本文選題：嗓音障礙 + 聲學測試��； 參考：《第二軍醫(yī)大學》2012年碩士論文

【摘要】：目的：以德語嗓音障礙RBH聽感知評估系統(tǒng)為參考,對RBH聽感知評估系統(tǒng)進行中文版化研究,并初步制定RBH聽感知評估系統(tǒng)中文版的標準培訓光碟,為嗓音障礙RBH主觀聽感知中文版化評估系統(tǒng)的臨床應用奠定基礎。 方法：(1)研究對象：嗓音障礙組79例,正常嗓音組15例。(2)主觀聽感知評估：采用德國RBH主觀聽感知評估系統(tǒng)中的R,B,H主觀參數(shù)對受試者進行主觀等級評分；每個評估參數(shù)分為4個等級：0代表正常,1代表輕度異常,2代表中度異常,代表重度異常。(3)嗓音客觀參數(shù)的測量：采用Davis2.5和Pratt軟件對受試者的客觀參數(shù)Jitter、Shimmer、HNR、MPT和DSI的相關數(shù)值進行測量。(4)統(tǒng)計學分析：首先對R,B,H進行信度檢驗,包括評委自身一致性和評委間一致性；再比較H每相鄰兩個等級之間客觀嗓音聲學參數(shù)的差異,進行效度檢驗；最后將R,B,H與DSI進行一致性檢驗,篩選出DSI與H等級完全一致的樣本作為RBH評估系統(tǒng)中文版的標準培訓材料。采用SPSS11.5統(tǒng)計軟件,一致性檢驗時選用Kappa系數(shù),效度檢驗使用Mann-Whitney Test檢驗。 結果：(1)以RBH作為主觀聽感知參數(shù),評委自身一致性以Kappa系數(shù)值表示,其數(shù)值為0.428-0.601,說明5位評委前后兩次對RBH這個整體參數(shù)評估的一致性好；評委間一致性以組內相關系表示,2次評估的組內相關系數(shù)值分別為0.74-0.79,0.689-0.762,證明第1次評估時5位評委間的一致性和第2次評估時5位評委間的一致性均好。(2)主觀聽感知參數(shù)R,B,H與客觀參數(shù)Jitter、 Shimmer、HNR、MPT和DSI等之間的相關性分析結果顯示：①主觀聽感知參數(shù)R,B,H與Jitter、Shimmer、HNR、MPT及DSI之間均具有顯著的相關性,差異有統(tǒng)計學意義(P均0.01)；②R與Jitter和HNR的相關性最強,相關系數(shù)分別為0.551、0.499、0.550；③B與MPT,H與DSI呈高度負相關,相關系數(shù)分別達0.620和0.613。說明主觀評估的結果與客觀結果大體上一致。(3)主觀聽感知參數(shù)R,B,H的4個等級中每相鄰2個等級之間的Jitter、Shimmer、HNR、 MPT及DSI比較差異均有統(tǒng)計學意義(p均0.05),說明R,B,H的等級劃分是合理、正確的。(4)通過R,B,H與DSI之間的一致性分析,將H與DSI完全一致的42例嗓音樣本納入標準培訓光碟中,男女組成在各等級中基本平均分布,疾病譜廣泛全面,可作為RBH聽感知評估系統(tǒng)中文版的標準培訓光碟,也為嗓音障礙RBH主觀聽感知評估系統(tǒng)中文版標準化的建立提供藍本。 結論：(1)以RBH主觀聽感知評估系統(tǒng)中文版評估參數(shù)評估嗓音障礙患者,評委自身一致性以及評委間一致性均好。(2)主觀評估的R,B,H參數(shù)結果與客觀評估參數(shù)的結果大體上一致。(3)R,B,H的等級劃分是合理、正確的。(4)初步制定的RBH聽感知評估系統(tǒng)中文版的標準培訓光碟比較合理、可行,為進一步開展全國多中心研究及臨床應用打下良好的基礎。
[Abstract]:Objective: to study the Chinese version of the RBH auditory perception evaluation system based on the RBH auditory perception evaluation system for German voice disorders, and to develop a Chinese version of the standard training disc for the RBH auditory perception assessment system. To lay a foundation for the clinical application of RBH subjective auditory perception evaluation system. Methods: (1) subjects: 79 patients in the voice disorder group and 15 in the normal voice group. (2) subjective auditory perception assessment: the subjective parameters of RNBHs in the RBH subjective auditory perception evaluation system in Germany were used to evaluate the subjective grade of the subjects. Each evaluation parameter was divided into 4 grades: 0: 0 for normal and 1 for mild abnormality and 2 for moderate abnormality. (3) Measurement of objective voice parameters: using Davis2.5 and Pratt software to measure the relative values of the objective parameters Jitteri ShimmerHNRGMPT and DSI. (4) Statistical analysis: first, the reliability of RGN BH was tested. Including the consistency of the judges themselves and the consistency between the judges; then compare the differences of the objective voice acoustic parameters between the two adjacent grades of H, and test the validity; finally, we test the consistency between RBHs and DSI. Samples of DSI and H grades are selected as standard training materials for the Chinese version of RBH evaluation system. Using SPSS 11.5 statistical software, Kappa coefficient and Mann-Whitney Test were used for consistency test and validity test respectively. Results: (1) using RBH as the subjective auditory perception parameter, the consistency of the judges was expressed as the Kappa coefficient, whose value was 0.428-0.601, which indicated that the evaluation of RBH was consistent twice before and after the 5-bit judges; The intra-group correlation coefficient values of the two evaluations were 0.74-0.79 / 0.689-0.762respectively, which proved that the consistency of the five judges in the first evaluation and the consistency among the five judges in the second evaluation were good. (2) subjective sense of hearing. The results of correlation analysis between the known parameter RG BHH and objective parameters Jitter, ShimmerHNRNRT and DSI showed that the subjective auditory perception parameter RGBH1 had significant correlation with JitterShimmerHNRMMPT and DSI. There was significant difference (P0.01) in the correlation between jitter and HNR. The correlation coefficient was 0.551U 0.4990.5053B and MPTH was negatively correlated with DSI, and the correlation coefficients were 0.620 and 0.613respectively. The results of subjective assessment are consistent with objective results generally. (3) there are significant differences in Jitter ShimmerHNR, MPT and DSI between each of the four grades of subjective auditory perception parameter RG BNH (p 0.05). (4) through the consistency analysis between RDSI and RDSI, 42 voice samples with the same H and DSI were included in the standard training disc. The composition of male and female was distributed equally in all levels, and the disease spectrum was extensive and comprehensive. It can be used as the standard training disc of RBH auditory perception evaluation system in Chinese, and it can also provide a blueprint for the standardization of the Chinese version of RBH subjective auditory perception evaluation system for voice disorders. Conclusion: (1) the evaluation parameters of RBH subjective auditory perception evaluation system were used to evaluate patients with voice disorders. The consistency of the judges themselves and the consistency among the judges are good. (2) the results of the subjective evaluation of RGB-H parameters are generally consistent with the results of the objective evaluation parameters. (3) the classification of the RGB-H parameters is reasonable. (4) the Chinese version of RBH auditory perception evaluation system is reasonable and feasible, which lays a good foundation for further multi-center research and clinical application.
【學位授予單位】：第二軍醫(yī)大學
【學位級別】：碩士
【學位授予年份】：2012
【分類號】：R767.92

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