Treatment efficacy of electronic endoscope-guided botulinum toxin injection in adductor spasmodic dysphonia patients
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摘要: 目的 探讨经内镜下A型肉毒素声带注射治疗内收型痉挛性发声障碍(SD)的疗效及可行性。方法 回顾性分析确诊为SD并行A型肉毒素声带注射治疗的43例患者的临床资料。患者均由经验丰富的嗓音专家进行诊断, 并根据病情严重程度进行分级, 再采用内镜下A型肉毒素声带注射法治疗。治疗前及治疗后常规行频闪喉镜检查, 同时由患者本人填写嗓音障碍指数10(VHI-10)量表, 并行嗓音相关症状VAS评分(自评和他评), 以嗓音的主观评估进行治疗前后的疗效对比。结果 35例患者首次注射有效, 平均药物起效时间为注射后(2.33±1.86) d, 药效持续时间为1~6个月, 平均持续时间为(2.42±1.65)个月。注射A型肉毒素后, 无一例出现严重或持续性不良反应。注射前后相比, 中、重度SD患者VHI-10的总分、功能及生理比较差异均有统计学意义(P < 0.05), 中度SD患者嗓音相关症状VAS评分(自评和他评)中, 说话清晰度在治疗前后差异无统计学意义(P>0.05), 嗓音质量总体评价及其余子项比较差异均有统计学意义(P < 0.05)。SD重度患者嗓音相关症状VAS评分(自评和他评)中, 发声时的挤压程度和发声时的费力程度在治疗前后比较差异无统计学意义(P>0.05), 嗓音质量总体评价及其余子项比较差异均有统计学意义(P < 0.05)。结论 在没有喉肌电图的情况下, 内镜下行A型肉毒素声带注射能明显改善SD患者的嗓音质量, 嗓音相关生活质量亦大有提高。该方法操作简单、创伤小、安全有效, 易于门诊开展。Abstract: Objective To investigate the treatment efficacy of electronic endoscope-Guided botulinum toxin injection in Adductor Spasmodic Dysphonia Patients.Method Clinical characteristics of forty- three cases were retrospectively analyzed. The disease were diagnosed with adductor spasmodic dysphonia and graded according to the severity of the disease by experienced voice specialist. All the cases were treated by electronic endoscope-guided botulinum toxin type A injection in bilateral thyroarytenoid muscles. All the subjects underwent stroboscopic laryngoscope examination and filled in the Voice Handicap Index-10(VHI-10). They also filled in the VAS score of Voice related symptoms by self evaluation and other evaluation. One month Later, the patients and someone they lived with filled in the VAS score of Voice related symptoms again.Result After the first injection, the voice-related symptoms of 35 patients improved to varying degrees..All The average onset time of drug was(2.33±1.86) days. The duration of curative effect ranged from 1 to 6 months, the average duration was(2.42±1.65) months. After injection, no one had serious or persistent adverse reactions. There were significant differences in the total score of VHI-10, physiology(P) and function(F) dimensions in VHI-10 of moderate and severe SD patients before and after injection(P < 0.05) in all patients. For moderate cases, no significant change in speech articulation(P>0.05), overall evaluation of voice quality and any other subprojects are statistically significant(P < 0.05) in the VAS score of Voice related symptoms; For severe cases, the degree of squeezing and effort during vocalization are no statistically significant(P>0.05), overall evaluation of voice quality and any other subitems are statistically significant(P < 0.05) in the VAS score of Voice related symptoms.Conclusion In the absence of LEMG, electronic endoscope-guided botulinum toxin injection in adductor spasmodic dysphonia patients can significantly improve the voice quality and quality of life of adductive SD patients. The method is simple to operate, less traumatic, safe and effective, and easy to carry out outpatients service.
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Key words:
- spasmodic dysphonia /
- electronic endoscope /
- botulinum toxin
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表 1 43例患者注射后起药物反应统计学结果
组别 起效时间/d 持续时间/月 注射后声音开始稳定的时间/d 中度组 1.95±1.42 3.17±1.72 12.25±6.33 重度组 3.31±2.84 2.63±1.15 11.50±5.45 
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表 2 8例重度SD患者VHI-10量表评估结果
时间 功能(F) 生理(P) 情感(E) 总分 注射前 17.00±4.341) 10.25±2.661) 5.25±1.75 32.50±8.051) 注射后 12.80±3.26 4.40±3.71 5.00±2.44 15.20±9.41 与注射后比较，1)P < 0.05。
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表 3 8例重度SD患者嗓音相关症状VAS评分结果(自评)
时间 总体评价 发声时卡顿频率 发声时挤压程度 发声时费力程度 发声时震颤程度 说话清晰度 注射前 8.25±1.901) 7.50±2.871) 8.50±1.77 8.50±2.78 7.00±3.301) 8.75±1.031) 注射后 5.87±3.31 5.87±3.31 6.62±4.17 5.35±3.45 4.75±2.31 6.25±2.39 与注射后比较，1)P < 0.05。
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表 4 8例重度SD患者嗓音相关症状VAS评分结果(他评)
时间 总体评价 发声时卡顿频率 发声时挤压程度 发声时费力程度 发声时震颤程度 说话清晰度 注射前 8.25±1.581) 9.00±1.851) 8.50±1.60 8.79±1.46 7.25±1.161) 6.00±2.731) 注射后 5.25±2.82 5.62±3.25 6.62±1.17 6.35±3.72 4.37±2.13 4.25±1.39 与注射后比较，1)P < 0.05。
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表 5 35例中度SD患者VHI-10量表评估结果
组别 功能(F) 生理(P) 情感(E) 总分 注射前 13.23±5.551) 8.68±2.601) 5.70±2.08 24.14±7.981) 注射后 10.82±4.45 6.88±3.51 4.64±1.84 17.65±9.12 与注射后比较，1)P < 0.05。
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表 6 35例中度SD患者嗓音相关症状VAS评分结果(自评)
时间 总体评价 发声时卡顿频率 发声时挤压程度 发声时费力程度 发声时震颤程度 说话清晰度 注射前 7.41±1.561) 7.77±1.691) 7.59±1.681) 8.00±1.541) 7.09±2.501) 7.31±1.48 注射后 5.37±2.39 4.56±1.71 4.75±1.91 5.18±2.63 4.69±2.09 7.00±2.50 与注射后比较，1)P < 0.05。
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表 7 35例中度SD患者嗓音相关症状VAS评分结果(他评)
时间 总体评价 发声时卡顿频率 发声时挤压程度 发声时费力程度 发声时震颤程度 说话清晰度 注射前 7.29±1.471) 7.37±1.781) 7.69±1.341) 7.94±1.341) 6.87±2.001) 6.94±1.88 注射后 5.82±2.51 5.16±2.17 5.62±2.70 5.63±2.70 5.18±2.48 6.47±1.82 与注射后比较，1)P < 0.05。
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