CN102512759B - Pacemaker system for treating laryngeal muscular paralysis and operating method thereof - Google Patents
Pacemaker system for treating laryngeal muscular paralysis and operating method thereof Download PDFInfo
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Abstract
The invention relates to a pacemaker system for treating laryngeal muscular paralysis and an operating method thereof. The system comprises a respiration sensor, a signal conditioning circuit, a microprocessor, a stimulating pulse generating circuit, a stimulating output electrode and a power management circuit. When the pacemaker system for treating the laryngeal muscular paralysis runs, a respiration signal is detected by adopting the respiration sensor, and then, processing, such as amplification, filtering and the like, is performed on the respiration signal by using the signal conditioning circuit. The microprocessor is used for sampling an output signal of the signal conditioning circuit and processing sampled data; through the extreme point and the variation tendency of a detected respiration wave shape, the stimulating pulse generating circuit is controlled to generate a stimulating pulse with a certain wave shape. The pulse is output by the stimulating output electrode to stimulate laryngeal muscles, thereby, the paralytic laryngeal muscles are recovered in function. According to the pacemaker system for treating the laryngeal muscular paralysis, a skillful circuit design can be effectively performed according to a physiological property; an implementation method is simple and novel. The problem of laryngeal muscle paralysis can be well solved. Simultaneously, the pacemaker system for treating the laryngeal muscular paralysis has the characteristics of low cost, good real-time performance, high robustness and high precision.
Description
Technical field
The invention belongs to Medical Instruments technical field, relating to a kind of for recovering to stimulate pacemaker device and the pacing method thereof of object throat muscles function.
Background technology
Bilateral vocal cord paralysis can cause patient respiratory, sounding, function of deglutition to suffer damage, and can cause dyspnea and threat to life, all do not have good solution all the time when serious.Although operative treatment can improve breathing to a certain extent, keep pronunciation, curative effect is still certainly difficult.FNS finds atrophy and the fibrosis that can stop muscle in zoopery, recovers the function that patient suffers damage, and is a kind of effective Therapeutic Method.
Functional electric stimulation is treated the concept introducing department of otorhinolaryngology of motion muscular paralysis by Zealear and Dedo of Northwestern Univ USA at first.Afterwards, the pacemaker current that Bergmann utilized the pressure receptor of thoracic wall to produce synchronously triggers functional electric stimulation makes glottis open greatly.After this, somebody attempts using the methods such as diaphram change when breathing, trachea elongation and tracheal strips variations in temperature to trigger, but has its limitation.As insufficient in breath signal, non-respiratory signal disturbing etc.
The present invention obtains respiratory waveform by respiration pickup, by judging the trend of respiratory waveform and detecting the limit of respiratory waveform, determines to breathe the residing stage, provides corresponding boost pulse.Therefore accurately can follow the tracks of respiratory waveform, generation pulsewidth, the boost pulse that amplitude is adjustable, effectively solve this problem of bilateral vocal cord paralysis.
Summary of the invention
The object of the invention is can not the problem of normally sounding, swallowing act and breathing in order to what solve that throat muscles paralysis causes, and provide the treatment pacemaker system that throat muscles is benumbed and operation method thereof, concrete technical scheme is as follows.
The pacemaker system for the treatment of throat muscles paralysis, comprise the respiration pickup, signal processing circuit, microcontroller, boost pulse generation circuit and the stimulation output electrode that connect in turn, electric power management circuit is that above-mentioned each ingredient is powered; Described microcontroller by carrying ADC (analog digital conversion) sampled signal treatment circuit output signal, and produces control signal control boost pulse generation circuit by carrying DAC (digital-to-analogue conversion); Described respiration pickup is used for obtaining breath signal, signal processing circuit carries out amplification filtering process to breath signal, and within sample range signal being adjusted to the ADC of microcontroller, to be sampled by the ADC of microcontroller and after carrying out date processing, form triggering signal and control boost pulse generation circuit generation boost pulse, boost pulse is exported by stimulating electrode.
In the pacemaker system of above-mentioned treatment throat muscles paralysis, described stimulation produces circuit and comprises add circuit and constant current output circuit; The DAC of microcontroller output is added with the reference voltage that a 2.5V pin (Vref+ foot) of microcontroller exports and produces Bipolar control signal by described add circuit, controls constant-current circuit and produces bipolarity constant current boost pulse; The pulsewidth of boost pulse is set by the intervalometer of microcontroller, and pulse amplitude is regulated by adjustable resistance.
