维吾尔族老年反流性咽喉病病人临床症状及其嗓音声学指标观察

目的观察维吾尔族老年反流性咽喉病(laryngopharyngeal reflux disease,LPRD)病人治疗后临床症状及嗓音声学特征指数的变化情况。方法选择我院耳鼻咽喉科门诊就诊的100例维吾尔族老年LPRD病人(排除咽喉占位性病变)作为研究对象(LPRD组);选择同期100例体检合格的健康老年维吾尔族志愿者作为对照组,所有对象均行动态频闪喉镜检查。采用德国XION DIVAS嗓音测试分析系统检测2组受试者的嗓音相关指标:基频微扰(Jitter)、振幅微扰(Shimmer)、声压级(SPL)、最长发声时间(MPT)、最大基频(FOmax)、最小基频(FOmin)、嗓音障碍指数(DSI)。观察LPRD组治疗后的反流症状指数(RSI)评分、反流体征指数(RFS)评分和嗓音相关指标,并与对照组进行比较。结果治疗后,LPRD组病人声音嘶哑、咽部异物感及反酸烧心感等不适均有明显好转,RSI和RFS评分均恢复至正常参考值范围内,且与对照组比较差异无统计学意义(P0.05)。治疗后3月随访发现,与对照组比较,LPRD组的基频微扰显著增高,DSI均值显著降低,2组比较差异有统计学意义(P0.05)。结论 LPRD可能导致老年病人声带病理改变而造成嗓音损害。     

六字诀应用于老年甲状腺术后单侧声带麻痹患者嗓音矫治的疗效分析

目的 探讨传统气功六字诀应用于甲状腺术后单侧声带麻痹(UVCP)老年患者嗓音矫治的疗效。方法 56例符合纳入标准的甲状腺术后UVCP患者，采用六字诀进行嗓音矫治四周。评估治疗前后GRBAS量表、嗓音障碍指数量表(VHI)评分，基频(F0)、基频微扰(Jitter)、振幅微扰(Shimmer)、噪谐比(NHR)、最长发声时间(MPT)的变化。结果 治疗后的GRBAS评分和VHI量表评分显著下降，F0、 Jitter、 Shimmer、 NHR显著降低，MPT延长，存在统计学差异(P<0.05)。结论 老年甲状腺术后UVCP患者，采用传统气功六字诀进行嗓音矫治，可改善其嗓音功能。     

咽喉反流对声带接触性肉芽肿治疗的研究

目的评价声带接触性肉芽肿的发病原因及咽喉反流在声带接触性肉芽肿发生中的作用。 方法对2012年1月至2017年1月由新疆维吾尔自治区人民医院确诊并手术治疗的声带接触性肉芽肿患者42例术前进行病因分析及反流症状指数量表（RSI ）和咽喉反流的体征量表（RFS）测量,同时行24 h胃食管pH监测,术后行质子泵抑制剂治疗,15 d、3、6个月行术后随访及电子喉镜检查,评价疗效。 结果RSI阳性22例,RFS阳性26例,24 h动态胃食管PH值监测,咽喉部阳性患者达29例,术后复发患者31例,其中咽喉反流占26例,治疗后15 d、3、6个月的有效率为15.38%、69.23%、92.30%,3个时期疗效存在明显差异,有统计学意义（P<0.05）。 结论声带接触性肉芽肿治疗手术治疗要慎重,正规抗反流治疗可能提高治疗疗效。     

