神经肌电图监测下经皮肉毒素A喉肌注射治疗痉挛性发音障碍  

Transcutaneous EMG-guided botulinum toxin A injection for spasmodic dysphonia

作　　者：何双八[1] 张庆翔[1] 董园园[1] 孙国燕[1] 于振坤[1] HE Shuangba;ZHANG Qingxiang;DONG Yuanyuan;SUN Guoyan;YU Zhenkun(Department of Otolaryngology Head and Neck Surgery,Nanjing Tongren Hospital,School of Medicine Southeast University,Nanjing Tongren ENT Hospital,Nanjing,Jiangsu,211102,China)

机构地区：[1]东南大学医学院附属南京同仁医院耳鼻咽喉头颈外科南京同仁耳鼻喉医院,江苏南京211102

出　　处：《中国耳鼻咽喉头颈外科》2018年第9期461-464,共4页Chinese Archives of Otolaryngology-Head and Neck Surgery

基　　金：江苏省自然科学基金(BK20161116);南京市2015年度科技发展计划(201503057)联合资助

摘　　要：目的探索神经肌电图监测下经皮肉毒素A注射治疗痉挛性发音障碍的效果和价值。方法根据喉内镜、嗓音学检查后诊断为痉挛性发音障碍的患者18例,进行神经肌电图监测下经皮肉毒素A,根据痉挛的部位,注射部位为甲杓肌、甲会厌肌、环杓后肌等,剂量为0.1~1.0U,注射频率为每月1次,行频闪喉镜检查和嗓音障碍指数(voice handicap index,VHI)主观评分以及客观嗓音分析,包括喉肌电图检查(EMG)、基频微扰(jitter)、振幅微扰(shimmer)以及最大发音持续时间(maxium phonation time,MPT)测定等来评估患者的嗓音质量。结果 18例患者注射后24小时起效,发音震颤及中断症状明显改善,发音流利、平稳,无音质紧张,疗效均持续1个月,经过3次注射后,患者喉内镜下见声带震颤症状明显消失,患者发音流利,嗓音主观评估和客观嗓音分析明显改善,注射前声带闭合时挤压明显,声门上区代偿;注射后声带闭合时节奏感,声门上区代偿减轻。喉肌电图和多维嗓音分析程序(MDVP)提示注射后比注射前改善明显。所有患者术后均并发程度不等的声嘶症状,一般在注射后2天出现,持续3~5天,3例患者出现饮水呛咳,所有患者无呼吸困难。所有患者随访6~36个月,发音良好。结论神经肌电图监测下经皮肉毒素A喉肌注射是治疗痉挛性发音障碍的有效方法。OBJECTIVE To Explore the voice outcome of spasmodic dysphonia（SD） after transcutaneous EMG-guided botulinum toxin A（ BT X-A）i nje c t ion. METHODS Eighteen patients diag nosed as SD by laryngoscope and EMG were treated with transcutaneous EMG-guided BTX-A injection. BTX-A was injected into the laryngeal muscles, such as thyroarytenoid muscles, thyroepiglottic muscles, posterior cricoarytenoid muscles. Individual dose of BTX-A ranged from 0.1 U to 1.0 U per muscle once a month. The voice outcomes, including Voice Handicap Index（VHI）, EMG, jitter, shimmer and maximum phonation time（MPT） were analyzed after 3 times injections. RESULTS All the patients were followed up after injection. The average onset of toxin began to work in 24 hours after injection in all the patients. The voice qualities were improved. The patients communicated normally with 1 month. The closure of the vocal cords were well. The mucosal wave of vocal cords closed to the normal when voice. Parameters of voice analysis after injection in 3 months were better than pre-injection. The side-effects of toxin injection were breathy voice or occasional dysphagia and aspiration, which subsided spontaneously within one week. CONCLUSION Transcutaneous EMG-guided BTX-A injection is an effective method for treating SD and worth being recommended.

关 键 词：发音障碍 注射 痉挛性 肉毒素 嗓音质量 

分 类 号：R767[医药卫生—耳鼻咽喉科]