山东大学耳鼻喉眼学报 ›› 2021, Vol. 35 ›› Issue (3): 42-46.doi: 10.6040/j.issn.1673-3770.0.2020.451

• 临床研究 • 上一篇    下一篇

单侧特发性声带麻痹神经电刺激治疗后即刻疗效初步观察

闫静1,任晓勇1,向莉2,杜小滢1,李娜1,刘小红1,侯瑾1   

  1. 1. 西安交通大学第二附属医院 耳鼻咽喉头颈外科病院, 陕西 西安 710004;
    2. 西安交通大学第二附属医院 神经内科, 陕西 西安 710004
  • 发布日期:2021-05-14
  • 通讯作者: 侯瑾. E-mail:13319251982@126.com
  • 基金资助:
    陕西省重点研发计划(一般项目-社会发展领域)S2020-YF-YBSF-0207

Preliminary observation of the immediate curative effect of unilateral idiopathic vocal cord palsy after electrical stimulation of the nerve

YAN Jing1, REN Xiaoyong1, XIANG Li2, DU Xiaoying1, LI Na1, LIU Xiaohong1, HOU Jin1   

  1. 1. Department of Otorhinolaryngology & Head and Neck Surgery, Second Affiliated Hospital of Medical College, Xi'an Jiaotong University,  Xi'an 710004, Shanxi China;
    2. Department of Neurology, Second Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an 710004, Shanxi China
  • Published:2021-05-14

PDF (PC)

140

摘要： 目的 探讨单侧特发性声带麻痹喉返神经/喉上神经电刺激治疗后即刻对主观声音改变、声学参数以及动态喉镜观察结果的影响。 方法 选取诊断为单侧特发性声带麻痹的患者,回顾性收集其行喉肌电图检查并同期行神经电刺激治疗前后的动态喉镜及嗓音分析检查结果,分析检查及治疗前后主观声音改变,声学参数(jitter、shimmer、DSI、MPT)及动态喉镜观察结果。 结果 共计43例单侧特发性声带麻痹患者符合纳入标准,其中喉返神经合并喉上神经受损4例、喉上神经受损1例、喉返神经受损38例。喉肌电图检查及神经电刺激治疗后患者即刻均自觉讲话较前轻松感;治疗后即刻动态喉镜检查发现5例(11.6%)患者声带闭合较前无明显变化,声嘶无明显好转;38例(88.4%)患者动态喉镜显示声门裂均较检查前明显变小,可采集到基频及黏膜波,声嘶较前明显好转;声学参数前后变化:MPT(6.58±2.75 vs 10.3±5.18,P<0.001)、DSI(-3.79±6.7 vs -0.11±1.68,P=0.002),jitter及shimmer治疗前后比较差异无统计学意义(P>0.05)。 结论 特发性声带麻痹患者早期接受喉肌电图检查及神经电刺激干预治疗可改善患者声嘶,明显延长最长发音时间,改善嗓音障碍严重指数,显著改善声门闭合程度,提示对神经功能的恢复有促进作用。