雾化吸入布地奈德联合兰索拉唑治疗胃食管反流病合并食管裂孔疝效果观察

目的探讨分析雾化吸入布地奈德联合兰索拉唑治疗胃食管反流病合并食管裂孔疝的效果。方法选取2016年1月至2018年5月惠州市第六人民医院收治的96例胃食管反流病合并食管裂孔疝患者,随机分为观察组和对照组。均给予腹腔镜食管裂孔疝修补联合胃底折叠术治疗,围手术期对照组患者给予兰索拉唑治疗,观察组患者给予雾化吸入布地奈德联合兰索拉唑治疗。观察比较两组患者临床疗效,治疗前后肺功能指标、动脉血气分析指标、GerdQ量表评分、血清GAS、NO含量,食管黏膜愈合情况。结果观察组临床疗效总有效率为95.83%,显著高于对照组的81.25%(P0.05)。食管黏膜愈合率为97.92%,显著高于与对照组的83.33%(P0.05)。治疗前,两组肺功能、动脉血气、GerdQ量表评分、血清GAS、NO指标差异无统计学意义(P0.05);治疗后,观察组FEV1、FVC、FEV1/FVC、SaO2、PaO2、血清GAS水平均显著高于对照组,血清NO水平显著低于对照组,差异均具有统计学意义(P0.05)。治疗后两组MVV、PaCO2水平差异无统计学意义(P0.05)。两组不良反应发生率差异无统计学意义(P0.05)。结论胃食管反流病合并食管裂孔疝患者围手术期给予雾化吸入布地奈德联合兰索拉唑治疗可显著提高临床疗效、食管黏膜愈合率,保护气道,改善肺功能,缓解患者胃肠道症状,且治疗的安全性高。     

新型肺动脉带瓣支架Venus P植入围术期的监测与治疗

目的:探讨Venus P自膨胀瓣膜系统经皮肺动脉瓣植入术(PPVI)的围术期观察与处理策略。方法:回顾性分析2017年12月-2019年12月阜外华中心血管病医院儿童心脏中心共13例法洛四联症矫治术后行PPVI的患者,探讨围术期的具体管理方法,并分析手术前后肺动脉瓣反流程度、三尖瓣反流程度、右心室前后径、右心室流出道直径、左心室射血分数、血脑钠肽(BNP)值、QRS波宽度的变化、术后机械通气时间和重症监护室滞留时间。结果:13例患者均成功植入Venus P瓣膜支架,无严重并发症,术后肺动脉瓣均为无反流或者微量反流,肺动脉瓣反流面积术后为0.30(0.00,0.85) cm~2,与术前8.20(7.75,9.80) cm~2比较,差异有统计学意义(Z=-4.373,P0.01)。其他临床观察指标围术期手术前后变化差异均无统计学意义。结论:国产Venus P自膨胀瓣膜系统可安全有效解决法洛四联症跨瓣环补片矫治术后的肺动脉瓣重度反流、右心室流出道功能不全的问题,临床需要不断积累围术期观察与处理策略的经验,以增加手术的安全性,减少相关并发症的发生。     

微瓣术与CO2激光术治疗Reinke’s水肿疗效比较

目的比较支撑喉镜显微镜下喉显微器械微瓣术和CO：激光术治疗任克（Reinke’s）水肿的疗效。方法Reinke’s水肿患者68例,采用微瓣术治疗36例（微瓣术组）、CO2激光术治疗32例（CO2激光术组）,术后2周进行疗效评价,并进行动态喉镜及计算机嗓音检测。结果微瓣术组痊愈33例（91．6％）,好转3例（8．3％）,总有效率100％（36／36）;CO2激光术组痊愈29例（90．6％）,好转3例（10．3％）,总有效率100％（32／32）;两组痊愈率、好转率、总有效率比较差异均无统计学意义（P均〉0．05）。微瓣术组频闪喉镜下声门闭合、声带波动幅度、嗓音分析基频微扰及噪声能量均优于CO2激光术组（P均〈0．05）。结论微瓣术和CO2激光术治疗Reinke’s水肿安全可靠,前者术后客观检查的近期效果更好。     

