汉语卒中后失语症失语类型的诊断、鉴别诊断流程图和卒中后失语症的治疗  

A flowchart for the diagnosis and differential diagnosis of post-stroke aphasia types in the Chinese language and treatment of post-stroke aphasia

作　　者：王荫华[1] 杜万良[1,2] 杨晓娜[1,3] 闫俊 孙葳 白静[1] 周炯[1,5] 周爱红[1,6] 牛建平[1,7] 李传玲[1,8] 王健[1,9] Wang Yinhua;Du Wanliang;Yang Xiaona;Yan Jun;Sun Wei;Bai Jing;Zhou Jiong;Zhou Aihong;Niu Jianping;Chuanling;Wang Jian(Department of Neurology,Peking University First Hospital,Beijing 100034,China;Department of Neurology,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China;Department of Neurology&Psychiatry,Beijing Shijitan Hospital,Capital Medical University,Beijing 100038,China;Peking University Sixth Hospital,Peking University Institute of Mental Health,NHC Key Laboratory of Mental Health(Peking University),National Clinical Research Center for Mental Disorders(Peking University Sizth Hospital),Beijing 100191,China;Department of Neurology.The Second Affiliated Hospital,School of Medicine,Zhejiang University,Hangzhou 310009,China;Department of Neurology,Xuanan Hospital,Ca pital Medical University,Beijing 100053,China;Department of Neurology.The Second Affiliated Hospital of Xiamen Medical College,Xiamen 361021,China;Department of Neurology.Xuzhou Central Hospital,Xuzhou 221009,China;Department of Psychology,Guang'anmen Hospital.Beijing 100096,China)

机构地区：[1]北京大学第一医院神经内科,北京100034,北京大学第一医院神经内科,北京100034 [2]首都医科大学北京天坛医院神经内科,北京100070,北京大学第一医院神经内科,北京100034 [3]首都医科大学北京世纪坛医院神经与精神科,北京100038,北京大学第一医院神经内科,北京100034 [4]北京大学第六医院,北京大学精神卫生研究所,国家卫生健康委员会精神卫生学重点实验室(北京大学),国家精神心理疾病临床医学研究中心(北京大学第六医院),北京100191,北京大学第一医院神经内科,北京100034 [5]浙江大学医学院第二医院神经内科,杭州310009,北京大学第一医院神经内科,北京100034 [6]首都医科大学宣武医院神经内科,北京100053,北京大学第一医院神经内科,北京100034 [7]厦门医科大学第二医院神经内科,厦门361021,北京大学第一医院神经内科,北京100034 [8]徐州中心医院神经内科,徐州221009,北京大学第一医院神经内科,北京100034 [9]广安门医院心理科,北京100096

出　　处：《中华老年医学杂志》2022年第4期488-496,共9页Chinese Journal of Geriatrics

摘　　要：本文对汉语卒中后失语症(PSA)的概念、病因、分类及经典大脑皮质定位、评估、汉语PSA失语症类型的诊断与鉴别诊断流程、治疗、康复、PSA产生及恢复的机制、预后及影响因素做了全面的阐述.本文强调了脑和血管的神经影像学评估及神经心理学评估对汉语PSA诊断与鉴别诊断的必要性和意义;提出并提倡基于脑和血管解剖定位与语言区和语言障碍之间关系的"内外、前后二分法"为出发点,制定的汉语PSA的分类更适合指导脑卒中的临床治疗;以"四要素"作汉语PSA的诊断、分型和鉴别诊断,制定出的流程图使汉语PSA失语类型的确定不再困难.有益于给患者制定有针对性的、个体化的康复训练方案,使患者受益.介绍了美金刚、吡拉西坦、多奈派齐等药物在PSA治疗中的应用,美金刚治疗PSA的国内外临床研究及作用机制,康复训练治疗的疗效机制.美金刚、吡拉西坦、多奈派齐等药物结合非药物疗法和康复训练,针对卒中后失语症治疗的临床研究和应用值得推荐.This article aims to comprehensively review the concept,etiology,classification,classical cortical mapping,assessment,a proposed flowchart for the diagnosis and differential diagnosis,treatment,rehabilitation,mechanisms of development and recovery,prognosis,and influencing factors for post-stroke aphasia(PSA)types in the Chinese language.We emphasize the necessity and significance of neuroimaging assessment of the brain and blood vessels and neuropsychological assessment in the diagnosis and differential diagnosis of PSA in Chinese.We also recommend and encourage the use of the dichotomies of internal us.external and anterior ts.posterior as a starting point,based on the association of anatomical locations of the brain and blood vessels with brain language areas and language disorders.A classification system of PSA in Chinese developed from this approach in the form of a flowchart is well-suited for guiding the clinical treatment of cerebral stroke.Incorporating the"four elements",the flowchart enables convenient diagnosis,classification and differential diagnosis of PSA in Chinese and facilitates targeted and personalized rehabilitation planning to benefit the patient.This article introduces the use of memantine,piracetam,donepezil and otherdrugs for PSA treatment,evaluates clinical trials on memantine conducted in China and abroad and its mechanisms of action for the treatment of PSA,and discusses how rehabilitation therapy achieves therapeutic effects.For the treatment of PSA,clinical research and practice using drugs such as memantine,piracetam and donepezil in combination with non-pharmacotherapy and rehabilitation training should be promoted.

关 键 词：卒中后失语症 汉语卒中后失语症类型 二分法 四要素 诊断 治疗 

分 类 号：R743.3[医药卫生—神经病学与精神病学]