In the pacemaker system of above-mentioned treatment throat muscles paralysis, add circuit is made up of the first operational amplifier A 1 and the first resistance R1, the second resistance R2; Constant-current circuit puts A2, the 3rd operational amplifier A 3 and the 3rd resistance R3 by the second operational amplifier, the 4th resistance R4, the 6th resistance R6, the 7th resistance R7 and adjustable resistance R5 are formed; The in-phase end of described first operational amplifier A 1 connects a pin (DAC0 pin) of microcontroller, one end of first resistance R1 connects the 2.5V pin (Vref+ foot) of microcontroller, the other end connects the end of oppisite phase of the first operational amplifier A 1 and one end of the second resistance R2, and the other end of the second resistance R2 connects the outfan of the first operational amplifier A 1 and one end of the 3rd resistance R3; The other end of the 3rd resistance R3 connects end of oppisite phase and the 4th resistance R4 one end of the second operational amplifier A 2, and the other end of the 4th resistance R4 connects one end of variable resistance R5 and the outfan of the second operational amplifier A 2; The in-phase end of the second operational amplifier A 2 connects one end of the 6th resistance R6 and one end of the 7th resistance R7; The other end ground connection of the 6th resistance R6, the 7th resistance R7 other end connects the outfan of the 3rd operational amplifier A 3; The in-phase end of operational amplifier A 3 connects the other end of adjustable resistance R5, and end of oppisite phase is connected to outfan.
The operation method of the pacemaker system of above-mentioned treatment throat muscles paralysis, comprises and carries out date processing to collection and produce boost pulse, describedly carries out date processing to collection and comprises the steps:
(1) data sampling and storage: every four of the data sampled by the ADC of microcontroller are divided into a group to be averaging rear as storage data, for the difference capping between two storage data that front and back are adjacent and lower limit, the storage data of difference not within the scope of this upper and lower bound are considered to invalid and abandon, and the data be not dropped are stored in an adjustable length data queue; Each sampling process upgrades last data of data queue;
(2) Trend judgement: the result of difference after sign function effect in statistic procedure (1) described data queue between each data, equation is as follows:
Formula is middle x (n) 1., and (n=0,1,2...) is the data in the data queue after step (1) process.N is the length of data queue, is long for the window of observed data, can selects as required.Sign function sgn (x) is defined as follows:
②
The result of sgn (x) function effect two data difference is 1 and represents that respiratory waveform rises between these two data, for-1 represents that respiratory waveform declines between these two data.Y (n) represents rising in data queue between data and downward trend summation.
Trend rate can be calculated according to trend summation y (n) and length of data queue N.3. trend rate δ is calculated by formula: can obtain trend rate compared with the total item that trend summation and participation trend calculate.
The trend of respiratory waveform is calculated again according to gained trend rate 4. formula of pressing.P (d)=1 represents that the respiratory waveform within the scope of length of data queue N is in ascent stage, P (d)=0 represents that the respiratory waveform within the scope of length of data queue N is near crest or trough, and P (d)=-1 represents that the respiratory waveform within the scope of length of data queue N is in the decline stage.Formula is middle M 4.
δvalue is judgement threshold, can set as required.
④
(3) extreme point detects: judge whether present sample data are in the extreme point of respiratory waveform, and equation is as follows by the data in step (1) described data queue:
f＝sgn[x(n)-x(n-1)]sgn[x(n+1)-x(n)]⑤
Formula is middle x (n) (n=0 5., 1,2...) be through step (1) process after data queue in data, x (n-1), three data that x (n), x (n+1) are recent renewal in data queue.Sgn (x) is defined by 2. formula.Adjacent data subtracts each other and positive and negatively act as 1 expression slope for just through sign function; If-1, then slope is negative.If 0, then represent that respiratory waveform is 0 at this data place slope.
According to the feature of respiratory waveform, extreme point place slope be 0 or the symbol of slope will change, therefore when having f=-1 or f=0, respiratory waveform is in Near The Extreme Point.The type of extreme point can be judged again according to the value of P (d) in step (2).If P (d)=1 and f=-1 or f=0, sampled data is positioned at the maximum place of respiratory waveform, and namely starting respiratory waveform herein will enter the decline stage; If P (d)=-1 and f=-1 or f=0, sampled data is positioned at the minimum place of respiratory waveform, and starting respiratory waveform herein will enter ascent stage.
