痉挛性发声障碍的病因及发病机制探讨  

The etiology and pathogenesis of spasmodic dysphonia

作　　者：于萍[1] 屈歌 YU Ping;QU Ge(Department of otorhinolaryngology&Head and Neck Surgery,Institute of Otolaryngology,Chinese PLA General Hospital/Na-tional Clinical Research Center for Otolaryngologic Diseases,Beijing 100853,China;Music college of Capital Normal University,Beijing 100048,China)

机构地区：[1]中国人民解放军总医院耳鼻咽喉头颈外科医学部/国家耳鼻咽喉疾病临床医学研究中心,北京100853 [2]首都师范大学音乐学院,北京100048

出　　处：《山东大学耳鼻喉眼学报》2021年第3期14-19,共6页Journal of Otolaryngology and Ophthalmology of Shandong University

基　　金：国家自然科学基金面上项目(61273288)。

摘　　要：目的回顾性分析痉挛性发声障碍(SD)患者的人口学特点、发生背景、嗓音障碍特点及不同治疗方法的效果,探讨痉挛性发声障碍的病因及发病机制。方法受试者为68例痉挛性发声障碍患者,病程5个月~8年,男6例,女62例;调查患者的职业、受教育程度、家庭或(和)工作状况、嗓音障碍出现的背景、病程、嗓音障碍的表现形式等。录音文字为朗读一首短诗及发长元音[a:]。采用三种不同方式发声:正常说话声、耳语声、提高声调发声。根据患者的嗓音障碍程度、病史、年龄及意愿,按照下列原则治疗:①注射肉毒素;②放松训练;③音乐治疗;④药物治疗;⑤发声训练。结果SD的高发年龄段位于30~49岁,女性显著高于男性,性别比为1∶10.3。嗓音障碍发生在重要困难时期29例,发生在精神创伤后15例,经历过不良事件5例,无明确心理背景19例。治疗效果:22例接受过1~5次肉毒素治疗的患者中,治愈1例,缓解14例,无效7例;接受音乐治疗4例,治愈1例,缓解3例;23例接受发声训练治疗,缓解8例,无效15例;口服抗焦虑类药物12例,缓解2例,无效10例;自我放松训练7例,治愈4例,无效3例。结论多种治疗方法的选择及相同治疗方法产生不同的治疗效果,提示SD病因的多维性和发病机制的复杂性。负性生活事件或(和)长期的精神压力与SD的发生有高度相关性,提示心理背景是导致出现SD和影响治疗效果的一个重要因素。Objective To retrospectively analyze the demographic characteristics,occurrence background,characteristics of voice disorders,and effects of different treatment methods in patients with adduction spasmodic dysphonia(SD),as well as to explore the etiology and pathogenesis of SD.Methods Sixty eight SD patients aged 5 months to 8 years were enrolled,including 62 women and 6 men.We investigated the patient’s occupation,education,family or/and work status,background,onset mode and course of disease,manifestation of voice disorder,and others.The recorded text was a short poem and long vowel[a:].It was produced in three different ways:normal speech,whispering,and high-pitched voice.The anatomical morphology of the bilateral vocal cords was normal on electronic laryngoscopy.According to the patient?s age,degree of voice disorder,course of disease,and willingness to choose the treatment:injection of Botox,voice training and/or self-regulating relaxation therapy,music therapy,and anti-anxiety drugs.Results The age range of the SD patients was 30-49 years,and the number of females was significantly higher than that of males,with a sex ratio of 1:10.3.Voice disorders occurred in 29 cases of important difficult periods,15 cases of mental trauma,5 cases of adverse events,and 19 cases of no clear psychological background.Therapeutic effect:Among the 22 patients who received botulinum toxin treatment 1-5 times,1 case was cured,14 cases were relieved,and 7 cases were invalid;4 cases were treated with music therapy,of which 1 case was cured and 3 cases were relieved;23 cases were treated with vocal training,of which 8 cases were relieved and 15 cases were invalid;12 cases were treated with oral anti-anxiety drugs,of which 2 cases were relieved and 10 cases were invalid;and 7 cases were treated with self-relaxation training,of which 4 cases were cured and 3 cases were invalid.Conclusion The diversity of therapeutic methods resulted in different therapeutic effects,suggesting a multidimensional etiology and the complexity of the p

关 键 词：嗓音 发声障碍 痉挛性 人口学特点 负性生活事件 精神压力 

分 类 号：R767.92[医药卫生—耳鼻咽喉科]