Lessac-Madsen 共鸣嗓音疗法对声带良性增生性病变患者术后嗓音功能的影响

Effects of Lessac-Madsen Resonant Voice Therapy on Voice Function of Patients after Microscopy Supported Laryngoscope Resection of Vocal Cord Lesions

吴辉;李革临;

1:首都医科大学附属北京友谊医院物理康复科

2:首都医科大学附属北京友谊医院耳鼻咽喉头颈外科

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摘要

目的探讨Lessac-Madsen共鸣嗓音疗法(LMRVT)对支撑喉镜显微镜下声带良性增生性病变切除术后患者嗓音功能的疗效。方法选取声带良性增生性病变且行喉显微手术后1个月的患者64例,随机分为LMRVT组(32例)和仅手术组(32例),LMRVT组接受为期2个月的Lessac-Madsen共鸣嗓音疗法,仅手术组不做任何嗓音训练;两组均于术后1个月和3个月分别进行嗓音声学分析,记录元音/a/、/i/、/u/第一共振峰(F1)、第二共振峰(F2)、基频微扰(jitter)、振幅微扰(shimmer)、基频(F0)、噪谐比(NHR)及最长发声时间(MPT),并进行嗓音听感知觉评估(GRBAS)和嗓音障碍指数(voice handicap index, VHI)评估,选取与患者组年龄和性别相匹配的正常对照组32例进行一次嗓音声学分析、GRBAS及VHI评估,比较三组结果。结果 (1)组内比较:LMRVT组LMRVT训练结束后jitter、shimmer、NHR比训练前减小、MPT较训练前延长(P<0.05),元音/a/的F1、/i/的F2、/u/的F2以及总嘶哑度G和VHI自我评分均有显著改善(P<0.05);仅手术组术后3个月与术后1月相比,仅jitter、总嘶哑度G及VHI评分有明显改善(P<0.05)。(2)组间比较:LMRVT在训练结束后,与正常对照组相比,除MPT、总嘶哑度G和VHI评分仍差异显著(P<0.05)外,其余指标与正常对照组无显著差异;仅手术组术后3个月未达到正常水平,jitter、shimmer、MPT、/a/的F1、/i/的F1和F2、总嘶哑度G和VHI评分,仍与对照组有显著差异(P<0.05);仅手术组术后3个月/a/的F1、/i/的F1和F2均低于观察组训练后(术后3个月)(P<0.05)。结论 LMRVT能有效改善声带良性增生性病变难显微术后患者嗓音共鸣功能,提高嗓音清晰度,改善发音质量,比仅接受手术能获得更稳定的嗓音功能改善。

关键词

共鸣嗓音疗法;发声功能;共振峰

基金项目(Foundation):

作者

吴辉;李革临;

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吴辉李革临