【摘要】 目的 探讨负性情绪对声带息肉术后嗓音质量恢复的影响。方法 收集2014-2017年我院收治的声带息肉术后4周嗓音质量恢复不良的成人患者36例,同时选取恢复良好的成人患者22例及正常对照组34例进行比较。应用焦虑自评量表(SAS)、抑郁自评量表(SDS)、视觉评分法(VAS)对受试者情绪进行评估,并采用嗓音障碍指数(VHI)量表及嗓音障碍严重指数(DSI)分析其嗓音质量。再将恢复不良患者随机分为两组,非心理疏导组20例仅接受发声指导,心理疏导组16例接受发声指导及心理疏导,1月后再次行SAS、SDS、VAS、VHI及DSI评估并进行比较。研究过程中,所有受试者均接受发声指导。结果 心理疏导组1例受试者因出现重度焦虑,无法配合治疗转至精神科就诊,其余15例受试者均获得良好治疗效果。将其接受心理疏导治疗后SAS、SDS、VAS、VHI(E值)、DSI(分别为38.62±0.68、38.46±0.66、0.62±0.02、2.14±1.56、-0.17±0.91)与治疗前(43.07±0.68、41.69±0.78、1.64±0.03、9.69±2.40、-4.75±1.32)比较,差异有统计学意义(均为P<0.05);且与非心理辅导组受试者治疗后SAS、SDS、VAS、VHI(E值)、DSI(40.47±0.77、39.92±0.61、0.91±0.06、9.58±2.06、-3.21±0.98)比较,差异亦有统计学意义(均为P<0.05),心理疏导治疗效果显著。结论 声带息肉患者术后的焦虑甚至抑郁状态等负性情绪会对嗓音恢复造成不良影响,临床医生应引起足够重视并予妥善处理,可提高声带息肉患者术后的嗓音质量。
【关键词】 声带息肉;焦虑自评量表;抑郁自评量表;嗓音障碍指数;发声困难指数
The effect of negative emotion on voice quality after the vocal cord polyp
ZHU Yue HENG Weiwei
(Department of Otolaryngology, Affiliated Stomatology Hospital, Medical college of Nanjing University, Nanjing 210008, China. Department of Otolaryngology, Institute and Hospital of Stomatology, Nanjing University Medical School, Nanjing, 210008, China)
【Abstract】 Objective To investigate the effect of negative emotion on vocal quality after polyp. Method 58 cases of vocal cord polyp were selected. 36 cases of poor recovery, 22 cases of
1 南京大学医学院附属口腔医院耳鼻咽喉科(南京 210008)
通讯作者:衡伟伟(hengww006@163.com)
good recovery and 34 cases of healthy persons as control. The 36 cases of poor recovery were randomly divided into two groups, with group 1 of 20 patients receiving only vocal guidance, and the group 2 of 16 patients receiving vocal guidance and psychological counseling. The subjects were evaluated by self-rating anxiety scale (SAS), self-rating depression scale (SDS) and visual analogue scale (VAS). Then all 92 cases were analyzed the voice quality with voice disability index (VHI) scale and dysphonia severity index (DSI). Next the group1 should need receive the vocal guidance. The vocal guidance and psychological counseling were performed on the group 2. After a month, the SAS, SDS, VAS, VHI and DSI were evaluated in the two groups of poor recovery. All 92 cases were received the vocal guidance during the study Result In group 2 we suggested one patient to have the psychiatric treatment because of her severe anxiety. The remaining 15 subjects showed significant improvement in their main complaints. Psychological counseling subjects after SAS, SDS, VAS, VHI (Emotion), DSI (38.62±0.68, 38.46±0.66, 0.62±0.02, 2.14±1.56, -0.17±0.91) before the treatment (43.07±0.68, 41.69±0.78, 1.64±0.03, 9.69±2.40, -4.75±1.32) improved significantly, compared with before treatment the differences were significant (all P<0.05). Also compared with the group 1(40.47±0.77、39.92±0.61、0.91±0.06、9.58±2.06、-3.21±0.98), the SAS, SDS, VAS, VHI (Emotion), DSI results of group two improved significantly, and the differences were significant (all P<0.05). Conclusion The negative emotion on post-operation patients of vocal polyps will affect the recovery of voice. We should pay attention to this status and properly handle, which can improve the voice quality of postoperative patients with vocal cord polyp.
【Key words】 Vocal polyp;SAS;SDS;VHI;DSI
声带息肉是临床上造成声音嘶哑的主要原因之一,手术是常用的治疗方式。术后嗓音质量的恢复是评价手术疗效的重要指标,影响因素也较多。根据文献[1-4]报道,与息肉性状、手术方式、术后声休方案、术后发音训练及术后药物治疗等有关。声带息肉造成的嗓音障碍通常会引起患者情感方面的变化,加重患者心理负担。手术治疗后,绝大多数患者嗓音质量恢复的同时,负性情绪可以得到明显改善直至消失[5]。然而我们在临床上发现有少部分患者术后负性情绪扩大,甚至出现焦虑、抑郁状态,从而导致发声障碍,术后恢复不良。近年来研究显示[6-7],患者自身心理精神状况与嗓音功能关系密切,是影响嗓音质量恢复的重要原因之一。我们通过对声带息肉手术后出现发声障碍患者精神心理状态的研究,探讨两者之间的关系,以期能为临床治疗提供参考。
1 对象与方法
1.1研究对象及分组 2014年1月-2017年11月,36例在南京大学医学院附属口腔医院耳鼻咽喉科行声带息肉手术,术后4周仍有发声障碍患者,其中男7例,女29例,年龄22-65岁,平均年龄44±11.7岁。术前病程1月-2年,平均0.7年。纳入标准:(1)术后4周仍声音嘶哑[8],电子喉镜检查示双侧声带边缘光滑,无息肉残留,无充血水肿等声带器质性疾病;(2)既往无咽喉慢性炎症及听力障碍病史;(3)无呼吸道及神经系统疾病;(4)无吸烟酗酒史。排除标准:(1)术后息肉残留或手术创伤较大引起声带充血水肿及慢性炎症;(2)拒绝本实验者。然后将恢复不良组受试者随机分为两组,非心理疏导组,其中男5例,女15例,年龄24-65岁,平均年龄45±12.8岁,术前病程3月-2年,平均0.8年;心理疏导组16例,其中男2例,女14例,年龄22-65岁,平均年龄43±10.3岁,术前病程1月-1.8年,平均0.7年。同时分别选取性别、年龄匹配的22名声带息肉术后4周恢复良好者,其中男4例,女18例,平均年龄45±13.6岁,及34名健康志愿者(发声正常,无咽喉疾病及嗓音障碍病史)作为对照组,其中男5例,女29例,平均年龄44±9.6岁。对照组均无吸烟酗酒史,无听力、呼吸道及神经精神系统疾病。研究中,手术治疗4周后,对恢复不良组、恢复良好组及正常对照组受试者行相关量表及声学评估,并比较结果,然后恢复不良组的两组受试者继续声休及发声指导1月,其中仅对心理疏导组加行心理疏导。经治疗后,即在手术治疗8周后,对恢复不良组的两组受试者再次行相关量表及声学评估并比较结果。本研究获得南京大学医学院附属口腔医院医学临床研究伦理委员会批准,征得患者同意,并签署知情同意书。
作者:朱越1 衡伟伟1