sensitivity is 1, the prevalence of specificity 1.000100%.
Conclusion the normal population mean airflow rate, there are gender differences in male and female, glottal resistance, physiological characteristics and anatomical structure of laryngeal vocal cords, may cause the disease of high incidence. In the female voice loud sound sound condition, significantly enhance the efficiency of high sounding efficiency is closely related with the vocal injury, loud sound more susceptible to vocal voice disorders. Disease room with sounding kinetic parameters of air conditions changed significantly, have different degrees of decline in the ability to regulate the sound loudness, and the pathological condition of glottal area, vocal quality, hardness, viscosity and elasticity is closely related to factors such as the change of various kinds of diseases. This study involves the change of aerodynamics the characteristics of the parameters, the aerodynamic check in the auxiliary diagnosis of voice disorders and vocal cord lesions, which has a certain significance function evaluation and so on.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類(lèi)號(hào)】：R767.92
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