In above-mentioned operation method, described boost pulse generating step comprises: the extreme point obtaining respiratory waveform behind described step (1), (2), (3); If the minimum of respiratory waveform detected, respiratory waveform will enter ascent stage, and microcontroller produces high level and opens boost pulse generation module by SHDN (electric power management circuit switch pin).Meanwhile, the DAC of microcontroller produces 2.5V voltage and outputs to boost pulse generation module by 5 feet, and make stimulating electrode export positive boost pulse, the timing that pulsewidth is set by the intervalometer of microcontroller is determined.After timing arrives, microcontroller powered-down management circuit, electrode exports 0V voltage, and the time span of closedown is set by the intervalometer of microcontroller.After the timeing closing time arrives, stimulation generation module opened again by microcontroller, and meanwhile, DAC produces 0V voltage, and make stimulating electrode export negative boost pulse, pulsewidth is set by intervalometer.As long as respiratory waveform is in ascent stage, just control the open and close of electric power management circuit and the DAC output voltage of microcontroller according to said sequence, the persistent period of three parts is all by the set timer of microcontroller.So just can produce pulsewidth and the adjustable bipolarity boost pulse of dutycycle.
If the maximum of respiratory waveform detected, respiratory waveform will enter the decline stage, now powered-down management circuit, close DAC and the timer module of microcontroller, make microcontroller enter low-power consumption mode, stop producing boost pulse.
Compared with prior art, tool of the present invention has the following advantages and technique effect: first the research and development of the pacemaker system for the treatment of throat muscles paralysis will solve this thorny problem of bilateral vocal cord paralysis, enable the patient being provided with pacemaker do muscle power work, make them be subject to the minimum puzzlement of disease.Present invention employs accurate instrumentation amplifier to amplify the breath signal collected, and step low-pass and high-pass filtering are carried out to signal, adopt double T trap circuit to suppress Hz noise, the signal like this after process eliminates the interference of other noises, can react respiratory variations more accurately.After signal data acquisition is come in, carry out amplitude limit and smothing filtering, remove the interference of occasionality.Adopt extreme point to detect and Trend judgement, judge rising and the decline stage of respiratory waveform accurately, more can provide effective respiratory triggering signal than various stimulators in the past.Have employed amplitude and the adjustable bipolarity stimulus waveform of stimulation time, have more wide subject range, effectively can avoid the infringement to biological tissue, less to the negative effect of organism.
Accompanying drawing explanation
Fig. 1 is the pacemaker system hardware configuration schematic diagram for the treatment of throat muscles paralysis in embodiment.
Fig. 2 is microcontroller circuit figure.
Fig. 3 is that boost pulse produces circuit block diagram.
Fig. 4 is that boost pulse produces circuit.
Fig. 5 is the workflow schematic diagram of larynx pacemaker device.
Fig. 6 is that breath signal contrasts figure with stimulus waveform.
Detailed description of the invention
Below in conjunction with accompanying drawing, the specific embodiment of the present invention is described further, but enforcement of the present invention is not limited thereto.
The pacemaker system hardware configuration schematic diagram for the treatment of throat muscles paralysis as shown in Figure 1.Primarily of signals collecting and conditioning module, micro controller module, boost pulse produces and forms with output module and electric power management circuit.Signals collecting and conditioning module comprise breath signal sensor and signal conditioning circuit.Respiration pickup is connected with signal processing circuit; Microcontroller by carrying ADC sampled signal treatment circuit output signal, and produces control signal control boost pulse generation circuit by carrying DAC; Stimulate output electrode to connect boost pulse and produce circuit; Electric power management circuit exports 3.3V, ± 5V, ± 15V voltage, powers for microcontroller, signal processing circuit and boost pulse produce circuit.Respiration pickup is used for the fluctuations of breathing the thorax abdomen caused to be converted to change in voltage; Voltage signal that respiration pickup obtains by signal conditioning circuit amplifies, and carries out some and goes interference process, and signal is adjusted to the scope that microcontroller can sample.Microcontroller mainly carries out sampling, calculates, produces timing signal, SHDN signal and DAC control signal, controls electric power management circuit and boost pulse generation module.Boost pulse produces to be responsible for producing with output module and to export the adjustable boost pulse of bipolarity constant current amplitude.
