中枢性吞咽功能障碍脑皮质相关中枢的BOLD-fMRI定量研究

发布时间：2018-03-14 00:34

本文选题：BOLD-fMRI　切入点：脑梗死　出处：《河北联合大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的研究正常成人吞咽相关皮层中枢的分布与特征；研究急性脑梗死所致中枢性吞咽功能障碍患者脑吞咽相关中枢损害和功能代偿重组的特征，分析中枢性吞咽功能障碍的临床康复机制，从而为有效地进行吞咽康复治疗提供理论依据。方法选取10名健康右利手志愿者及经MRI(T1和T2)证实为两侧大脑或桥脑多发性脑梗死，但DWI证实仅其中一个为新发急性脑梗死灶；同时，患者首次出现吞咽障碍，并经临床证实为中枢性吞咽障碍的患者10例，在吞咽水的同时进行BOLD-fMRI扫描采集原始数据，，应用SPM5进行后处理，获得脑功能区的激活坐标、体积和强度等参数，利用Spss13.0对脑功能区激活体积和强度的变化进行统计分析。结果1.对照组进行自主吞咽试验时主要激活BA4区、BA13区、BA6/8区、BA40区BA24/32区等区域。对照组左侧半球激活体积大于右侧（P＜0.05），其LI值为15.22％，其中的中央前回(BA4)LI值为13.49％，岛叶19.02％，缘上回10.89％。2.病例组激活区域主要有双侧的BA4、13、40区和BA6/8区，而双侧的BA24/32区激活减少，同时BA23/31、BA18/19、BA41、BA36区被激活，左侧再发脑梗死组还可见双侧BA7区以及小脑明显被激活，与对照组相比，病例组病灶同侧皮质BA4区、BA6/8区激活体积、激活强度减小(P＜0.05），右侧再发脑梗死组病灶对侧BA6/8区及左侧再发脑梗死组病灶对侧BA4、MA6/8区激活体积增大（P＜0.05）而激活强度与对照组无统计学差异。结论1吞咽运动的大脑皮层中枢调控具有明显的优势半球偏侧性特征。食欲相关的愉快情境刺激可以激活前脑岛和前扣带皮层等吞咽运动启动中枢，进而激活缘上回和辅助运动区等吞咽运动规划中枢以及吞咽运动的执行中枢，而且激活执行中枢的体积是进行正常吞咽运动的重要条件。2再发脑梗死急性期所致中枢性吞咽障碍，吞咽运动的规划和执行中枢具有激活反应，但急性病变同侧吞咽相关中枢的激活强度降低，而对侧吞咽相关中枢的激活强度无明显变化；但出现后扣带回、前额叶和视、听皮层等吞咽启动中枢的代偿性中枢功能重组。通过视觉和听觉等途径给予患者食欲刺激，可以促进皮层吞咽启动中枢的代偿性功能重组，从而促进吞咽功能的恢复，提高吞咽障碍的康复治疗效果。
[Abstract]:Objective to study the distribution and characteristics of swallowing associated cortical centers in normal adults, and to study the characteristics of swallowing related central lesions and functional compensatory recombination in patients with central swallowing dysfunction caused by acute cerebral infarction. To analyze the clinical rehabilitation mechanism of central dysphagia, so as to provide theoretical basis for effective rehabilitation therapy. Methods Ten healthy right-handedness volunteers and multiple cerebral infarction were confirmed by MRI(T1 and T2, but only one of them was confirmed by DWI as a newly developed acute cerebral infarction, and the patients had dysphagia for the first time. In addition, 10 patients with central dysphagia were examined by BOLD-fMRI scanning while swallowing water. The parameters of activation coordinate, volume and intensity of brain functional area were obtained by post-processing with SPM5. The changes of activation volume and intensity of brain functional area were statistically analyzed by Spss13.0. Results 1. In the control group, the active volume of the left hemisphere was larger than that of the right side (P < 0.05), and the Li value of the left hemisphere was 15.22. The Li of the precentral gyrus was 13.49 and 19.022.In the control group, the activation volume of the left hemisphere was greater than that of the right side (P < 0.05), and the LI of the precentral gyrus was 13.49. The activation areas in the case group were mainly bilateral BA4M1340 and BA6/8. The activation of bilateral BA24/32 was decreased, and BA23 / 31BA18 / 19BA41mBA36 was activated. Bilateral BA7 and cerebellum were also significantly activated in the left recurrent cerebral infarction group. Compared with the control group, the ipsilateral BA4 area of the lesion in the case group was activated by the activation volume of BA6 / 8. The activation intensity decreased (P < 0.05), and the activation volume increased in the contralateral BA6/8 area in the right recurrent cerebral infarction group and in the contralateral BA4 / MA6 / 8 area in the left recurrent cerebral infarction group (P < 0.05), but there was no significant difference in the activation intensity between the right recurrent cerebral infarction group and the control group. Conclusion (1) the central regulation of the cerebral cortex in swallowing motion has obvious hemispheric hemispheric characteristics. The stimulation of appetite-related pleasant situation can activate the activation center of swallowing movement such as forebrain island and anterior cingulate cortex. Furthermore, the supramarginal gyrus and auxiliary motor area were activated in the planning center of swallowing motion and the executive center of swallowing movement. Moreover, the volume of activation of the executive center is an important condition for normal swallowing. 2. The central swallowing disorder caused by recurrent cerebral infarction in acute stage, and the planning and execution of swallowing movement have activation response. However, the activation intensity of ipsilateral swallowing related center was decreased in acute lesion, while that of contralateral swallowing related center was not changed, but the posterior cingulate gyrus, prefrontal lobe and vision were found. The compensatory central function recombination of the auditory and other swallowing initiation centers. By stimulating the patient's appetite through visual and auditory channels, it can promote the recombination of the compensatory function of the cortical swallowing initiation center, thus promoting the recovery of the swallowing function. To improve the effect of rehabilitation treatment for dysphagia.
【学位授予单位】：河北联合大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R743.3

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