高级神经心理功能障碍疏忽的产生与脑卒中病变部位、面积及范围的关系  

Relationship of the occurrence of neglect with different lesion sites, areas and ranges in stroke

作　　者：牛建平[1] 张红宇[2] 刘波[2] 张奕文[1] 宋叶华[1] 陈丽红[1] 

机构地区：[1]厦门市第二医院心脑血管病诊治中心,福建省厦门市361021 [2]包头医学院第一附属医院神经内科,内蒙古包头市014010

出　　处：《中国临床康复》2005年第32期8-11,共4页Chinese Journal of Clinical Rehabilitation

基　　金：内蒙古自治区自然科学基金资助项目(980204)~~

摘　　要：目的:探讨高级神经心理功能障碍疏忽的产生与脑卒中不同病变部位及梗死面积的关系。方法:于1998-06/2001-05选择包头医学院第一附属医院神经内科的脑血管病患者为观察对象,选择其中首次发病,于发病24h后经头颅CT或MRI证实为大脑半球单一病灶的脑梗死,意识清醒,视野计检查排除同向偏盲,未接受过正规教育但可简单书写识字并自愿参加的患者67例,其中左侧大脑半球病变者33例,右侧大脑半球病变者34例,分别在发病后2.5～3个月进行疏忽补充检查和汉语失语等项检查,疏忽的诊断标准包括删除试验(按Albert法检测,患者不能把纸一边的一条或更多条短线删除视为异常)、二等分试验(按Peter二等分线法检测,以向左偏离1.16%,向右偏离2.51%视为异常)及临摹画图(要求临摹圆形、正方形、十字形等,图画中一边缺损视为异常);失语的诊断标准参照汉语失语检查法和失语类型鉴别诊断流程;梗死面积采用帕里西诺公式(梗死面积=π/6×梗死面积最长径×梗死面积最宽径×CT阳性层面)计算。主要观察左右两侧大脑半球病变不同病变部位及不同梗死面积的疏忽发生率。样本间率的比较采用χ2检验。结果:67例患者全部进入结果分析。检查结果显示33例左侧大脑半球脑梗死患者均无一例疏忽出现,34例右侧大脑半球脑梗死患者中7例存在疏忽现象,其病变部位分别在右侧颞顶、颞顶枕、额颞顶、额颞顶枕、颞顶基底节、基底节、壳核。梗死面积在30cm3以下出现疏忽2例(12.5%),31～60cm3之间出现疏忽1例(14.3%),大于61cm3出现疏忽4例(36.4%)。结论:导致疏忽的更可能部位是颞顶部位联合病变,额叶和枕叶可能并不独立导致疏忽的发生,基底节、壳核可能通过阻断了皮层-边缘系统-网状结构激活环路,损害注意-唤醒功能参与疏忽的形成,疏忽的产生与病变部位有着密切的关系,与梗死面积并无直�AIM： To probe into the relationship of the incidence of neglect of the high-grade neuro-psychological dysfunction with different lesion loci and infarction areas in stroke. METHODS： Patients with cerebrovascular disease hospitalized in the Department of Neurology, First Affiliated Hospital of Baotou Medical College between June 1998 to May 2001 were recruited. The patients with first morbidit and diagnosed as single cerebral infarction by skull CT or MRI, 24 hours after morbidit were selected. They had good consciousness. Patients with same directional hemianopia were excluded following examination by diopsimetcr. There were 67 volunteers who had not accepted normal education but can write and read simply, among them, 33 cases of left cerebral infarction and 34 of right cerebral infarction. All the 67 patients were given neglect-supplement examination and aphasia battery in Chinese examination 2.5 to 3 months after morbidit. Diagnosis criteria of neglect included deleting the test （According to Albert, patients can not delete one or more short-lines at one end of the paper that was set as abnormal）, bisect test（ According to the bisect method, 1.16% left away from the middle and 2.51% right away Aphasia from the middle were set as abnormal） and imitation（ imitate round shape , square , cross, and so on defect at one side of pictures was set as abnormal）; diagnosis criteria of aphasia was according to Aphasia Battery in Chinese Examniation and the diagnostic flow procedure of aphasia type ; Palisiuo formula was used to calculate the infarction area=π/6×the longgest diameter of infarction area×the widest diameter of infarction area×Ct positive lay）. The incidence rate of neglect of different lesion loci and different infarction areas at left and right side cerebral hemisphere were observed mainly.x^2 test was used for the comparison among the samples. RESULTS： Sixty-seven patients entered the result analysis. There were no neglect in 33 patients with left cerebral infarction, but seven negle

关 键 词：脑梗塞 神经心理学测验 半球优势 大脑 

分 类 号：R749.1[医药卫生—神经病学与精神病学]