功能性二尖瓣返流对慢性心力衰竭患者临床预后的影响

目的探讨116例功能性二尖瓣返流(Mitral regurgitation MR)程度对慢性心力衰竭患者预后的影响。方法回顾性分析116例慢性心力衰竭伴MR患者,按返流程度轻度、中度、重度分三组,检测并分析治疗前后N_端脑钠肽前体(NT_pro BNP)、左心室舒张末期内径(LVEDD)、左心室射血分数(LVEF)测值。结果治疗前各组间NT_pro BNP、LVEDD值比较差异有统计学意义(P0.05);LVEF值在轻度组与中度组之间比较差异无统计学意义(P0.05),而在轻中度组与重度组之间比较差异有统计学意义(P0.05)。优化治疗后在轻度和中度组NT_pro BNP、LVEF值治疗前后比较差异有统计学意义(P0.05),轻度组LVEDD值治疗前后比较差异有统计学意义(P0.05)。重度组NT_pro BNP、LVEDD及LVEF值治疗前后比较差异均无统计学意义(P0.05)。不同病因心脏病MR程度比较差异无统计学意义(P0.05),高血压性心脏病、冠心病患者治疗前后MR程度比较差异有统计学意义(P0.05),而扩张型心肌病患者治疗前后MR程度比较差异无统计学意义(P0.05)。结论 MR是影响慢性心力衰竭治疗效果的重要因素,优化药物治疗对轻、中度MR者效果较好,对部分伴中度MR药物治疗后临床指标改善不明显和重度MR及扩张型心肌病伴MR者疗效欠佳。     

支撑喉镜联合鼻内镜电凝治疗早期声门型喉癌的嗓音分析及声带新生情况观察

目的探讨支撑喉镜联合鼻内镜电凝切除病变声带治疗早期声门型喉的嗓音分析及声带新生情况。方法选取该院2012-01~2016-08诊治早期声门型喉癌患者100例,按照数字表法随机分为观察组和对照组,各50例。对照组接受喉裂开声带切除或喉部分切除术,观察组接受支撑喉镜联合鼻内镜电凝切除病变声带治疗,根据随访6个月有无声带新生将其分为声带新生组(35例)及无声带新生组(65例),比较两组人群声学特征。结果术前两组患者参数基顿(FO)、最长发音时间(MPT)比较,差异无统计学意义(P0.05),术后2周、1、3个月观察组FO均低于对照组,MPT均高于对照组,差异有统计学意义(P0.05);观察组声带新生率58.00%(29/50)高于对照组的12.00%(6/50),无声带新生组FO高于声带新生组,MPT低于声带新生组,差异有统计学意义(P0.05)。结论支撑喉镜联合鼻内镜电凝切除病变声带治疗早期声门型喉癌,损伤较小,利于患者术后声带新生及术后嗓音恢复,值得临床作进一步推广。     

胃食管反流病与慢性咳嗽的关系

胃食管反流病(GERD)临床表现分为食管症状和食管外症状,后者包括肺部症状(即哮喘、咳嗽、呼吸困难和支气管炎等)和耳鼻咽喉症状(即慢性咽喉炎、声嘶、声带结节、声带息肉和鼻窦炎等),易误诊.近年来国内外研究比较关注GERD对呼吸系统的损害及其诊治,此文就此作一综述.     

胃食管反流病合并焦虑及抑郁状态初步临床评估

目的比较胃食管反流病(gastroesophageal reflux disease,GERD)中非糜烂性反流病(non-erosive reflux disease,NERD)与反流性食管炎(reflux esophagitis,RE)患者精神心理异常症状表现,为其有效治疗提供依据。方法选择反酸、烧心、胸骨后疼痛为主诉,伴焦虑和(或)抑郁症状的患者,经胃食管反流病问卷(Gred Q)调查确定为GERD者为研究对象,依据胃镜检查结果分为RE组和NERD组。两组均进行汉密尔顿焦虑、抑郁量表问卷调查。结果 GERD伴焦虑和(或)抑郁患者共52例,其中NERD患者32例、RE患者20例。年龄、病程、文化程度及Gred Q评分等两组比较,差异无统计学意义(P0.05);抑郁状态患者中NERD组27例(84.4%),RE组19例(95.0%),抑郁量表评分两组比较,差异无统计学意义(P0.05);焦虑状态患者中NERD组32例(100%),以女性为主(84.4%),RE组20例(100%),女性7例(35.0%),焦虑量表评分两组比较,差异有统计学意义(P0.05);焦虑合并抑郁状态患者中NERD组27例(84.4%),RE组19例(95.0%),两组比较,差异无统计学意义(P0.05)。结论 GERD合并精神心理异常症状的患者中,NERD患者呈焦虑状态比例较RE高,且女性患病率高。汉密尔顿焦虑、抑郁量表测评有助于GERD伴有精神心理异常症状患者心理干预和(或)药物治疗的选择。     

