标题：内消瘰疬丸及小剂量甲泼尼龙片联合嗓音训练治疗声带小结疗效观察

      作者：王叶，王丽敏，赖小思    惠州市第六人民医院耳鼻咽喉头颈外科，广东 惠州 516211

      卷次： 2021年32卷13期

      【摘要】 目的 观察内消瘰疬丸及小剂量甲泼尼龙片联合嗓音训练治疗声带小结的临床效果。方法 选择2019年10月至2020年11月惠州市第六人民医院耳鼻咽喉头颈外科接诊的60例声带小结患者纳入研究，按照随机数表法分为观察组和对照组，每组30例，对照组采用嗓音训练治疗，观察组在对照组基础上联合内消瘰疬丸及小剂量甲泼尼龙片治疗，所有患者均连续治疗4周。比较两组患者治疗后的临床疗效，以及治疗前后的中文版嗓音障碍指数量表(VHI)评分、最长发声时间(MPT)、最大音量最长发声时间(MLPT)和噪音声学的变化，并比较治疗期间的不良反应发生情况。结果 观察组患者的临床治疗总有效率为 93.33%，明显高于对照组的 73.33%，差异有统计学意义(P<0.05)；治疗后，观察组患者VHI量表评分中的功能、生理、情感评分及总分分别为(7.92±1.06)分、(12.97±1.53)分、(6.97±1.02)分、(27.86±2.76)分，明显低于对照组的(9.73±1.48)分、(16.21±1.82)分、(8.74±1.39)分、(34.68±3.33)分，差异均有统计学意义(P<0.05)；治疗后，观察组患者的MPT、MLPT分别为(16.20±3.21) s、(13.72±2.18) s，明显长于对照组的(13.68±2.06) s、(10.94±2.06) s，差异均有统计学意义(P<0.05)；治疗后，观察组患者的基频为(259.12±26.30) Hz，明显高于对照组的(231.86±21.2) Hz，基频微扰、振幅微扰、噪谐比分别为(0.28±0.03)%、(1.87±0.20)%、(0.10±0.02) dB，明显低于对照组的(0.36±0.05)%、(2.14±0.26)%、(0.14±0.03) dB，差异均有统计学意义(P<0.05)；两组患者治疗期间均无明显不良反应发生。结论 内消瘰疬丸及小剂量甲泼尼龙片联合嗓音训练治疗声带小结患者疗效显著，值得推广应用。
      【关键词】 声带小结；嗓音训练；甲泼尼龙片；内消瘰疬丸；疗效；不良反应
      【中图分类号】 R767.4+1 【文献标识码】 A 【文章编号】 1003—6350（2021）13—1705—04

Curative effect of Neixiaoluoli Wan and low-dose methylprednisolone tablets combined with voice training in thetreatment of vocal nodules.
WANG Ye, WANG Li-min, LAI Xiao-si.Department of Otolaryngology Head and NeckSurgery, the Sixth People's Hospital of Huizhou, Huizhou 516211, Guangdong, CHINA
【Abstract】 Objective To observe the clinical effect of Neixiaoluoli Wan and low-dose methylprednisolone tab-lets combined with voice training in the treatment of vocal nodules. Methods A total of 60 patients with vocal noduleswho were admitted to the Department of Otorhinolaryngology Head and Neck Surgery at the Sixth People's Hospital ofHuizhou from October 2019 to November 2020 were selected and randomly divided into an observation group and a con-trol group, with 30 patients in each group. The control group was treated with voice training, and the observation groupwas additionally treated with Neixiaoluoli Wan and low-dose methylprednisolone tablets on the basis of the controlgroup. All patients were treated for 4 consecutive weeks. The clinical efficacy of the two groups after treatment was com-pared, as well as the changes in the Chinese version of the Voice Handicap Index (VHI), the longest Maximum Phona-tion Time (MPT), the Maximum Loudest Phonation Time (MLPT) and noise acoustics before and after the treatment.The occurrence of adverse reactions during the treatment was compared. Results The total effective rate of treatmentin the observation group was 93.33%, which was significantly higher than 73.33% in the control group (P<0.05). Aftertreatment, the functional, physiological, emotional and total scores on the VHI scale were significantly lower in the ob-servation group than in the control group, i.e. functional score (7.92±1.06) vs (9.73±1.48), P<0.05; physiological score(12.97±1.53) vs (16.21±1.82), P<0.05; emotional score (6.97±1.02) vs (8.74±1.39), P<0.05; and total score (27.86±2.76)vs (34.68±3.33), P<0.05. After treatment, the MPT and MLPT were respectively (16.20±3.21) s and (13.72±2.18) s in theobservation group, which were significantly longer than (13.68±2.06) s and (10.94±2.06) s in the control group (P<0.05).After treatment, the fundamental frequency was (259.12±26.30) Hz in the observation group, which was significantlyhigher than (231.86 ± 21.2) Hz in the control group; while the fundamental frequency perturbation (0.28 ± 0.03）% vs（0.36±0.05）%, amplitude perturbation (1.87±0.20）% vs（2.14±0.26）%, and noise-to-harmonic ratio (0.10±0.02）dB vs（0.14±0.03）dB were significantly lower in the observation group than in the control group (P<0.05). There were no ob-vious adverse reactions during the treatment of the two groups. Conclusion Neixiaoluoli Wan and low-dose methyl-prednisolone tablets combined with voice training are effective in treating patients with vocal nodules, which is worthyof promotion and application.
      【Key words】 Vocal nodules; Voice training; Methylprednisolone tablets; Neixiaoluoli Wan; Curative effect; Ad-verse reactions