张田

【摘要】 目的：观察质子泵抑制剂、金嗓散结丸联合发声训练治疗声带小结合并反流性咽喉炎的效果。方法：选取2016年6月-2019年1月收治的声带小结伴反流性咽喉炎患者70例。随机分为对照组（35例）和观察组（35例）。所有患者给予金嗓散结丸（3粒/次，2次/d）联合发声训练治疗，观察组加用40 mg 埃索美拉唑镁肠溶片（20 mg/次，2次/d），疗程1个月。比较两组患者治疗前后反流体征评分（reflux finding score，RFS）和反流症状指数（reflux symptoms index，RSI）、振幅微扰、基频微扰和噪谐比、临床疗效。结果：治疗前，两组的RFS、RSI、振幅微扰、基频微扰和噪谐比比较差异无统计学意义（P>0.05）;治疗后，两组鼻部RFS、RSI、振幅微扰、基频微扰和噪谐比评分均低于治疗前，而且观察组低于对照组，观察组显效率和总有效率高于对照组，差异均具有统计学意义（P<0.05）。结论：质子泵抑制剂、金嗓散结丸联合发声训练有效改善声带小结合并反流性咽喉炎的临床症状，更好地改善患者的嗓音状况，同时提高临床治疗效果。

【关键词】 质子泵抑制剂 发声训练 声带小结 咽喉反流

[Abstract] Objective： To observe the effect of proton pump inhibitor and Jinsheng Sanjie Pill combined with vocal training on vocal nodules with laryngopharyngeal reflux disease. Method： Seventy patients with vocal nodules accompanied by reflux laryngitis were selected from June 2016 to January 2019. They were randomly divided into control group （35 cases） and observation group （35 cases）. All patients were treated with Jinsang Sanjie Pill （3 pills per time， 2 times per day） combined with vocal training. The observation group was treated with Esomeprazole Magnesium Enteric-coated Tablets （20 mg per time， 2 times per day） 40 mg for one month. Reflux finding score （RFS） and reflux symptoms index （RSI）， amplitude perturbation， fundamental frequency perturbation and noise-to-harmonic ratio （NHR） were compared between the two groups before and after treatment. Result： There were no significant differences in RFS， RSI， amplitude perturbation， fundamental frequency perturbation and noise-to-harmonic ratio between the two groups before the treatment （P>0.05）. The RFS， RSI， amplitude perturbation， fundamental frequency perturbation and noise-to-harmonic ratio scores of the two groups were lower after the treatment than those before， the observation group were lower than the control group， and the remarkable efficiency and total effective rate of the observation group were higher than those of the control group， and the difference were all statistically significant （P<0.05）. Conclusion： The combination of proton pump inhibitor and Jinsang Sanjie Pill with vocal training can effectively improve the clinical symptoms of vocal nodules with LPRD， improve the voice condition and the clinical therapeutic effect of patients.

声带小结作为常见咽喉部的良性疾病，由于其声嘶症状较为明显，在临床上引起人们的重视[1]。研究发现声带小结的发病主要同不科学用嗓关系密切[2]。针对声带小结的治疗，有药物保守治疗和手术治疗[2-3]。尽管通过发声训练联合药物治疗，能够有效治疗大部分声带小结患者，已经是声带小结治疗的主流手段。但仍然有部分患者疗效欠佳，临床具体表现在声嘶症状和咽干、咽异物感等改善不明显或无改善[4]。针对声带息肉患者的这一现象，越来越多的研究发现与咽喉反流（laryngopharyngeal reflux，LPR）关系密切[5-6]，但目前对声带小结同咽喉反流的关系和是否运用质子泵抑制剂（proton pump inhibitors，PPI）治疗研究较少，本文选取PPI、金嗓散結丸联合发声训练治疗声带小结合并反流性咽喉炎的患者进行研究，以期为临床提供一定的诊疗依据，现报道如下。