摘要：

目的： 探讨腭裂（cleft palate，CP）术后嗓音障碍（voice disorder，VD）患儿的语音特点及言语康复治疗效果。方法： 选取我院2018年1月—2018年12月收治的40例行CP修复术的患儿，所有患儿均在CP修复术后1个月接受言语康复治疗，对比言语康复治疗前后/a/音声学特点参数和临床疗效。结果： 腭裂修补术后，患儿经言语康复治疗后，其发/a/音时的基频（F₀）值，与治疗前差异无统计学意义（t=0.661，P>0.05）；言语康复后，谐噪比（harmonic-noise ratio，HNR）值明显大于治疗前，标准化噪声能量（normalized noise energy，NNE）、振幅微扰（Shimmer）、基频微扰（Jitter）值明显小于治疗前（t=1.690、3.974、2.287、24.558，P<0.05）；言语康复治疗前，重度VD患儿语音清晰度（phonetic intelligibility，PI）明显低于轻度患儿（F=3.452，P<0.05），治疗后，不同程度术后VD患儿PI值均显著提升，组间对比，差异无统计学意义（F=1.153，P>0.05）。CP术后重、中、轻度VD患儿临床治疗有效率分别为88.89%、100.00%、100.00%。结论： CP修复术后常存在VD，言语康复治疗可有效提升CP患儿嗓音音质；临床应重视腭裂术后的VD训练。

关键词: 腭裂, 腭裂修复术, 嗓音障碍, 语音特点, 言语康复

Abstract:

Objective: To investigate the voice characteristics and the effect of speech rehabilitation in children with voice disorder (VD) after cleft palate (CP) plastic surgery. Methods: We selected 40 children who underwent CP repair in our hospital (January 2018 to December 2018), and all of them received speech rehabilitation one month after CP repair. The /a/ sound acoustic characteristic parameters and clinical efficacy were compared before and after speech rehabilitation treatment. Results: After the CP plastic surgery, there was no significant difference in the F₀ value of /a/ sound before and after the speech rehabilitation (t=0.661, P>0.05). After speech rehabilitation, the harmonic-noise ratio(HNR) value was significantly higher than that before treatment, and the normalized noise energy(NNE), amplitude perturbation (Shimmer) and fundamental frequency perturbation (Jitter) values were significantly lower than those before treatment (t=1.690, 3.974, 2.287, 24.558, P<0.05); before speech rehabilitation treatment, the phonetic intelligibility(PI) value of children with severe VD was significantly lower than that of children with mild VD (F=3.452, P<0.05). After treatment, the PI value of children with different postoperative VD severity increased significantly, and there was no difference among the groups (F=1.153, P>0.05). The effective rates of clinical treatment for severe, moderate and mild children were 88.89%, 100.00% and 100.00% respectively. Conclusions: VD often exists after CP palatoplasty, and speech rehabilitation can effectively improve the voice quality of children with CP. VD training after CP surgery should be emphasized in clinical practice.

Key words: cleft palate, cleft palate repair, voice disorder, phonetic features, speech rehabilitation