老年前循环和后循环脑梗死构音障碍患者的声学特征分析  

Analysis of acoustic characteristics in elderly patients with dysarthria in the anterior and posterior circulation cerebral infarction

作　　者：王璐 何蕾[1] 柴双双 冯宝玉 黄秀颖 田雨鑫 张冉[1] 徐文[2] 高磊 Wang Lu;He Lei;Chai Shuangshuang;Feng Baoyu;Huang Xiuying;Tian Yuxin;Zhang Ran;Xu Wen;Gao Lei(Department of Rehabilitation Medicine,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China;Department of Otolaryngology Head and Neck Surgery,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China)

机构地区：[1]首都医科大学附属北京同仁医院康复医学科,北京100730 [2]首都医科大学附属北京同仁医院耳鼻咽喉头颈外科,北京100730

出　　处：《中华老年医学杂志》2024年第12期1568-1574,共7页Chinese Journal of Geriatrics

摘　　要：目的探讨老年前循环和后循环脑梗死构音障碍患者声学特征的差异。方法病例对照研究,选取60例老年脑梗死构音障碍住院患者,分为前循环梗死组和后循环梗死组各30例,同时收集30例65岁及以上老年健康受试者设为健康对照组。使用嗓音嘶哑度评定分级(GRBAS)量表主观评估患者整体构音发声功能,再使用DIVAS2.5嗓音分析系统收集受试者构音功能相关客观参数数据,包括基频(F0)、基频微扰(Jitter)、振幅微扰(Shimmer)、最长发音时间(MPT)、最大声强(SPLmax)、最小声强(SPLmin)、发音障碍严重程度指数(DSI),对3组构音障碍患者以及健康受试者的声学特征进行分析。结果前循环梗死组与后循环梗死组患者的总嘶哑度(G)、粗糙度(R)、气息度(B)、无力度(A)和紧张度(S)均明显高于健康对照组受试者(F=16.574、39.793、46.309、52.154、25.603,均P<0.001);两两比较结果显示,前循环梗死组患者声音的粗糙度(R)和紧张度(S)明显高于后循环梗死组,而后循环梗死组患者声音的气息度(B)、无力度(A)以及总嘶哑度(G)则明显大于前循环梗死组患者(均P<0.001)。前循环梗死组患者声音基频值(F0)明显高于后循环梗死组患者以及健康对照组(F=39.050,P<0.001);而后循环梗死组患者基频值(F0)低于健康对照组(P=0.003)。前循环梗死组的Jiiter值大于后循环梗死组患者以及健康对照组(F=64.976,P<0.001);前循环梗死组的Shimmer值低于后循环梗死组,高于健康对照组(均P<0.001);前循环梗死组的MPT、SPLmin、SPLmax值均高于后循环梗死组患者,低于健康对照组(F=90.406、24.003、16.164,均P<0.001);前循环梗死组的DSI值较后循环梗死组患者和健康对照组更低(F=87.921,P<0.001)。结论老年脑梗死患者不同解剖位置损伤导致的构音障碍其声学特征参数存在差异,在实际临床工作中应结合损伤的解剖位置、主观症状评估以及客观声学特征分析对老年脑�ObjectiveTo investigate the differences in acoustic characteristics between older patients with dysarthria resulting from anterior and posterior circulation cerebral infarctions.MethodsA case-control study was conducted.Sixty hospitalized older patients with dysarthria were selected and divided into two groups:the anterior circulation cerebral infarction group and the posterior circulation cerebral infarction group,each comprising 30 cases.Additionally,thirty healthy individuals aged 65 and above were included as a control group.The subjective evaluation of the patients'overall phonetic function was conducted using the GRBAS scale.Objective parameters,including fundamental frequency(F0),Jitter,Shimmer,maximum phonation time(MPT),maximum sound pressure level(SPLmax),minimum sound pressure level(SPLmin),and the dysphonia severity index(DSI),were collected using the DIVAS2.5 voice analysis system.We analyzed the acoustic characteristics across the three groups:patients with dysarthria and healthy subjects.ResultsThe grade(G),roughness(R),breathiness(B),asthenia(A),and strain(S)scores of patients in both the anterior and posterior circulation cerebral infarction groups were significantly higher than those of the healthy control group(F=16.574,39.793,46.309,52.154,25.603;all P<0.001).Furthermore,the roughness(R)and strain(S)of the voice in the anterior circulation cerebral infarction group were significantly elevated compared to the posterior circulation cerebral infarction group,whereas the breathiness(B),asthenia(A),and grade(G)scores in the posterior circulation cerebral infarction group were significantly higher than those in the anterior circulation cerebral infarction group(all P<0.001).The fundamental frequency value(F0)of the voice in patients with anterior circulation cerebral infarction was significantly greater than that of both the posterior circulation cerebral infarction group and the healthy control group(F=39.050,P<0.001).In contrast,the fundamental frequency value(F0)of patients with posterior circula

关 键 词：脑梗死 声学 构音障碍 

分 类 号：R767.92[医药卫生—耳鼻咽喉科] R743.33[医药卫生—临床医学]