四部矫治康复训练在声带良性病变手术患者中的应用研究

doi:10.3761/j.issn.0254-1769.2022.01.001

摘要/Abstract

摘要：

目的探讨四部矫治康复训练在声带良性病变手术患者中的应用效果。方法便利选取2020年4月—2021年3月在天津市某三级甲等医院耳鼻喉科,首次行全麻支撑喉镜下显微手术治疗的106例声带良性病变患者为研究对象,采用随机数字表法分为试验组55例和对照组53例。试验组在常规护理基础上进行四部矫治康复训练,对照组接受常规护理方案。于入院当天、出院当天、术后2周、术后4周使用嗓音障碍指数量表 (Voice Handicap Index,VHI) 和多维嗓音分析软件进行评价,对VHI评分、噪谐比 (noise to harmonic ratio, NHR) 、振幅微扰 (Shimmer) 、基频微扰 (Jitter) 、最长发声时间 (maximum phonation time,MPT) 进行比较和分析。结果两组术后2周和术后4周的VHI评分、NHR、Shimmer、Jitter、MPT比较,差异具有统计学意义 (均P<0.05),试验组优于对照组。各组随着出院时间的增加VHI评分、NHR、Shimmer、Jitter逐渐下降,MPT逐渐增高,两组存在时间和组间的交互作用 (P<0.05) 。结论四部矫治康复训练能够有效改善声带良性病变手术患者嗓音障碍主观感受和嗓音声学指标,纠正患者不良用嗓习惯和行为,促进患者康复。

关键词: 四部训练, 声带良性病变, 耳鼻咽喉科学, 康复护理

Abstract:

Objective To explore the application effect of four-part correction rehabilitation training in patients with vocal cord benign lesions. Methods A total of 106 patients with benign vocal cord lesions undergoing microsurgery under general anesthesia for the first time in the department of otolaryngology of a tertiary A hospital in Tianjin from April 2020 to March 2021 were selected and divided into an experimental group and a control group by random number table method,with 55 patients in the experimental group and 53 patients in the control group. The experimental group was given four-part correction rehabilitation training on the basis of routine nursing,and the control group received routine nursing program. The voice handicap index and multidimensional voice analysis were used for evaluation. The voice impairment index (VHI) and acoustic parameters (NHR),Shimmer,Jitter and MPT were compared and analyzed on the day of admission,the day of discharge,2 weeks and 4 weeks after surgery. Results There was no statistical significance in NHR,Shimmer,Jitter,MPT and VHI values on the day of admission and discharge between the 2 groups (P>0.05). The data of 2 weeks and 4 weeks after surgery were compared between the 2 groups,and the NHR,Shimmer,Jitter and VHI values of the experimental group were lower than those of the control group,while the MPT value was higher. The differences between the 2 groups were statistically significant (P<0.05). Conclusion Four-part correction rehabilitation training can effectively improve the subjective feeling and voice quality of patients with voice disorders after surgery for benign vocal cord lesions,help to change patients’ bad voice habits and behaviors,and promote the rehabilitation of patients.

Key words: Four-Part Training, Benign Vocal Cord Lesions, Otolaryngology, Rehabilitation Nursing

赵春娜, 黄永望, 潘静, 傅德慧, 赵京, 庄丕伟, 尤海燕, 于金宝, 李恺玥. 四部矫治康复训练在声带良性病变手术患者中的应用研究[J]. 中华护理杂志, 2022, 57(1): 10-16.

ZHAO Chunna, HUANG Yongwang, PAN Jing, FU Dehui, ZHAO Jing, ZHUANG Piwei, YOU Haiyan, YU Jinbao, LI Kaiyue. Application of rehabilitation training for four-part correction in patients undergoing surgical treatment of benign vocal cord lesions[J]. Chinese Journal of Nursing, 2022, 57(1): 10-16.