Speech pathology for chronic cough: A new approach

Chronic cough may persist despite systematic evaluation and medical treatment of known associated diseases such as asthma, rhinitis, and gastro-esophageal reflux. These patients have refractory chronic cough and many exhibit laryngeal hypersensitivity that is manifest at both a sensory and motor level. Examples of this are heightened sensitivity of the cough reflex to capsaicin, and laryngeal motor dysfunction with hoarse vocal quality and paradoxical vocal cord movement. Chronic cough that persists despite medical treatment may respond to speech pathology intervention. A multidimensional speech pathology treatment programme was designed based upon methods used to treat hyperfunctional voice disorders and paradoxical vocal fold movement. This included education, vocal hygiene training, cough suppression strategies and psychoeducational counseling. When tested in a single-blind, randomized, placebo-controlled trial involving 87 patients, participants in the treatment group demonstrated a significant reduction in cough, breathing, voice and upper airway symptoms following intervention, as well as improvements in auditory perceptual ratings of voice quality (breathy, rough, strain and glottal fry) and significant improvement in voice acoustic parameters (maximum phonation time, jitter and harmonic-to-noise ratio). Speech pathology intervention can be an effective way to treat refractory chronic cough.     

右美托咪定对食管裂孔疝合并胃食管反流病患者围术期免疫功能的影响

目的探讨右美托咪定对食管裂孔疝合并胃食管反流病患者围术期免疫功能的影响。 方法选取2014年3月至2016年3月,新疆维吾尔自治区人民医院收治并择期行全麻下腹腔镜手术治疗的食管裂孔疝合并胃食管反流病患者180例为研究对象,采用随机数字表法将上述研究对象分为观察组和对照组,各90例。观察组在麻醉诱导前30 min给予负荷剂量的右美托咪定(0.5 μg/kg),手术开始后以维持剂量0.3 μg/(kg·h)的速率泵人至手术结束;而对照组患者给予等负荷量和维持剂量的生理盐水。分别在不同时间点,即麻醉前(T1)、患者手术结束时(T2)、患者手术结束后30 min(T3)及患者手术结束后24 h(T4)使用流式细胞仪检测T淋巴细胞亚群和NK细胞水平并记录不良反应发生情况。 结果2组患者在T1时点免疫功能指标如血清CD3＋、CD4＋、CD8＋、CD4＋/CD8＋和NK细胞水平比较,差异无统计学意义(P>0.05);与T1时点比较,2组患者在T2、T3和T4时点时CD3＋、CD4＋、CD4＋/CD8＋水平均显著降低;与对照组比较,观察组患者T2、T3和T4时CD3＋、CD4＋、CD4＋/CD8＋和NK水平明显升高(P<0.05)。与对照组比较,观察组心动过速、高血压发生情况有所降低(P<0.05),而心动过缓、低血压及苏醒延迟发生情况有所升高(P<0.05);寒颤、呼吸抑制的发生情况,2组比较,差异无统计学意义。 结论右美托咪定辅助麻醉可显著改善行腹腔镜下治疗食管裂孔疝合并胃食管反流病患者围术期机体免疫功能,值得临床推广。     

RT3D-TTE评价AMI伴中度二尖瓣反流患者PCI术前后二尖瓣构型变化

目的 通过经胸实时三维超声心动图(RT3D-TTE)评价急性心肌梗死(AMI)伴中度二尖瓣反流患者经皮冠状动脉介入治疗(PCI)术前后二尖瓣构型变化,预测PCI术后患者二尖瓣返流改善情况.方法 选取保定市第一中心医院AMI伴中度二尖瓣反流患者行PCI术治疗患者90例,均接受RT3D-TTE检查.根据术后3个月患者的二尖...     