As shown in Figure 2, microcontroller, by 3.3V Power supply, to be sampled breath signal after modulate circuit process by 59 foot ADC0; The control signal SHDN that microcontroller exports controls the opening and closing of electric power management circuit; DAC signal is exported by DAC0 pin, and the 2.5V reference voltage coordinating microcontroller Vref+ pin to export controls boost pulse and produces the polarity that circuit exports boost pulse.
As shown in Figure 3 and Figure 4: stimulate and produce circuit and comprise the add circuit that is made up of operational amplifier A 1 and resistance R1, R2 and put by operational amplifier the constant-current circuit that A2, A3 and resistance R3, R4, R6, R7 and adjustable resistance R5 form; Described operational amplifier A 1 end of oppisite phase contact resistance R1, R2, outfan contact resistance R2, R3 and operational amplifier A 2; End of oppisite phase contact resistance R3, R4 of operational amplifier A 2, in-phase end contact resistance R6, R7; One end of outfan contact resistance R4 and adjustable resistance R5; The in-phase end of operational amplifier A 3 connects the other end of adjustable resistance R5, and end of oppisite phase is connected to outfan, outfan contact resistance R7.The DAC of microcontroller output is added with 2.5V reference voltage and produces Bipolar control signal by described add circuit, controls constant-current circuit and produces bipolarity constant current boost pulse; The pulsewidth of boost pulse is set by the intervalometer of microcontroller, and pulse amplitude is regulated by described adjustable resistance.
Carry out the calculating shown in Fig. 5 after sampled data, concrete implementation step is as follows:
(1) data sampling and storage: every four of the data sampled by the ADC of microcontroller are divided into a group to be averaging rear as storage data, for the difference capping between two storage data that front and back are adjacent and lower limit, the storage data of difference not within the scope of this upper and lower bound are considered to invalid and abandon, and the data be not dropped are stored in an adjustable length data queue; Each employing process upgrades last data of data queue;
(2) Trend judgement: the result of difference after sign function effect in statistic procedure (1) described data queue between each data, equation is as follows:
①
Formula is middle x (n) 1., and (n=0,1,2...) is the data in the data queue after step (1) process.N is the length of data queue, is long for the window of observed data, can selects as required.Sign function sgn (x) is defined as follows:
②
The result of sgn (x) function effect two data difference is 1 and represents that respiratory waveform rises between these two data, for-1 represents that respiratory waveform declines between these two data.Y (n) represents rising in data queue between data and downward trend summation.
Trend rate can be calculated according to trend summation y (n) and length of data queue N.3. trend rate δ is calculated by formula: can obtain trend rate compared with the total item that trend summation and participation trend calculate.
The trend of respiratory waveform is calculated again according to gained trend rate 4. formula of pressing.P (d)=1 represents that the respiratory waveform within the scope of length of data queue N is in ascent stage, P (d)=0 represents that the respiratory waveform within the scope of length of data queue N is near crest or trough, and P (d)=-1 represents that the respiratory waveform within the scope of length of data queue N is in the decline stage.Formula is middle M 4.
δvalue is judgement threshold, can set as required.
④
(3) extreme point detects: judge whether present sample data are in the extreme point of respiratory waveform, and equation is as follows by the data in step (1) described data queue:
f＝sgn[x(n)-x(n-1)]sgn[x(n+1)-x(n)]⑤
Formula is middle x (n) (n=0 5., 1,2...) be through step (1) process after data queue in data, x (n-1), three data that x (n), x (n+1) are recent renewal in data queue.Sgn (x) is defined by 2. formula.Adjacent data subtracts each other and positive and negatively act as 1 expression slope for just through sign function; If-1, then slope is negative.If 0, then represent that respiratory waveform is 0 at this data place slope.
According to the feature of respiratory waveform, extreme point place slope be 0 or the symbol of slope will change, therefore when having f=-1 or f=0, respiratory waveform is in Near The Extreme Point.The type of extreme point can be judged again according to the value of P (d) in step (2).If P (d)=1 and f=-1 or f=0, sampled data is positioned at the maximum place of respiratory waveform, and namely starting respiratory waveform herein will enter the decline stage; If P (d)=-1 and f=-1 or f=0, sampled data is positioned at the minimum place of respiratory waveform, and starting respiratory waveform herein will enter ascent stage.
