摘要
目的:喉癌患者术后一般会有语言表达上的障碍,探讨术后进行构音训练的患者其构音障碍的改善程度及不同时间段对患者生活质量的影响。方法:选取2001-11/2004-09海门市人民医院五官科门诊收治的喉癌患者63例,经口腔进行手术来清除肿瘤组织。术后至构音训练前1星期使用Frenchay评定法(每项损伤程度分为a,b,c,d,e级,a占28个回答中的比例越多说明越接近正常,反之说明患者构音能力越弱。正常值为27～28个a,轻度障碍为26～18个a,中度障碍为17～14个a,重度障碍为13～7个a,极重度障碍为6～0个a)对患者构音障碍程度进行评估,并同时使用癌症患者生活质量评估问卷(总分98分,得分越高代表生活质量越好。得分0～30分为差;31～60分为良;61～90分为较好;91～98分为优)对患者生活质量进行评估。在患者有能力参加构音训练时进行口舌运动训练(患者面对镜子练习口的张开、闭合、前突、收回,舌的前伸、后缩、上抬、两侧运动,1～3min/次,每天三四次);发音训练(先训练发元音后训练发辅音,待能较顺利的发出辅音后,训练将元音与辅音相结合,最后过度到单词和句子的训练,30～40min/次,2次/d);呼吸训练(让患者贴近物体吹气,待物体因气体流动往远处移时,让患者延长呼吸,20min/次,1次/d),至第2,4,6个月分别对构音障碍程度及生活质量再次进行评估,观察构音训练对患者生活质量的影响。结果:纳入实验患者63例,全部进入结果分析。①构音训练前后患者Frenchay评分比较:与构音训练前比较,构音训练后2,4,6个月处于重度障碍、极重度障碍的患者数量百分率均明显降低(54.0%,12.7%,9.5%,6.3%;4.7%,3.2%,1.6%,1.6%;u=1.96,P<0.05)。②构音训练前后患者生活质量的变化:与构音训练前比较,构音训练后2,4,6个月均有显著改善,尤其是第6个月时差异显著(u=3.18,P<0.01)。③构音训练前后患者在各领域的生活质量评分情况:与构音训练前比较,构音训练后2,4,6个月患者生活质量评分在躯体、精神心理、社会关系、机能领域均明显升高,第6个月时最为显著(t=2.26～3.15,P<0.01)。结论:喉癌患者手术后进行适当的构音训练,随着训练时间的延长其生活质量一直有所提高,表明适当的构音训练能够改善喉癌术后患者的语言能力,有利于患者自我情绪的调整,心理压力的缓和,从而提高生活质量。
AIM： The operation for carcinoma of larynx usually causes the disturbance in patients＇ language expression. In this study, we aimed to investigate the improvement degree of dysarthria and quality of life（QOL） at different time in the patients following operation for carcinoma of larynx after articulation training. METHODS：The tumor tissues were cleaned up trough oral cavity in 63 patients with carcinoma of larynx treated in the Outpatient Department of Five Organs, Haimen People＇s Hospital from November 2001 to September 2004.The degree of dysarthria was evaluated by the Frenchay evaluationscoring and the QOL was assessed by the questionnaire for QOL in cancer patients after the operation and one week before articulation training. For the Frenchay evaluation scoring, each degree of lesion is classified as a, b, c, d, e grades, the more the ＂a＂ accounts for in 28 questions, the closer to normal the ability of articulation is, and oppositely, the milder the ability of articulation is; There are 27 or 28 ＂a＂ for normality, 26 to 18 ＂a＂for mild disturbance, 17 to 14 ＂a＂ for moderate disturbance, 13 to 7 ＂a＂ for severe disturbance, and 6 to 0 ＂a＂ for greatly severe disturbance. For the questionnaire for cancer patients, the total score is 98 marks,and the higher the score is, the better the QOL is; The score from 0 to 30 marks is poor, 31 to 60 fair, 61 to 90 good, and 91 to 98 fair. The patients able to join in the articulation training was guided to mouth and tongue exercises （Facing a mirror, the patients practised month to open, close, protrude, and retract, practised the tongue to extend forwards,retract backwards,rise,move bilaterally 1 to 3 minutes once,three or four times a day）,phonation exercise （The patients practised pronouncing vowels and consonants one and after the other. When the patients could pronounce consonants smoothly, they would practised pronouncing vowels combined consonants until the exercise of words and sentences.The exercise was 30 to 40 minutes once, twice a day） and breath exercise （The patients hlew a substance in a very near distance, and when the substance moved distantly because of the airflow, the patients was instructed to prolong their breath 20 minutes once per day）. At 2, 4 and 6 months after articulation training, the degree of dysarthria and QOL in patients were evaluated again, and the influence of articulation training on the QOL was also investigated. RESULTS： All the 63 selected patients were involved in the result analysis. ①The score of the Frenchay evaluation scoring before and after articulation training： As compared with before articulation training, the number percentage of patients suffering from severe and greatly severe dysarthria was significantly decreased at 2,4 and 6 months after articulation training（54.0%, 12.7%, 9.5%, 6.3%; 4.7%, 3.2%, 1.6%, 1.6%;u=1.96, P 〈 0.05）. ②The change of QOL before and after articulation training： As compared with before articulation training, the QOL was significantly improved at 2,4 and 6 months after articulation training, especially more significantly at 6 months（u=3.18, P 〈 0.01）. ③The QOL from different aspects in patients before and after articulation training： As compared with before articulation training, the score of the body, mental health, social relationship and function in QOL was significantly promoted at 2, 4 and 6 months after articulation training, especially at 6 months （t= 2.26 to 3.15, P 〈 0.01）. CONCLUSION： Proper articulation training for patients following operation for carcinoma of larynx will always promote the QOL in patients along with the prolonging of training, indicating that the proper articulation training can enhance the language ability of patients after operation for carcinoma of larynx, be beneficial to adjusting the self-emotion of patients, relax mental pressure and thus improve their QOL.
出处
《中国临床康复》
CSCD
北大核心
2005年第36期18-20,共3页
Chinese Journal of Clinical Rehabilitation