Inhaled beclomethasone dipropionate improves acoustic measures of voice in patients with asthma.

BACKGROUND: Inhaled corticosteroids have the potential to produce upper-airway side effects such as hoarseness. As new compounds and delivery devices are developed and compared, it is difficult to quantify their adverse upper-airway effects. OBJECTIVE: We undertook the following study to test the ability of an acoustic analysis technique to quantify changes in vocal function in steroid-naive patients with asthma who receive inhaled beclomethasone dipropionate (BDP), 1,000 microg/d for 4 months. METHODS: Patients self-administered one of four regimens of inhaled BDP. Group 1 patients received one 250-microg puff qid via metered-dose inhaler (MDI); group 2 patients received one 250-microg puff qid via MDI with a holding chamber; group 3 patients received two 250-microg puffs bid via MDI; and group 4 patients received two 250-microg puffs bid via MDI with a holding chamber. A smaller cohort of nonsmoking asthmatic patients was managed without steroid intervention for 4 months. At baseline and again at 8 weeks and 16 weeks after the initiation of BDP treatment, patients underwent spirometry and methacholine challenge. At baseline and again at 2, 4, 8, 12, and 16 weeks, patients underwent voice recording for analysis of voice parameters. The recorded vowels were low-pass filtered (10 KHz), digitized (22 KHz), and analyzed by software to obtain two acoustic measures: (1) jitter, the cycle-to-cycle variation in the time period of the voice signal; and (2) shimmer, the cycle-to-cycle variation in voice signal amplitude. RESULTS: We recruited 77 patients for randomization to inhaled steroid therapy and 10 patients who continued to receive only occasional inhaled bronchodilator therapy. In all active treatment groups, FEV(1), FVC, and provocative concentration of methacholine causing a 20% fall in FEV(1) improved significantly after BDP treatment. Mean jitter scores, a measurement of variation in voice pitch, were not significantly influenced by BDP treatment. However, mean shimmer scores, a reflection of perturbation in vocal amplitude, fell significantly (p < 0.05) in the active treatment groups. These reductions in shimmer scores were not significantly different in the active treatment groups. Shimmer scores in the bronchodilator-treated group were unchanged during the 16 weeks of follow-up. CONCLUSIONS: Our data show that a simple and noninvasive acoustic analysis of voice is sensitive to subclinical changes associated with inhaled corticosteroid therapy. We have shown that 1,000 microg/d of inhaled BDP actually improves specific acoustic measures of voice in patients with inadequately controlled asthma. These improvements were uninfluenced by dosing schedule and whether a spacing chamber was used.     

Transient vocal cord paralysis after fine-needle aspiration biopsy of thyroid tumor.

OBJECTIVE: Complications of thyroid fine-needle aspiration biopsy (FNAB) are exceedingly rare. Hematoma formation is the most commonly encountered complication. Infection and seeding of carcinoma cells in the needle track has also been reported in a rare case. Here we describe patients diagnosed as having transient vocal cord paralysis after FNAB of benign thyroid tumor. DESIGN: Retrospective review of patients with concurrent diagnosis of vocal cord paralysis after FNAB. MAIN OUTCOME: Among 10,974 patients who underwent FNAB, 4 patients showed vocal cord paralysis on laryngoscopy. These patients had solid and/or cystic lesion in the thyroid. Routine FNAB of the nodule was performed using a 23-gauge needle. Cytologic findings were benign tumor. Change of voice in the patients occurred 1 or 2 days after FNAB and vocal cord paralysis ipsilateral to FNAB was determined by flexible laryngoscopy. Vocal cord paralysis of all patients resolved spontaneously within 6 months (average, 4 months). CONCLUSION: Although the incidence of vocal cord paralysis in patients with thyroid tumor after FNAB is reported to be 0.036%, the true incidence is unknown because asymptomatic subjects are not screened. This report should alert the examiner to the possibility of vocal cord palsy after FNAB.     