图/表 7

表1 声带良性病变手术患者四部矫治康复训练方案

Table 1 Rehabilitation training program of four parts correction nursing for patients with benign vocal cord lesions

表2 两组一般资料比较[例 (百分比,%) ]

Table 2 Comparison of two general data [Example (percentage,%) ]

表3 两组各时间点嗓音障碍指数量表评分比较 (分,$\bar{x}±s$)

Table 3 Comparison of the scores of the Voice Handicap Index between the two groups at each time point (scores,$\bar{x}±s$)

表4 两组各时间点噪音声学指标噪谐比比较 ($\bar{x}±s$)

Table 4 NHR value at different time points in 2 groups ($\bar{x}±s$)

表5 两组各时间点噪音声学指标振幅微扰比较 (%,$\bar{x}±s$)

Table 5 Shimmer value at different time points in 2 groups (%,$\bar{x}±s$)

表6 两组各时间点噪音声学指标基频微扰比较 (%,$\bar{x}±s$)

Table 6 Jitter value at different time points in 2 groups (%,$\bar{x}±s$)

表7 两组各时间点噪音声学指标最长发音时间比较 (s, $\bar{x}±s$)

Table 7 MPT value at different time points in 2 groups (s,$\bar{x}±s$)

参考文献 22

[1]	孔维佳. 耳鼻咽喉头颈外科学[M]. 北京: 人民卫生出版社, 2010.
	Kong WJ. Otorhinolaryngology head and neck surgery[M]. Beijing: People’s Medical Publishing House, 2010.
[2]	Stachler RJ, Francis DO, Schwartz SR, et al. Clinical practice guideline:hoarseness(dysphonia)(update)[J]. Otolaryngol Head Neck Surg, 2018, 158(1suppl):S1-S42. DOI URL
[3]	朱越, 衡伟伟. 负性情绪对声带息肉术后嗓音质量恢复的影响[J]. 听力学及言语疾病杂志, 2019, 27(1):53-57.
	Zhu Y, Heng WW. The effect of negative emotion on voice quality after the vocal cord polyp surgery[J]. J Audiol Speech Pathol, 2019, 27(1):53-57.
[4]	Flynn JP, Villwock JA, Chiu AG, et al. Appraising otolaryngology-head and neck surgery clinical practice guidelines for effective dissemination and implementation design[J]. Otolaryngol Head Neck Surg, 2020, 163(2):209-215. DOI URL
[5]	李睿文, 席淑新. 耳鼻咽喉科高级实践护士培养的研究进展[J]. 中华护理杂志, 2017, 52(12):1516-1519.
	Li RW, Xi SX. Research progress on training of advanced practice nurses in otorhinolaryngological specialty[J]. Chin J Nurs, 2017, 52(12):1516-1519.
[6]	庄佩耘. 2019年美国秋季嗓音论坛纪实[J]. 听力学及言语疾病杂志, 2020, 28(1):101.
	Zhuang PY. Documentary of American autumn voice forum in 2019[J]. J Audiol Speech Pathol, 2020, 28(1):101.
[7]	田梓蓉, 韩杰. 耳鼻咽喉头颈外科护理健康教育与康复手册[M]. 北京: 人民卫生出版社, 2019.
	Tian ZR, Han J. Manual of nursing health education and rehabilitation in otorhinolaryngology head and neck surgery[M]. Beijing: People’s Medical Publishing House, 2019.
[8]	黄永望, 傅德慧, 潘静. 实用临床嗓音疾病矫治学[M]. 天津: 天津科技翻译出版有限公司, 2018.
	Huang YW, Fu DH, Pan J. Practical clinical voice therapy[M]. TianJin: Tianjin Science & Technology Translation & Publishing Corp, 2018.
[9]	Saltürk Z, zdemir E, Sari H, et al. Assessment of resonant voice therapy in the treatment of vocal fold nodules[J]. J Voice, 2019, 33(5):810.e1-810.e4.