关键词: 特发性声带麻痹, 喉肌电图, 电刺激治疗, 声学参数, 喉上神经, 喉返神经

Abstract: Objective To explore the effects of idiopathic vocal cord paralysis on subjective sound changes, acoustic parameters, and dynamic laryngoscope observations immediately after electrical stimulation of the recurrent laryngeal nerve/supralaryngeal nerve. Methods The records of patients who were diagnosed with unilateral idiopathic vocal cord paralysis at the Throat Clinic of the Second Affiliated Hospital of Xi'an Jiaotong University from March 2018 to April 2020 before and after undergoing laryngeal EMG examination and concurrent neuroelectric stimulation treatment were reviewed. The stroboscopic laryngoscopy and voice analysis results, subjective voice changes before and after examination and treatment, acoustic parameters(jitter, shimmer, MPT), and dynamic laryngoscope observation results were assessed. Results A total of 43 patients with unilateral idiopathic vocal cord paralysis met the inclusion criteria: 4 had recurrent laryngeal nerve damage of the superior laryngeal nerve, 1 had superior laryngeal nerve damage, and 38 had recurrent laryngeal nerve damage. After laryngeal electromyography and nerve electrical stimulation treatment, the patients felt that their speech was more relaxed than before. Stroboscopic laryngoscopy immediately after treatment revealed that 5 patients(11.6%)had closed vocal cords. There was no significant change. In 38 cases(88.4%), the glottis was significantly smaller after than before the examination, and the fundamental frequency and mucosal waves could be collected. The changes in acoustic parameters did not significantly differ after treatment: MPT(6.58±2.75 vs 10.3±5.18, P<0.000 1), DSI(-3.79±6.7vs -0.11±1.68, P=0.002), jitter and shimmer(P>0.05). Conclusion Patients with idiopathic vocal cord palsy receiving early laryngeal electromyography and nerve electrical stimulation intervention can improve hoarseness, significantly extend the longest pronunciation time, improve the severity index of voice disorders, and significantly improve the degree of glottis closure. The recovery of the nerve function has a positive effect.

Key words: Idiopathic vocal cord paralysis, Laryngeal electromyography, Electrical stimulation treatment, Acoustic parameters, Superior laryngeal nerve, Recurrent laryngeal nerve

中图分类号: 

