国际口腔医学杂志

国际口腔医学杂志 ›› 2024, Vol. 51 ›› Issue (6): 722-727.doi: 10.7518/gjkq.2024068

• 论著 • 上一篇    

语音训练治疗边缘性腭咽闭合不全的效果与预后因素分析

毛奇蓉(),尹恒,吴敏,石冰,郑谦,李精韬()   

  1. 口腔疾病防治全国重点实验室 国家口腔医学中心 国家口腔疾病临床医学研究中心四川大学华西口腔医院唇腭裂外科 成都 610041
  • 收稿日期:2023-12-27 修回日期:2024-05-05 出版日期:2024-11-01 发布日期:2024-11-04
  • 通讯作者: 李精韬
  • 作者简介:毛奇蓉，硕士，Email：qirong.mao@outlook.com
  • 基金资助:
    四川大学华西口腔医院临床医学研究项目(LCYJ-2022-YF-2)

Efficacy of speech training in treating marginal velopharyngeal inadequacy: analysis of treatment outcomes and prognostic factors

Qirong Mao(),Heng Yin,Min Wu,Bing Shi,Qian Zheng,Jingtao Li()   

  1. State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Dept. of Cleft Lip and Palate Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
  • Received:2023-12-27 Revised:2024-05-05 Online:2024-11-01 Published:2024-11-04
  • Contact: Jingtao Li
  • Supported by:
    Clinical Research Project of West China Hospital of Stomatology, Sichuan University(LCYJ-2022-YF-2)

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摘要：

目的 探讨对腭裂术后边缘性腭咽闭合不全（MVPI）患者进行语音训练的可行性及预后因素分析。 方法 对腭裂术后确诊为MVPI并接受语音训练的患者进行了回访。对比治疗前后患者的语音情况评估语音训练的效果。分别进行单因素和多因素逻辑回归检验，分析语音训练后MVPI治疗效果的影响因素。 结果 语音训练能明显改善患者的高鼻音、构音和语音清晰度，但未能明显改善患者的鼻漏气。逻辑回归分析表明，治疗时的年龄是影响预后的重要因素。8岁以上患者的语音训练有效率（17.6%）明显低于8岁以下患者（58.3%）。 结论 语音训练是改善MVPI患者语音清晰度的有效治疗方法，年龄和是否存在鼻漏气可能是影响MVPI语音训练效果的关键因素。

关键词: 腭咽闭合不全, 腭裂, 鼻漏气, 语音训练

Abstract:

Objective The feasibility and prognostic factors of speech training for patients with marginal velopharyngeal inadequacy (MVPI) were explored. Methods Patients diagnosed with MVPI after primary palatoplasty and received speech training were recruited. Their speech condition before and after treatment was compared to assess the effectiveness of speech training. Univariate and multivariate logistic regression analysis were used to analyze the influencing factors of the treatment outcomes for MVPI after speech training. Results Speech training significantly improved the hypernasality, articulation, and speech clarity of patients with MVPI but failed to ameliorate their nasal emission. Univariant and multivariant logistic regression analyses suggested age at treatment as a factor significantly correlated with the prognosis of speech training. The effective rate of speech training was significantly lower among patients above the age of 8 years (17.6%) than those aged below 8 years (58.3%). Conclusion Speech training is an effective treatment in impro-ving speech clarity in patients with MVPI. Age at treatment and nasal emission may be the prognostic factors of MVPI management.

Key words: velopharyngeal insufficiency, cleft palate, nasal emission, speech training

中图分类号: 

  • R782.2+2

表 1

语音训练前后MVPI患者治疗效果的比较 (n/%)"

观察项目

训练前

（n=58）

训练后

（n=58）

P值
鼻腔共鸣情况<0.001
无高鼻音0/0.0030/51.72
轻度高鼻音48/82.7628/48.28
中度高鼻音10/17.240/0.00
重度高鼻音0/0.000/0.00
鼻漏气0.052
未闻及6/10.3418/31.03
可闻及52/89.6640/68.97
构音<0.001
正常0/0.0038/65.52
省略20/34.486/10.34
代偿22/37.9310/17.24
省略加代偿16/27.594/6.90
语音清晰度<0.001
清晰0/0.0020/34.48
轻度不清晰18/31.0328/48.28
中度不清晰40/68.9710/17.24
重度不清晰0/0.000/0.00

表 2

MVPI 患者语音训练潜在预后因素的单因素逻辑回归分析"

观察项目

有效组

（n=20）

无效组

（n=38）

P值
性别0.493
男1022
女1016
腭裂类型0.567
不完全性腭裂1220
单侧完全性腭裂814
双侧完全性腭裂04
高鼻音0.403
无高鼻音00
轻度高鼻音1434
中度高鼻音64
重度高鼻音00
鼻漏气0.033
未闻及60
可闻及1438
构音0.429
正常00
省略416
代偿1012
省略加代偿610
语音清晰度0.573
清晰00
轻度不清晰810
中度不清晰1228
重度不清晰00
治疗时年龄（均数±标准差）6.29±7.2810.00±7.63<0.001

表 3

排除混杂因素影响后多元逻辑回归模型结果"

观察项目B值P值OR（95% CI）
治疗时年龄-0.1450.0310.865（0.759~0.987）
鼻漏气-0.1730.4060.486（-0.579~0.233）

图 1

ROC曲线计算年龄最佳截断值AUC：曲线下面积（area under curve）。"

表 4

不同年龄段接受语音训练的MVPI患者的语音清晰率 (n/%)"

观察项目治疗时年龄P值
<8岁（n=24）≥8岁（n=34）
有效14/58.36/17.60.027
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