本文選題：聲學分析 + 非線性動力學分析　； 參考：《復旦大學》2010年博士論文

【摘要】： 吸煙引起呼吸道疾病發(fā)生率增高,導致喉部的各類疾病例如喉部慢性炎癥,返流性喉炎,任克氏間隙水腫,從而引起各種嗓音疾病。目前已經(jīng)有研究對吸煙引起的嗓音基頻下降進行了報道,空氣動力學方面研究發(fā)現(xiàn)最長發(fā)聲時間下降,但對于吸煙相關嗓音分析的綜合性研究較少。非線性動力學研究克服了傳統(tǒng)嗓音研究的缺點,目前已經(jīng)用于大量的病理性及非病理的嗓音樣本中,但是吸煙相關嗓音的非線性動力學分析仍然是空白。本文擬對吸煙者及非吸煙者的嗓音進行全面的微擾分析、非線性動力學分析以及空氣動力學分析。在此基礎上,定量探索吸煙對于喉功能引起的損害的性質(zhì),以期建立無創(chuàng)性評估吸煙者嗓音及聲帶受損程度的檢查方法,從而對無癥狀吸煙者進行宣教,促進無煙運動。 一、成年男性吸煙者的嗓音微擾分析及非線性動力學分析目標：吸煙導致嗓音變化,若使吸煙者及時察覺嗓音異常改變,可鼓勵其進行戒煙。嗓音變化通常是聲帶病理改變的首發(fā)表現(xiàn)。對嗓音的評估研究主要集中在傳統(tǒng)的嗓音分析,然而,非線性動力學分析方法已經(jīng)被證明是客觀可靠的評估嗓音的方法。我們將這兩種方法一起用于分析正常者及吸煙者的嗓音。方法：本項目為前瞻性研究。共包括73名研究對象,36名非吸煙者及37名吸煙者。每個研究對象錄制一段持續(xù)的元音發(fā)聲。數(shù)據(jù)使用了嗓音分析及關聯(lián)維數(shù)分析。結果用Mann-Whitney秩和檢驗,回歸分析及受試者工作特征(Receiver Operating Characteristics, ROC)對各項研究結果進行分析。結果：吸煙組的D2值明顯要比非吸煙組高(p0.001),頻率微擾和振幅微擾分析的參數(shù)在抽煙組中較高。邏輯回歸分析提示關聯(lián)維數(shù)(Correlation Dimension, D2)有較高的預測能力,ROC分析兩種方法未發(fā)現(xiàn)有顯著性差異。討論：本研究提示關聯(lián)維數(shù)對于吸煙相關的變化是非常敏感的,臨床上可以提示嗓音異常。進一步研究可以集中于用非線性動力學分析方法創(chuàng)建正常嗓音數(shù)據(jù)庫,建立標準閾值,監(jiān)控吸煙所致的嗓音變化。 二、成年男性吸煙者的空氣動力學分析目標:空氣動力學反映的是喉作為傳感器將聲門下空氣動力能轉換為聲能時的一系列參數(shù)。最小發(fā)聲氣流(Phonation Threshold Flow, PTF)作為發(fā)聲所需最小氣流,對于喉部組織、聲門結構的微小變化較敏感。我們將比較男性吸煙者與非吸煙者的一系列空氣動力學參數(shù),包括PTF、平均氣流(Mean Flow Rate, MFR)等,以研究吸煙引起的喉部結構改變。方法：本項目為前瞻性研究。共包括73名研究對象,36名非吸煙者及37名吸煙者。每個研究對象分別進行空氣動力學測量。結果用Mann-Whitney秩和檢驗進行分析。結果：可見吸煙組的聲門下壓(Subglottal Pressure, SGP)平均均值高于非吸煙組,吸煙組的PTF以及MFR均值低于非吸煙組,但是無統(tǒng)計學意義(p0.05)。討論：影響空氣動力學結果的因素較多,PTF作為新的空氣動力學參數(shù),運用于臨床還需要進一步的完善操作規(guī)范和技術。進一步研究可以集中于將空氣動力學與臨床的聲學、影像學等結合,以達到全面定量診斷吸煙對于喉功能的影響的作用。
[Abstract]:Smoking causes an increase in the incidence of respiratory diseases, causing various diseases such as chronic larynx inflammation, reflux laryngitis, and Kirschner's gap edema, resulting in a variety of voice diseases. There are few comprehensive studies on smoking related voice analysis. The nonlinear dynamics study overcomes the shortcomings of the traditional voice research. It has been used in a large number of pathological and non pathological voice samples, but the nonlinear dynamic analysis of smoking related voices is still blank. The voice of smokers and non smokers is proposed in this paper. On the basis of the comprehensive perturbation analysis, nonlinear dynamic analysis and aerodynamics analysis, the nature of the damage caused by smoking in the larynx was quantitatively explored in order to establish a noninvasive method to assess the degree of damage of the voice and vocal cord of smokers, so as to promote the smokeless smoker and promote the smokeless movement.
First, the voice perturbation analysis and nonlinear dynamic analysis of adult male smokers: smoking leads to voice changes. If smokers detect abnormal voice changes in time, they can be encouraged to quit smoking. Voice changes are usually the first manifestation of vocal pathological changes. The evaluation of voice is mainly focused on traditional voice analysis, but However, the nonlinear dynamic analysis method has been proved to be an objective and reliable method of voice evaluation. We use these two methods to analyze the voice of normal people and smokers. Methods: this project is a prospective study. A total of 73 subjects, 36 non smokers and 37 smokers are included in this project. Each research object is recorded for a continuous period of time. The data used voice analysis and correlation dimension analysis. Results the results were analyzed with Mann-Whitney rank sum test, regression analysis and Receiver Operating Characteristics (ROC). Results: the D2 value of smoking group was significantly higher than that of non smoking group (p0.001), frequency perturbation and amplitude perturbation. The parameters of the analysis were higher in the smoking group. The logistic regression analysis suggested that the correlation dimension (Correlation Dimension, D2) had higher prediction ability. The two methods of ROC analysis did not find significant difference. The study can focus on creating a normal voice database using nonlinear dynamic analysis, establishing standard thresholds, and monitoring voice changes caused by smoking.
Two, the aerodynamics analysis of adult male smokers: Aerodynamics reflect a series of parameters when the throat is used as a sensor to convert the aerodynamic energy of the glottal into sound energy. The minimum sound flow (Phonation Threshold Flow, PTF) is the minimum air flow required for the sound, and the minute changes in the glottal structure are more sensitive to the larynx. We will compare a series of aerodynamic parameters between male smokers and non smokers, including PTF, Mean Flow Rate (MFR), etc. to study the structural changes in the larynx caused by smoking. Methods: this project is a prospective study. A total of 73 subjects, 36 non smokers and 37 smokers were included. The results were analyzed with the Mann-Whitney rank sum test. Results: the mean mean value of subglottic pressure (Subglottal Pressure, SGP) in smoking group was higher than that of non smoking group, and the mean value of PTF and MFR in smoking group was lower than that of non smoking group, but there was no statistical significance (P0.05). The factors affecting the aerodynamic results were more than that of smoking group (P0.05). PTF, as a new aerodynamic parameter, needs further improvement of operational specifications and techniques in clinical practice. Further research can be focused on the combination of aerodynamics and clinical acoustics and imaging to achieve a comprehensive and quantitative diagnosis of the effect of smoking on laryngeal function.

【學位授予單位】：復旦大學
【學位級別】：博士
【學位授予年份】：2010
【分類號】：R767.92

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本文編號：1832723