Vocal cord dysfunction in children and adolescents

Vocal cord dysfunction (VCD) is a nonorganic disorder of the larynx that involves unintentional paradoxical adduction of the vocal cords while breathing. The resultant symptoms can include dyspnea, chest tightness, cough, throat tightness, wheezing, or voice change. Most patients with VCD are female, and among adolescents and children, VCD tends to be triggered by exercise and is typically confused with exercise-induced asthma. Both gastroesophageal reflux disease (GERD) and psychiatric illness have been reported as having strong associations with VCD, although, to date, there is no evidence that either causes VCD. VCD often coexists with asthma, and should be suspected in any patient in whom asthma treatment fails. Confirming the diagnosis involves direct visualization of abnormal vocal cord motion, and this usually only occurs during symptoms. Adolescent athletes often require free running exercise challenge to reproduce their symptoms and confirm abnormal vocal cord motion laryngoscopically. The primary treatment for VCD involves a combination of patient education and speech therapy, and, in most cases, patients may resume their activities without significant limitation.     

胃食管吻合术联合Nissen胃底折叠术对食管中段癌患者术后胃食管反流的影响

目的探讨胃食管吻合术联合Nissen胃底折叠术对食管中段癌术后患者胃食管反流的影响。 方法选取2015年9月至2017年3月,新疆维吾尔自治区人民医院住院并行食管癌切除术31例食管中段癌患者的临床资料。根据手术方式分为2组,即接受胃食管吻合术联合Nissen胃底折叠术15例（观察组）,接受胃食管吻合术16例（对照组）,术后2周待患者恢复正常的胃肠道功能后采用pH动态监测仪对其进行24 h pH监测,术后1、3、6、12个月依据胃食管反流病调查问卷（GerdQ）对患者的胃食管反流相关症状进行评分,比较2组患者术后胃食管反流发生情况。 结果2组患者均未出现死亡病例,且术后均未发生有吻合口瘘及胸胃排空障碍等并发症;观察组患者术后2周24 h酸反流次数显著少于对照组、最长酸反流时间和pH值<4的总时间短于对照组,DeMeester评分显著低于对照组,组间比较均有统计学意义（P<0.05）;观察组术后3、6、12个月胃食管反流病调查问卷（GerdQ）评分显著低于对照组,组间比较均有统计学意义（P<0.05）。 结论胃食管吻合术联合Nissen胃底折叠术对食管癌切术后的胃食管反流病情起到更为理想的控制效果,为食管中段癌患者术中吻合术式的选择提供一定参考价值。     

Endoscopic resection of a vocal cord polyp with a bipolar snare in a patient with cervical disc herniation

A 55-year-old male with progressively worsening hoarseness was found to have a vocal cord polyp of >10 mm in diameter on the right true cord. It was necessary to remove the polyp in order to prevent airway obstruction by prolapse. However, the patient was a poor candidate for resection by standard otolaryngologic procedures because of the large size of the polyp and because he had a symptomatic cervical disc herniation. Therefore, endoscopic resection under general anesthesia using a bipolar electrocautery snare was selected. This case was our first attempt to treat a vocal cord polyp using this technique, and we found that polypectomy with the bipolar snare was an efficient and safe method for the treatment of this lesion.     

六味安消对非糜烂性反流病患者食道动力及酸反流的影响

[目的]观察六味安消对非糜烂性反流病（NERD）患者食道动力及胃食管反流的影响,并与莫沙必利比较疗效.[方法]选取具有典型胃食管反流症状的NERD患者52例,行胃食管反流症状评估、食管测压及24 h pH监测,随机分成试验组26例和对照组26例.给予药物治疗（试验组六味安消,对照组莫沙必利）4周后,对比治疗前后临床症状、食管动力学及胃食管反流的改变情况.[结果]试验组与对照组症状总积分、食管蠕动功能、pH＜4反流次数、反流＞5 min次数、总计pH＜4的百分比、DeMeester评分自身治疗前后相比较,差异均有显著统计学意义（P＜0.05）,而2组组间比较差异均无统计学意义.[结论]六味安消能有效缓解NERD患者的胃食管反流症状,改善食管蠕动功能及减少酸反流.