Influence of voice training combined with active breathing and circulation technique on voice recovery after vocal cord polyp surgery
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摘要: 目的 探讨声带息肉术后嗓音训练联合主动呼吸循环技术对嗓音恢复的影响。 方法 选取2022年5月-2023年11月在武汉市中西医结合医院耳鼻咽喉科行声带息肉术的患者110例，以随机数字表法分为对照组(n=55)和联合组(n=55)。2组术后恢复期控制饮食并进行雾化治疗，对照组给予嗓音训练，联合组在嗓音训练的基础上联合主动呼吸循环技术，持续训练2个月。比较2组形态学改变、嗓音声学指标[振幅微扰(Shimmer)、基频微扰(Jitter)、最大发声时间(MPT)]及嗓音障碍指数(VHI)，并评估临床疗效。 结果 与对照组比较，训练后联合组临床疗效更高，差异有统计学意义(P＜0.05)。与训练前比较，训练后2组闭合不全、黏膜波异常、声门上代偿的占比均有所下降(P＜0.05)；训练后，2组闭合不全、黏膜波异常占比比较，差异无统计学意义(P>0.05)，联合组声门上代偿患者占比低于对照组(P＜0.05)。训练后，2组Shimmer、Jitter值较训练前降低，联合组更低(P＜0.05)，2组MPT值较训练前升高，联合组更高(P＜0.05)。与训练前比较，训练后2组VHI的功能、生理、情感评分均下降，联合组上述指标评分低于对照组，差异有统计学意义(P＜0.05)。 结论 嗓音训练联合主动呼吸循环技术应用于声带息肉术后的疗效好，可明显改变声带形态学及嗓音声学指标，改善嗓音障碍，促进嗓音恢复。Abstract: Objective To explore the influence of voice training combined with active breathing and circulation techniques on voice recovery following vocal cord polyp surgery. Methods A total of 110 patients who underwent vocal cord polyp surgery at our hospital from May 2022 to November 2023 were selected and randomly divided into a control group (n=55) and a combination group (n=55) using a random number table method. During the recovery period, both groups received dietary control and aerosol treatment. The control group participated in voice training, while the combination group received active breathing and circulation techniques in addition to voice training for 2 months. Morphological changes, voice acoustic indicators (Shimmer, Jitter, Maximum Phonation Time[MPT]), and the Voice Handicap Index (VHI) were compared between the two groups, and clinical efficacy was evaluated. Results The combination group demonstrated higher clinical efficacy after training compared to the control group, with a statistically significant difference (P < 0.05). The proportion of incomplete closure, abnormal mucosal wave, and supraglottic compensation decreased in both groups after training (P < 0.05). However, there was no significant difference in the proportions of incomplete closure and abnormal mucosal wave between the two groups (P>0.05). Notably, the proportion of patients with supraglottic compensation in the combination group was lower than in the control group (P < 0.05). After training, the Shimmer and Jitter values decreased in both groups, with the combination group exhibiting lower values (P < 0.05). Conversely, the MPT values increased in both groups, again with higher values in the combination group (P < 0.05). Additionally, after training, the functional, physiological, and emotional scores of the VHI decreased in both groups, with the scores in the combination group lower than those in the control group, demonstrating statistical significance (P < 0.05). Conclusion Voice training combined with active breathing and circulation techniques has a beneficial effect on recovery following vocal cord polyp surgery. This combined approach significantly improves vocal cord morphology and acoustic indices, alleviates voice disorders, and enhances overall voice recovery.
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表 1 临床疗效比较
例(%) 组别 例数 治愈 好转 无效 总有效率 对照组 55 34(61.82) 18(32.73) 3(5.45) 52(94.55) 联合组 55 24(43.64) 21(38.18) 10(18.18) 45(81.82) χ2 4.274 P 0.039 
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表 2 形态学比较
例(%) 组别 例数 闭合不全 黏膜波异常 声门上代偿 训练前 训练后 训练前 训练后 训练前 训练后 对照组 55 55(100.00) 12(21.82)1) 52(94.55) 9(16.36)1) 29(52.73) 18(32.73)1) 联合组 55 55(100.00) 5(9.09)1) 55(100.00) 3(5.45)1) 27(49.09) 8(14.55)1) χ2 - 3.409 3.084 3.367 0.146 5.037 P - 0.065 0.079 0.067 0.703 0.025 与训练前比较，1)P＜0.05。
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表 3 嗓音声学指标比较
X±S 组别 例数 Shimmer/% Jitter/% MPT/s 训练前 训练后 训练前 训练后 训练前 训练后 对照组 55 17.72±3.66 11.82±2.421) 9.12±1.83 5.25±1.081) 12.63±2.87 15.75±3.551) 联合组 55 18.30±3.75 9.78±2.061) 8.89±1.77 3.94±0.761) 11.90±2.54 19.67±4.131) t 0.821 4.760 0.670 7.357 1.413 5.338 P 0.414 ＜0.001 0.504 ＜0.001 0.161 ＜0.001 与训练前比较，1)P＜0.05。
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表 4 VHI比较
X±S 组别 例数 功能 生理 情感 训练前 训练后 训练前 训练后 训练前 训练后 对照组 55 30.58±5.23 16.14±3.691) 32.16±5.37 18.92±4.151) 30.74±5.62 15.03±2.841) 联合组 55 29.40±4.88 13.83±3.001) 31.90±5.52 16.33±4.071) 31.50±5.39 11.50±2.451) t 1.223 3.602 0.250 3.304 0.724 6.980 P 0.224 ＜0.001 0.803 0.001 0.471 ＜0.001 与训练前比较，1)P＜0.05。
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