抑制性重复经颅磁刺激对脑卒中后非流畅性失语的临床疗效观察  

Clinical observation of inhibitory repetitive transcranial magnetic stimulation in stroke patients with non-fluent aphasia

作　　者：朱慧敏[1] 程欣欣[1] 刘莉[1] 田丽[1] 饶江[1] 刘尧飞 张传文 ZHU Huimin;CHENG Xinxin;LIU Li;TIAN Li;RAO Jiang;LIU Yaofei;ZHANG Chuanwen(Department of Rehabilitation,Brain Hospital Affiliated to Nanjing Medical University,Nanjing 210029,China;不详)

机构地区：[1]南京医科大学附属脑科医院康复医学科,210029 [2]南京市秦淮区止马营社区卫生服务中心

出　　处：《浙江医学》2023年第11期1140-1145,1151,共7页Zhejiang Medical Journal

基　　金：南京市医学科技发展项目(YKK16152)。

摘　　要：目的探讨抑制性重复经颅磁刺激(rTMS)对脑卒中后非流畅性失语的临床疗效。方法选择2018年1月至2021年12月在南京医科大学附属脑科医院康复医学科行康复治疗的脑卒中后非流畅性失语患者60例,按随机数字表法分为观察组和对照组各30例,对照组接受常规药物治疗及训练,观察组在对照组治疗方案基础上加用rTMS治疗(右侧大脑半球Broca同源区1 Hz的rTMS刺激,1次/d,6次/周),于治疗前和治疗3周后评定两组患者西方失语成套测验(WAB)中失语商评分、自发语、听理解、命名、复述,并按照不同病程(<1个月、1~3个月、>3个月)分组进一步比较治疗效果。结果治疗后观察组自发语、复述、命名、失语商评分均高于对照组(均P<0.05);两组患者WAB各项目评分均高于治疗前,差异均有统计学意义(均P<0.05)。治疗后病程<1个月和1~3个月观察亚组患者的WAB各项目评分高于对照组,差异均有统计学意义(均P<0.05)。结论抑制性rTMS抑制右侧大脑半球Broca同源区对改善脑卒中非流畅性失语患者的语言功能有一定作用,且在不同时间起到不同作用。Objective To evaluate the efficacy of inhibitory repetitive transcranial magnetic stimulation(RTMS)in the treatment of non fluent aphasia after stroke.Methods From January 2018 to December 2021,60 patients with non fluent aphasia after stroke who received rehabilitation treatment in the Department of Rehabilitation Medicine of the Brain Hospital Affiliated to Nanjing Medical University were selected,and were divided into the observation group(n=30)and the control group(n=30)according to the random number table.The control group received conventional drug treatment and training.The control group received conventional pharmacotherapy and training,and the observation group was treated with rTMS on the basis of the control group protocol(1-Hz rTMS stimulation frequency at the homology of left Broca's area in the right cerebral hemisphere,once a day,6 times a week,a total of 3 weeks).Aphasia quotient score,spontaneous speech,auditory comprehension,naming,repetitions in the Western Aphasia Battery(WAB)were assessed in both groups before and 3 weeks after treatment,and further compared among different groups according to different disease duration(<1 month,1-3 months,>3 months).Results After 3 months of treatment the scores of each item of the WAB were higher than those before treatment in both groups(P<0.05);while the scores of spontaneous speech,retelling,naming,and aphasic quotient in the study group were significantly higher than those in the control group(P<0.05).For study group the scores of each item of the WAB in patients with disease duration<1 month and between 1 and 3 months were significantly higher than those in the control group after treatment(P<0.05).Conclusion Inhibition of the right Broca homologous region by RTMS can improve the speech function in stroke patients with non-fluent aphasia,and the efficacy is better for those with shorter disease duration.

关 键 词：抑制性重复经颅磁刺激 非流畅性失语 脑卒中 西方失语成套测验 

分 类 号：R743.3[医药卫生—神经病学与精神病学]