抑酸治疗联合嗓音训练对伴嗓音障碍的反流性咽喉炎的疗效研究  

Therapeutic effect of acid-suppressing therapy combined with voice therapy in patients with voice-related symptoms caused by laryngopharyngeal reflux

作　　者：李林[1] 任庆宜 麦韵屏 LI Lin;REN Qingyi;MAI Yunping(Department of Otorhinolaryngology Head and Neck Surgery,Guangdong General Hospital Zhuhai Hospital,Zhuhai Golden Bay Center Hospital,Zhuhai,519040,China;Department of Otorhinolaryngology Head and Neck Surgery,Guangdong General Hospital,Guangdong Academy of Medical Sciences;Department of Gastroenterology,Guangdong General Hospital,Guangdong Academy of Medical Sciences)

机构地区：[1]广东省人民医院珠海医院(珠海市金湾中心医院)耳鼻咽喉头颈外科,广东珠海519040 [2]广东省医学科学院广东省人民医院耳鼻咽喉头颈外科 [3]广东省医学科学院广东省人民医院消化科

出　　处：《临床耳鼻咽喉头颈外科杂志》2018年第22期1714-1718,共5页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

摘　　要：目的:前瞻性对比研究抑酸治疗联合嗓音训练对伴有嗓音障碍的反流性咽喉炎的临床疗效。方法:71例伴有嗓音障碍的反流性咽喉炎患者,按随机数字法随机分为A、B 2个组。其中A组35例仅口服奥美拉唑肠溶片(20mg,2次/d,连续8周),B组36例口服奥美拉唑肠溶片(20mg,2次/d,连续8周)加嗓音训练4个月治疗,包括嗓音教育和发声训练,根据"呼吸-发声-共鸣"平衡原理,采用按摩练习、呼吸训练、唇舌肌练习、发声训练、共鸣练习的训练方法,每周训练1次,1～2h/次,共5次。比较分析2组患者治疗前、疗程结束时及疗程结束后1、2个月的反流症状指数量表(RSI),反流体征指数量表(RFS)评分,嗓音障碍指数量表(VHI)评分,总嘶哑度、粗糙声、气息声、无力嗓音、紧张嗓音听感知评估量表(GRBAS)评分和电子喉镜检查,并评定疗效。结果:2组患者治疗前后RSI、RFS、VHI、GRBAS评分、有效率均差异有统计学意义,治疗后2组各项评分在各时间点差异有统计学意义,各项评分的改善率差异亦有统计学意义,2组治疗有效率差异有统计学意义。结论:抑酸治疗联合嗓音训练治疗伴有嗓音障碍的反流性咽喉炎能改善患者的症状和体征,缩短治疗周期。Objective：Patients with laryngopharyngeal reflux frequently experience voice-related symptoms.This was a prospective study that designed to investigate the effectiveness of combined voice and medical therapy in comparison with medical therapy alone in the improvement of voice-related symptoms and parameters in patients with laryngopharyngeal reflux.Method：In this prospective study,total of 71 patients diagnosed with laryngopharyngeal reflux with voice symptoms were randomly divided into 2 groups（A and B）.Thirty-five patients in group A were treated with medication alone,and 36 patients in group B were treated with medication plus voice therapy.The following data were recorded before treatment and at the end of treatment and 1,2 months posttreatment：reflux symptom index（RSI）,reflux finding score（RFS）,voice handicap index（VHI）,and change in grade,roughness,breathiness,asthenia,and strain scale（GRBAS）were analysised.The Electronic laryngoscopywere performed to assess efficacy.The numbers of patients showing clinically significant reductions in these parameters were compared between groups.Result：Significantly more patients in the B group showed a clinically significant change in RSI,VHI,and GRBAS score at the end time,1-,and 2-month follow-up evaluations.No clinically significant change in RFS was achieved in either group at the end time or 1 months,but a significantly greater change was achieved in the study group at 2 months.Conclusion：Voice therapy may help to restore reversible mucosal change secondary to acidic reflux,inducing rapid resolution of symptoms and shortening of the treatment period.

关 键 词：咽喉反流 奥美拉唑 发声障碍 

分 类 号：R767.64[医药卫生—耳鼻咽喉科]