主观判听在腭咽闭合功能诊断中的应用价值

摘要

Objective To investigate the application of the perceptual assessment in the diagnosis of the velopha- ryngeal function, to provide a reference to the improvement of the velopharyngeal function diagnosis through comparing the consistency between the diagnosis of the perceptual assessment and the objective assessment. Methods All subjects (254) were selected from the Department of Cleft Lip and Palate Surgery, West China School of Stomatology, Sichuan University, from 2000-2010. The results of the perceptual and the nasopharyngeal fiberscope (NPF) assessment were retrospectively analyzed, and the consistent rate between the two assessment methods was calculated. The Kappa test and the correlation analysis were performed to analyze the consistency and correlation, and the factors relating to the perceptual assessment were analyzed by the correlation coefficient. Results There were 254 patients met the inclusion criteria. The consistent number of the patients diagnosed by the perceptual and the objective assessment as velopharyngeal competence (VPC) and velopharyngeal insufficiency (VPI) were 58 and 167 respectively. The consis-' tent rate was 88.58% for all patients, and 66.67% for the VPC patients. The Kappa value was 0.721, Spearman's R=0.751, P<0.05. There were correlation between the hypernasality, the nasal emission and the subjective assessment, and Spearman's R=0.697, 0.590, P<0.05. Conclusion The VPC patients and the VPI patients with moderate and severe hypernasality and nasal emission diagnosed by the perceptual assessment could be exempt from the objective examination. Patients diagnosed with mild hypernasality and nasal emission by the perceptual assessment should be further referred to NPF or other instruments.%目的 通过比较主观判听与客观检查诊断腭咽闭合功能的一致性,阐明主观判听在腭咽闭合诊断上的临床应用状况.方法 对2000-2010年在四川大学华西口腔医院唇腭裂外科就诊的254例腭裂患者的语音资料进行回顾性分析.统计其主观判听结果和鼻咽纤维镜检查结果,计算二者的诊断一致率.应用Kappa检验和相关分析统计主客观评估的一致性和相关性.应用相关分析统计主观评估影响因素的相关系数.结果 在254例腭裂患者中,主、客观评估一致的腭咽闭合完全(VPC)与腭咽闭合不全(VPI)病例数分别为58、167例,诊断一致率为88.58％,其中VPC诊断一致率为66.67％.Kappa值为0.721,R=0.751,P＜0.05,主、客观评估具有高度的一致性和相关性.高鼻音和鼻漏气与主观判听结果的相关系数R分别为0.697、0.590,P＜0.05,二者具有明显的相关性.结论 主观判听诊断为VPC,以及主观判听为中重度高鼻音及鼻漏气的VPI患者可以免作客观检查；主观判听为轻度鼻漏气和高鼻音的患者需要结合客观检查,进一步明确腭咽闭合的诊断.