  • R767.92
[1] Al-Khtoum N, Shawakfeh N, Al-Safadi E, et al. Acquired unilateral vocal fold paralysis: retrospective analysis of a single institutional experience[J]. N Am J Med Sci, 2013, 5(12): 699-702. doi:10.4103/1947-2714.123254.
[2] Seyed Toutounchi SJ, Eydi M, Golzari SE, et al. Vocal cord paralysis and its etiologies: a prospective study[J]. J Cardiovasc Thorac Res, 2014, 6(1): 47-50. doi:10.5681/jcvtr.2014.009.
[3] 高楠,赵霞,孙广滨.喉肌电图临床应用进展[J].听力学及言语疾病杂志,2017,25(5):547-552. doi:10.3969/j.issn.1006-7299.2017.05.025
[4] Robert Thayer Sataloff,庄佩耘. 喉肌电图[M].3版. 北京:人民卫生出版社,2019.
[5] 许栋岳, 李克勇. 单侧声带麻痹的病因及治疗[J]. 临床耳鼻咽喉头颈外科杂志, 2016, 30(5): 423-426. doi:10.13201/j.issn.1001-1781.2016.05.028. XU Dongyue, LI Keyong. Cause and treatment of unilateral vocal cord paralysis[J]. J Clin Otorhinolaryngol Head Neck Surg, 2016, 30(5): 423-426. doi:10.13201/j.issn.1001-1781.2016.05.028.
[6] 冯云,杨大章,吕秋萍,等. 喉返神经修复术及非喉返神经修复术治疗声带麻痹[J].山东大学耳鼻喉眼学报, 2015(3): 54-58. doi: 10.6040/j.issn.1673-3770.0.2015.077. FENG Yun, YANG Dazhang, LÜ Qiuping, et al. Reinnervation vesus non-reinnervation surgery for vocal fold paralysis[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2015(3): 54-58. doi: 10.6040/j.issn.1673-3770.0.2015.077.
[7] 杨奉玲, 王彪, 黄恒, 等. 单侧特发性声带麻痹的临床特点及药物治疗疗效分析[J]. 临床耳鼻咽喉头颈外科杂志, 2016,30(3): 235-237. doi:10.13201/j.issn.1001-1781.2016.03.017. YANG Fengling, WANG Biao, HUANG Heng, et al. The clinical features and drug therapy of unilateral idiopathic vocal fold paralysis[J]. J Clin Otorhinolaryngol Head Neck Surg, 2016, 30(3): 235-237. doi:10.13201/j.issn.1001-1781.2016.03.017.
[8] Weddell G, Feinstein B, Pattle RE. The electrical activity of voluntary muscle in man under normal and pathological conditions[J]. Brain, 1944, 67(3): 178-257. doi:10.1093/brain/67.3.178.
[9] Stager SV. Vocal fold paresis: etiology, clinical diagnosis and clinical management[J]. Curr Opin Otolaryngol Head Neck Surg, 2014, 22(6): 444-449. doi:10.1097/MOO.0000000000000112.
[10] Zarzur AP,Duprat AC,Cataldo BO,et al. Laryngeal electromyography as a diagnostic tool for Parkinson'sdisease[J]. Laryngoscope,2014,124: 725-729. doi: 10.1002/lary.24379.
[11] Rickert SM, Childs LF, Carey BT, et al. Laryngeal electromyography for prognosis of vocal fold palsy: a meta-analysis [J].Laryngoscope,2012, 122:158 -161. doi: 10.1002/lary.22354.
[12] 徐文,韩德民,侯丽珍,等.声带运动不良的喉肌电图特征[J]. 中华耳鼻咽喉头颈外科杂志,2006, 41(9):653-656. doi:10.3760/j.issn:1673-0860.2006.09.004. XU Wen, HAN Demin, HOU Lizhen, et al. Laryngeal electromyographic characteristics of vocal fold immobility[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2006, 41(9):653-656. doi:10.3760/j.issn:1673-0860.2006.09.004.
[13] 侯丽珍,韩德民,徐文,等.喉返神经麻痹的肌电特点及相关研究[J].临床耳鼻咽喉头颈外科杂志,2007, 21(15):673-678. doi:10.3969/j.issn.1001-1781.2007.15.001. HOU Lizhen, HAN Demin, XU Wen, et al. Study of laryngeal electromyographic behaviors of recurrent laryngeal nerve paralysis[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2007, 21(15):673-678. doi:10.3969/j.issn.1001-1781.2007.15.001.