(4) boost pulse is produced: the extreme point that can detect respiratory waveform after step (1) (2) (3), when the minimum of respiratory waveform being detected, respiratory waveform enters ascent stage, and microcontroller produces high level and opens boost pulse generation module by SHDN (electric power management circuit switch pin).Meanwhile, the DAC of microcontroller produces 2.5V voltage and outputs to boost pulse generation module by 5 feet, and make stimulating electrode export positive boost pulse, the timing that pulsewidth is set by the intervalometer of microcontroller is determined.After timing arrives, microcontroller powered-down management circuit, electrode exports 0V voltage, and the time span of closedown is set by the intervalometer of microcontroller.After the timeing closing time arrives, stimulation generation module opened again by microcontroller, and meanwhile, DAC produces 0V voltage, and make stimulating electrode export negative boost pulse, pulsewidth is set by intervalometer.As long as respiratory waveform is in ascent stage, the just open and close of sequential control electric power management circuit and the DAC output voltage of microcontroller according to this, the persistent period of three parts is all by the set timer of microcontroller.So just can produce pulsewidth and the adjustable bipolarity boost pulse of dutycycle.
When the maximum of respiratory waveform being detected, respiratory waveform enters the decline stage by starting, now powered-down management circuit, closes DAC and the timer module of microcontroller, makes microcontroller enter low-power consumption mode.
Fig. 6 is that respiratory waveform contrasts figure with stimulus waveform.As shown in the figure, respiratory waveform ascent stage produces bipolarity boost pulse, and the respiratory waveform decline stage does not stimulate.
Claims (1)
1. treat the pacemaker system of throat muscles paralysis, it is characterized in that, comprise the respiration pickup, signal processing circuit, microcontroller, boost pulse generation circuit and the stimulation output electrode that connect in turn, electric power management circuit is that above-mentioned each ingredient is powered; Described microcontroller by carrying ADC sampled signal treatment circuit output signal, and produces control signal control boost pulse generation circuit by carrying DAC; Described respiration pickup is used for obtaining breath signal, signal processing circuit carries out amplification filtering process to breath signal, and within sample range signal being adjusted to the ADC of microcontroller, to be sampled by the ADC of microcontroller and after carrying out date processing, form triggering signal and control boost pulse generation circuit generation boost pulse, boost pulse is exported by stimulating electrode; Described stimulation produces circuit and comprises add circuit and constant current output circuit; The DAC of microcontroller output is added with the reference voltage of a 2.5V pin of microcontroller and produces Bipolar control signal by described add circuit, controls constant-current circuit and produces bipolarity constant current boost pulse; The pulsewidth of boost pulse is set by the intervalometer of microcontroller, and pulse amplitude is regulated by adjustable resistance; Add circuit is made up of the first operational amplifier and the first resistance, the second resistance; Constant-current circuit is put by the second operational amplifier, the 3rd operational amplifier and the 3rd resistance, the 4th resistance, the 6th resistance, the 7th resistance and adjustable resistance are formed; The in-phase end of described first operational amplifier connects a pin of microcontroller, one end of first resistance connects another foot of microcontroller, the other end connects the end of oppisite phase of the first operational amplifier and one end of the second resistance, and the other end of the second resistance connects the outfan of the first operational amplifier and one end of the 3rd resistance; The other end of the 3rd resistance connects end of oppisite phase and the 4th resistance one end of the second operational amplifier, and the other end of the 4th resistance connects the outfan of variable-resistance one end and the second operational amplifier; The in-phase end of the second operational amplifier connects one end of the 6th resistance and one end of the 7th resistance; The other end ground connection of the 6th resistance R6, the 7th resistance other end connects the outfan of the 3rd operational amplifier; The in-phase end of operational amplifier A 3 connects the other end of adjustable resistance, and end of oppisite phase is connected to outfan; The function of described microcontroller comprises: every four of the data that the ADC of microcontroller samples are divided into one group to be averaging rear as storage data, for the difference capping between two storage data that front and back are adjacent and lower limit, the storage data of difference not within the scope of this upper and lower bound are considered to invalid and abandon, and the data be not dropped are stored in an adjustable length data queue; Each sampling process upgrades last data of data queue;