[10]	Meerschman I, Van Lierde K, Ketels J, et al. Effect of three semi-occluded vocal tract therapy programmes on the phonation of patients with dysphonia:lip trill,water-resistance therapy and straw phonation[J]. Int J Lang Commun Disord, 2019, 54(1):50-61. DOI URL
[11]	Sundberg J, Bitelli M, Holmberg A, et al. The "overdrive" mode in the "complete vocal technique":a preliminary study[J]. J Voice, 2017, 31(5):528-535. DOI PMID
[12]	曹淑卿, 王申, 宋晨婕. 五官科、皮肤科和精神科常见疾病护理常规(培训教材)[M]. 北京: 人民卫生出版社, 2018.
	Cao SQ, Wang S, Song CJ. Nursing routine of common diseases in ent,dermatology and psychiatry(training materials)[M]. Beijing: People’s Medical Publishing House, 2018.
[13]	Jacobson BH, Johnson A, Grywalski C, et al. The voice handicap index(VHI)[J]. Am J Speech Lang Pathol, 1997, 6(3):66-70.
[14]	徐文, 李红艳, 胡蓉, 等. 嗓音障碍指数量表中文版信度和效度评价[J]. 中华耳鼻咽喉头颈外科杂志, 2008, 43(9):670-675.
	Xu W, Li HY, Hu R, et al. Analysis of reliability and validity of the Chinese version of Voice Handicap Index(VHI)[J]. Chin J Otorhinolaryngol Head Neck Surg, 2008, 43(9):670-675.
[15]	黄永望, 傅德慧. 嗓音的声学分析[J]. 中国听力语言康复科学杂志, 2016, 14(5):351-355.
	Huang YW, Fu DH. The acoustic analysis of voice[J]. Chin Sci J Hear Speech Rehabilitation, 2016, 14(5):351-355.
[16]	Abe D, Tüzün K, Tuhanio lu B, et al. Effect of endotracheal intubation on voice[J]. J Voice, 2021, 9:892.
[17]	Li GL, Hou Q, Zhang C, et al. Acoustic parameters for the evaluation of voice quality in patients with voice disorders[J]. Ann Palliat Med, 2021, 10(1):130-136. DOI URL
[18]	Cavallaro G, Di Nicola V, Quaranta N, et al. Acoustic voice analysis in the COVID-19 era[J]. Acta Otorhinolaryngol Ital, 2021, 41(1):1-5. DOI PMID
[19]	刘阳, 黄永望, 潘静, 等. 四步训练嗓音矫治法在声带息肉术后的应用及体会[J]. 中国中西医结合耳鼻咽喉科杂志, 2019, 27(4):259-263.
	Liu Y, Huang YW, Pan J, et al. Application of four steps method about voice therapy on patients with vocal polyps after surgery[J]. Chin J Otorhinolaryngol Integr Med, 2019, 27(4):259-263.
[20]	欧阳杰, 黄永望, 高晓葳, 等. 手术联合围手术期嗓音训练治疗声带息肉的疗效分析[J]. 听力学及言语疾病杂志, 2018, 26(5):492-495.
	Ouyang J, Huang YW, Gao XW, et al. The clinical efficacy of voice training on patients with vocal cord polyps during perioperative period[J]. J Audiol Speech Pathol, 2018, 26(5):492-495.
[21]	张滢滢, 王海芳, 钮美娥, 等. 吞咽障碍患者嗓音评估与训练的研究进展[J]. 中华护理杂志, 2019, 54(6):940-944.
	Zhang YY, Wang HF, Niu ME, et al. Research progress on voice evaluation and voice training in patients with dysphagia[J]. Chin J Nurs, 2019, 54(6):940-944.
[22]	施素华, 王培莉, 邹琼芳, 等. "互联网+"营养教育在维持性血液透析患者中的应用[J]. 中华护理杂志, 2021, 56(1):33-39.
	Shi SH, Wang PL, Zou QF, et al. Application of "Internet+" nu-trition education on patients with maintenance hemodialysis[J]. Chin J Nurs, 2021, 56(1):33-39.