[14] 侯丽珍, 徐文, 韩德民, 等. 正常喉诱发电位特点的研究[J]. 中华耳鼻咽喉头颈外科杂志, 2007, 42(3): 207-210. doi:10.3760/j.issn: 1673-0860.2007.03.015. HOU Lizhen, XU Wen, HAN Demin, et al. Characteristics of normal laryngeal nerve evoked potentials[J]. Chin J Otorhinolaryngol Head Neck Surg, 2007, 42(3): 207-210. doi:10.3760/j.issn: 1673-0860.2007.03.015.
[15] 李洁. 经皮电神经刺激疗法联合超短波及康复训练治疗特发性面神经麻痹的疗效观察[J]. 中华物理医学与康复杂志, 2012, 34(1): 77-78. doi:10.3760/cma.j.issn.0254-1424.2012.01.026.
[16] 孟凛冽, 戴艳萍, 曹利, 等. 观察高压氧与经皮神经电刺激治疗面神经炎疗效[J]. 中国卫生标准管理, 2020, 11(5): 51-53. doi:10.3969/j.issn.1674-9316.2020.05.023. MENG Linlie, DAI Yanping, CAO Li, et al. Therapeutic effect of hyperbaric oxygen combined with transcutaneous nerve electrical stimulation on facial neuritis[J]. China Heal Stand Manag, 2020, 11(5): 51-53. doi:10.3969/j.issn.1674-9316.2020.05.023.
[17] 张颜伟, 赵见文, 宋书昌, 等. 吞咽针刺法配合神经肌肉电刺激治疗脑卒中后吞咽障碍的临床分析[J]. 医学理论与实践, 2019, 32(8): 1153-1154. doi:10.19381/j.issn.1001-7585.2019.08.018.
[18] 严佳虞, 任朝晖. 经皮神经电刺激的临床应用研究进展[J]. 中国康复医学杂志, 2018, 33(3): 361-364. doi:10.3969/j.issn.1001-1242.2018.03.025.
[1] 刘大昱,孙睿杰,李学新,姜震,岳建林,林云,雷大鹏,潘新良. 支撑喉镜下CO2激光杓状软骨部分切除术治疗双侧声带麻痹的疗效分析[J]. 山东大学耳鼻喉眼学报, 2018, 32(6): 18-21.
[2] 王志祥,薛凯,魏宁,韩双,金春顺. 误诊为甲状腺肿物的颈部喉返神经神经鞘瘤一例[J]. 山东大学耳鼻喉眼学报, 2017, 31(6): 33-35.
[3] 张转,刘涛,周长明,马璐. 胸内迷走甲状腺肿一例并文献复习[J]. 山东大学耳鼻喉眼学报, 2017, 31(6): 36-38.
[4] 吕正华. 喉返神经减压术[J]. 山东大学耳鼻喉眼学报, 2016, 30(2): 17-19.
[5] 冯云, 杨大章, 吕秋萍, 刘丹丹, 王娜亚. 喉返神经修复术及非喉返神经修复术治疗声带麻痹[J]. 山东大学耳鼻喉眼学报, 2015, 29(3): 54-58.
[6] 冯云, 杨大章, 程靖宁, 王成元, 刘丹丹. 甲状腺外科手术操作与手术并发症的相关性[J]. 山东大学耳鼻喉眼学报, 2015, 29(1): 78-82.
[7] 庄大勇，贺青卿，范子义，郑鲁明，朱见，周鹏，段松建，岳涛，董学峰. 术中神经监测技术在分化型甲状腺癌再次手术中的应用[J]. 山东大学耳鼻喉眼学报, 2013, 27(6): 5-8.
[8] 娄 锋 . 喉上神经阻滞预防喉显微手术心血管反应[J]. 山东大学耳鼻喉眼学报, 2008, 22(2): 173-175 .
[9] 王玉芝,井玉生 . 甲状腺手术中喉返神经的保护[J]. 山东大学耳鼻喉眼学报, 2006, 20(5): 449-450 .
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
[1] 张晗,黄一飞 . 抗角膜移植排斥的研究进展[J]. 山东大学耳鼻喉眼学报, 2006, 20(1): 84 -87 .
[2] 牛善利,柴茂文,李振秀 . 鼻内镜下鼻甲成形术治疗慢性肥厚性鼻炎60例[J]. 山东大学耳鼻喉眼学报, 2006, 20(1): 16 -18 .
[3] 孟庆国,卢永田,范献良 . 杀伤细胞免疫球蛋白样受体基因多态性与鼻咽癌的关联性[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 196 -199 .
[4] 马玉起,孔祥春 . 先天性双侧下唇窦道1例[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 199 -199 .
[5] 万俐佳,鲁海涛,姜义道,刘 辉,李 琴,佘腊枝 . 改良腭咽成形术治疗阻塞性睡眠呼吸暂停综合征41例[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 204 -205 .
[6] 于青青 ,王跃建 . 硬质耳内镜的临床应用进展[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 222 -224 .
[7] 吉晓滨,邓家德,臧林泉,王 磊,谢 军 . 豚鼠变应性鼻炎模型血清组胺的测定[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 228 -230 .
[8] 向登,卢永田,孙焕吉 . 鼻内镜下修补脑脊液鼻漏19例并文献复习[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 234 -236 .
[9] 邱恩惠,李志春,方文旭 . 嗅觉障碍的中西医治疗[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 253 -257 .
[10] 殷国华,钟 笑 . 激光减容术治疗舌扁桃体肥大的远期疗效[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 280 -282 .
网站版权所有 © 2018 《山东大学耳鼻喉眼学报》编辑部　
地址：山东省济南市山大南路27号（250100）电话：+86-0531-88366912 E-mail: ebhxb@sdu.edu.cn
本系统由北京玛格泰克科技发展有限公司设计开发