The described date processing that carries out comprises:
(1) data sampling and storage: every four of the data sampled by the ADC of microcontroller are divided into a group to be averaging rear as storage data, for the difference capping between two storage data that front and back are adjacent and lower limit, the storage data of difference not within the scope of this upper and lower bound are considered to invalid and abandon, and the data be not dropped are stored in an adjustable length data queue; Each sampling process upgrades last data of data queue;
(2) Trend judgement: the result of difference after sign function effect in statistic procedure (1) described data queue between each data, equation is as follows:
Formula 1. in x (n), n be more than or equal to 0 integer, be through step (1) process after data queue in data; N is the length of data queue, and be long for the window of observed data, sign function sgn (x) is defined as follows:
The result of sgn (x) function effect two data difference is 1 and represents that respiratory waveform rises between these two data, for-1 represents that respiratory waveform declines between these two data, y (n) represents rising in data queue between data and downward trend summation;
Can calculate trend rate according to trend summation y (n) and length of data queue N, 3. trend rate δ is calculated by formula: can obtain trend rate compared with the total item that trend summation and participation trend calculate,
The trend of respiratory waveform is calculated again according to gained trend rate 4. formula of pressing; P (δ)=1 represents that the respiratory waveform within the scope of length of data queue N is in ascent stage, P (δ)=0 represents that the respiratory waveform within the scope of length of data queue N is near crest or trough, P (δ)=-1 represents that the respiratory waveform within the scope of length of data queue N is in the decline stage, and formula is middle M 4.
δvalue is judgement threshold, is setting value,
(3) extreme point detects: judge whether present sample data are in the extreme point of respiratory waveform, and decisive equation is as follows by the data in step (1) described data queue:
f＝sgn[x(n)-x(n-1)]sgn[x(n+1)-x(n)] ⑤
Formula is middle x (n) (n=0 5., 1,2...) be through step (1) process after data queue in data, x (n-1), x (n), three data that x (n+1) is recent renewal in data queue, sgn (x) is defined by 2. formula; Adjacent data subtracts each other and positive and negatively act as 1 expression slope for just through sign function; If-1, then slope is negative; If 0, then represent that respiratory waveform is 0 at this data place slope;
According to the feature of respiratory waveform, extreme point place slope be 0 or the symbol of slope will change, therefore when having f=-1 or f=0, respiratory waveform is in Near The Extreme Point; The type of extreme point can be judged again according to the value of P (δ) in step (2); If P (δ)=1 and f=-1 or f=0, sampled data is positioned at the maximum place of respiratory waveform, and namely starting respiratory waveform herein will enter the decline stage; If P (δ)=-1 and f=-1 or f=0, sampled data is positioned at the minimum place of respiratory waveform, and starting respiratory waveform herein will enter ascent stage.
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| CN111537772B (en) * | 2020-05-19 | 2023-03-28 | 广东电网有限责任公司东莞供电局 | Electricity larceny prevention and false wiring prevention electric energy meter and electricity larceny prevention and false wiring prevention method |
| CN112564705B (en) * | 2020-12-02 | 2022-07-01 | 湖北方圆环保科技有限公司 | Multi-channel data acquisition method for radon measuring instrument |
| CN112415352A (en) * | 2021-01-22 | 2021-02-26 | 杭州富特科技股份有限公司 | On-line insulation detection circuit based on inverter and inverter system |
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| CN1543909A (en) * | 2003-11-19 | 2004-11-10 | 叶学强 | Method and apparatus for integrated multi-parameter detecting and treating |
| CN201161060Y (en) * | 2007-11-19 | 2008-12-10 | 练洪深 | Closed-loop control non-invasive high-frequency ventilation diaphragm pacemaker |
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| Publication number | Priority date | Publication date | Assignee | Title |
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| CN1543909A (en) * | 2003-11-19 | 2004-11-10 | 叶学强 | Method and apparatus for integrated multi-parameter detecting and treating |
| CN201161060Y (en) * | 2007-11-19 | 2008-12-10 | 练洪深 | Closed-loop control non-invasive high-frequency ventilation diaphragm pacemaker |
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| 喉起搏器治疗喉麻痹动物模型的研究;景江华等;《中华耳鼻咽喉科杂志》;20031010;第38卷(第5期);第351－358页 * |
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