重复经颅磁刺激联合言语康复训练治疗脑梗死后失语症的临床研究  

Clinical study of repetitive transcranial magnetic stimulation combined with speech rehabilitation training in the treatment of aphasia after cerebral infarction

作　　者：彭慧[1] 周成[2] PENG Hui;ZHOU Cheng(Rehabilitation Department,Second Affiliated Hospital of Nanchang University,Nanchang,Jiangxi,360000;Department of Neurology,Hongdu Hospital of Traditional Chinese Medicine in Nanchang City of Jiangxi Province,Nanchang,Jiangxi,360000)

机构地区：[1]南昌大学第二附属医院康复科,江西南昌360000 [2]江西省南昌市洪都中医院神经内科,江西南昌360000

出　　处：《实用临床医药杂志》2020年第17期36-40,共5页Journal of Clinical Medicine in Practice

基　　金：江西省科技厅项目(20161BBG70221)。

摘　　要：目的观察重复经颅磁刺激(r TMS)联合言语康复训练治疗脑梗死后失语症的临床疗效。方法选取120例脑梗死后失语症患者作为研究对象,采用随机数表法分为言语训练组、假刺激组和联合组,每组40例。言语训练组采用常规言语康复训练,假刺激组采用言语康复训练联合r TMS假刺激,联合组采用言语康复训练联合低频r TMS康复治疗,3组均持续治疗观察4周。治疗前和治疗4周后采用汉语失语成套检查(ABC)评估3组患者的康复疗效,采用西方失语症成套测验(WAB)计算失语指数(AQ)评分,同时对中枢激活脑区进行功能性磁共振(f MRI)检查,比较选定感兴趣区(ROI)的激活情况。结果联合组的康复总有效率为82.50%,高于言语训练组、假刺激组的57.50%、62.50%,差异有统计学意义(P<0.05);治疗后,联合组AQ评分高于言语训练组、假刺激组,差异有统计学意义(P<0.05);f MRI检查显示,治疗后,联合组大脑皮质感觉运动区(SM1)、枕叶、颞叶和基底核区的激活率均高于言语训练组、假刺激组,差异有统计学意义(P<0.05)。结论r TMS联合言语康复训练能充分激活脑梗死后失语症患者大脑语言功能区,减轻失语症严重程度,促进言语功能恢复。Objective To observe the clinical effect of repetitive transcranial magnetic stimulation( r TMS) combined with speech rehabilitation training in the treatment of aphasia after cerebral infarction. Methods A total of 120 patients with aphasia after cerebral infarction were collected,and were divided into speech training group( n = 40),false stimulation group( n = 40) and combination group( n = 40) according to table method random,given conventional speech training,speech training combined with r TMS false stimulation,speech training combined with low frequency r TMS rehabilitation treatment,respectively. All patients were treated for 4 weeks. Before treatment and 4 weeks after treatment,the patients in the three groups were examined with complete Chinese aphasia( ABC) to evaluate the rehabilitation effect,Western Aphasia Battery( WAB) was used to calculate the aphasia index( AQ) score,functional magnetic resonance imaging( f MRI) was performed on the central activated brain area,and the activation of selected regions of interest( ROI) was compared. Results The total effective rates of in the combination group was 82. 50%,which was significantly higher than57. 50% and 62. 50% in the speech training group and false stimulation group( P < 0. 05). After treatment,AQ score of combination group was significantly higher than that of speech training group and false stimulation group( P < 0. 05). FMRI findings showed that the activation rates of area one of sensorimotor cortex( SM1),occipital lobe,temporal lobe and basal nucleus in the combination group were significantly higher than those in the speech training group and the false stimulation group( P < 0. 05). Conclusion r TMS combined with speech rehabilitation training can activate the speech ared of patients with aphasia after cerebral infarction,relieve severity of aphasia,and promote the speech function of patients.

关 键 词：脑梗死 失语症 重复经颅磁刺激 言语康复训练 失语指数 

分 类 号：R743.3[医药卫生—神经病学与精神病学]