健侧半球高频重复经颅磁刺激对左侧大面积脑梗死后完全性失语的效果观察  

Effect of high-frequency repetitive transcranial magnetic stimulation to contralesional hemisphere on global aphasia patients after left massive cerebral infarction

作　　者：高飞[1,2] 张玉阁[1,2] 马琳 陈予东[1,2] 刘丽旭 胡雪艳[1,2] GAO Fei;ZHANG Yuge;MA Lin;CHEN Yudong;LIU Lixu;HU Xueyan(Department of Neurorehabilitation,China Rehabilitation Research Center,Beijing 100068,P.R.China;School of Rehabilitation Medicine,Capital Medical University,Beijing 100068,P.R.China)

机构地区：[1]中国康复研究中心北京博爱医院神经康复一科,北京100068 [2]首都医科大学康复医学院,北京100068

出　　处：《华西医学》2024年第10期1625-1630,共6页West China Medical Journal

基　　金：中国残联课题(2023CDPFHS-03);中国康复研究中心课题(2021ZX-16)。

摘　　要：目的观察健侧半球高频重复经颅磁刺激(repetitive transcranial magnetic stimulation,rTMS)对左侧大面积脑梗死后完全性失语患者的治疗效果。方法选择2021年8月—2023年12月中国康复研究中心神经康复一科左侧大面积脑梗死后完全性失语患者。按照随机数字表法,患者被随机分为低频rTMS组和高频rTMS组。rTMS刺激位点为右侧大脑半球Broca区镜像区。于治疗前后对两组患者采用中文版西方失语症成套检验(western aphasia battery,WAB)进行语言评估并进行组内治疗前后及组间的比较。结果共纳入患者27例,低频rTMS组14例、高频rTMS组13例。治疗前,两组患者的WAB测试各项指标比较差异均无统计学意义(P>0.05)。与治疗前相比,治疗后两组WAB测试各项指评分(自发语言、听理解、命名、复述、失语商)均改善(P<0.05);高频rTMS组与低频rTMS组在治疗后比较,高频rTMS组自发言语、听理解、复述、命名、失语商评分均高于低频rTMS组(P<0.05)。结论高频rTMS兴奋健侧半球的神经调控方案有助于改善对左侧大面积脑梗死后完全性失语症患者的言语功能,其效果优于常规的低频rTMS抑制方案。Objective To observe the efficacy of high-frequency repetitive transcranial magnetic stimulation(rTMS)applied at contralesional hemisphere Broca’s homologue on patients with global aphasia after left massive cerebral infarction.Methods Patients with global aphasia after left massive cerebral infarction in the Department of Neurorehabilitation of China Rehabilitation Research Center between August 2021 and December 2023 were selected.According to the random number table method,patients were randomly divided into a low-frequency rTMS group and a high-frequency rTMS group.rTMS targeted the mirror area within the right hemispheric Broca’s area.Patients’language ability was assessed pre-and post-treatment by the Chinese version of the western aphasia battery(WAB).Results A total of 27 patients were included,with 14 in the low-frequency rTMS group and 13 in the high-frequency rTMS group.Before treatment,there was no statistically significant difference in the WAB test indicators between the two groups of patients(P>0.05).After treatment,WAB scores(spontaneous speech,auditory comprehension,naming,repetition,aphasia quotients)in both groups were significantly improved(P<0.05);compared to the low-frequency rTMS group,the high-frequency rTMS group exhibited significant improvement in spontaneous speech,auditory comprehension,repetition,naming and aphasia quotients(P<0.05).Conclusion The effect of high-frequency rTMS excitation to contralesional hemisphere is better than that of conventional low-frequency rTMS inhibition to contralesional hemisphere in improving the speech function of patients with global aphasia after left massive cerebral infarction.

关 键 词：康复 重复经颅磁刺激 完全性失语 

分 类 号：R743.33[医药卫生—神经病学与精神病学]