低频重复经颅磁刺激治疗脑卒中后外侧裂周失语症的疗效观察

发布时间：2018-04-14 07:54

本文选题：低频重复经颅磁刺激 + 外侧裂周失语症　；参考：《泸州医学院》2013年硕士论文

【摘要】：近年来，脑卒中的发病率正以每年近9%的速度上升，随着我国脑卒中患者日益增多，卒中后失语症的发生也在逐年增加。世界卫生组织(WHO)的调查资料显示，失语症的恢复往往需要2年以上的时间，且仅有20%的患者可以完全恢复[1]。由此可见，失语症不仅康复过程缓慢，而且预后也不尽人意，绝大部分患者长期遗留程度不等的言语功能障碍，严重者甚至完全丧失与外界的语言交流能力，严重影响了其社会交际能力，降低了日常生活质量，还带给家庭和社会巨大的负担。因此对卒中后失语患者的治疗越来越受到国内外学者的重视。失语症的种类很多，预后也各不相同。依据Benson法，失语症可分为三大类：皮质下失语综合征、分水岭区失语综合征及外侧裂周失语综合征。资料显示，皮质下失语一般能自行恢复，预后好；外侧裂周失语综合征预后相对较差。后者的共同特征是在复述方面都有程度不等的障碍，且病灶都位于外侧裂周。根据言语障碍的特征以及病变部位的不同又可分为：（１）Broca失语；（２）Wernicke失语；（３）传导性失语。其中，传导性失语预后相对较理想，而Wernicke失语的预后最差[2,3]。目前国内外仍以传统的语言训练为主要治疗手段，但疗效难以肯定。近年来有报道认为低频重复经颅磁刺激刺激大脑非优势半球有利于卒中后失语症患者的康复，但这些研究并没有将失语症进行分类，并且样本量小，无随机试验，故rTMS对各类失语症的具体疗效还有待证明。目的：本研究通过临床病例，旨在观察低频重复经颅磁刺激在早期干预治疗卒中后外侧裂周失语症患者的疗效，探讨该方法的治疗价值。方法：本研究纳入24例急性脑卒中后外侧裂周失语症患者。随机分为rTMS治疗组和空白对照组（每组12例）。rTMS治疗组患者采用重复经颅磁刺激,刺激频率为1Hz,每个序列10次脉冲，每次80个序列，序列间隔10秒，平均刺激强度40%~90%不等（具体根据患者年龄、病情、耐受程度调整），共10次。并分别于入组前、rTMS治疗2周末、入组12周末对其汉语失语成套检查（ABC评分），，以判定其疗效。结果：1. rTMS治疗组与对照组在入组时ABC评分差异无统计学意义（P＞0.05）。2. rTMS治疗组与对照组在rTMS治疗2周末与入组时ABC评分差异无统计学意义（P＞0.05）；入组12周末两组间差异有统计学意义（P＜0.05）。3.入组12周末，rTMS治疗组与对照组ABC评分较入组时都有明显改善，且差异有统计学意义（P＞0.05），但rTMS治疗组改善更为明显。4. rTMS治疗组与对照组在入组12周末的图命名、听理解、复述、自发言语较入组时都有所改善，其中图命名改善最明显，自发性言语次之，听理解和复述较差。结论：1.早期采用低频重复经颅磁刺激干预治疗可能对卒中后外侧裂周失语症患者的预后有一定帮助。2.在rTMS治疗中患者并未出现明显的并发症或不良反应，故该治疗方法不但有效而且较为安全。
[Abstract]:In recent years, the incidence of stroke is increasing at an annual rate of nearly 9%. With the increasing number of stroke patients in China, the incidence of post-stroke aphasia is also increasing year by year.The World Health Organization (WHO) survey shows that the recovery of aphasia usually takes more than 2 years, and only 20% of the patients can recover completely.It can be seen that aphasia is not only slow in recovery, but also unsatisfactory in prognosis. Most of the patients have long been left with varying degrees of speech dysfunction, and in severe cases they have completely lost their ability to communicate with the outside world.It has seriously affected its social communication ability, reduced the quality of daily life, and brought a huge burden to family and society.Therefore, more and more scholars at home and abroad pay attention to the treatment of post-stroke aphasia.There are many kinds of aphasia and different prognosis.According to Benson method, aphasia can be divided into three categories: subcortical aphasia syndrome, watershed aphasia syndrome and lateral fissure aphasia syndrome.The data showed that subcortical aphasia can recover itself and prognosis is good, while the prognosis of lateral perifissure aphasia syndrome is relatively poor.The common feature of the latter is that there are varying degrees of retelling disorders, and the lesions are located around the lateral fissure.According to the characteristics of speech disorders and the different location of the lesions, we can divide them into two groups: 1 / 1 Broca aphasia (2) Wernicke aphasia / 3) conduction aphasia.Among them, the prognosis of conductive aphasia was relatively satisfactory, while that of Wernicke aphasia was the worst.At present, the traditional language training is still the main treatment at home and abroad, but the curative effect is difficult to confirm.In recent years, it has been reported that low frequency repetitive transcranial magnetic stimulation is beneficial to the rehabilitation of patients with post-stroke aphasia, but these studies do not classify aphasia, and have small sample size and no randomized trials.Therefore, the specific effect of rTMS on all kinds of aphasia has yet to be proved.Objective: to observe the effect of low frequency repetitive transcranial magnetic stimulation (LTMS) on early intervention in the treatment of aphasia around the posterolateral fissure of stroke, and to explore the therapeutic value of this method.Methods: 24 patients with aphasia of posterolateral fissure after acute stroke were included in this study.They were randomly divided into rTMS treatment group and blank control group (12 patients in each group were treated with repetitive transcranial magnetic stimulation (TMS), the stimulation frequency was 1Hz, each sequence was 10 pulses, 80 sequences per sequence, the interval of sequence was 10 seconds.The average stimulus intensity varied from 40% to 90% (10 times) according to the patient's age, condition and tolerance.After 2 weeks of rTMS treatment, ABC scores of Chinese aphasia were assessed at the end of 12 weeks in order to evaluate the efficacy of rTMS.Results 1. There was no significant difference in ABC scores between the rTMS group and the control group at the entry stage (P > 0.05). There was no significant difference in the ABC score between the rTMS treatment group and the control group at the end of 2 weeks of rTMS treatment and that in the control group (P > 0.05), and there was significant difference between the two groups at the end of 12 weeks (P < 0.05).The ABC scores in the rTMS treatment group and the control group were significantly improved at the end of 12 weeks, and the difference was statistically significant (P > 0.05), but the improvement was more obvious in the rTMS treatment group than in the control group at the end of the 12th week. The nomenclature, comprehension, and repetition of the map between the rTMS treatment group and the control group at the 12th weekend of the treatment group were more obvious than those of the control group.Spontaneous speech was better than that of group, among which the most obvious improvement was in picture naming, the second in spontaneous speech, and the worse in listening comprehension and retelling.Conclusion 1.Early intervention with low frequency repetitive transcranial magnetic stimulation may be helpful to the prognosis of patients with post-lateral fissure aphasia.There were no obvious complications or adverse reactions in the treatment of rTMS, so the treatment was not only effective but also safe.
【学位授予单位】：泸州医学院
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R749.13

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