李燕梅教授治疗中风失语症经验研究

发布时间：2018-04-25 07:09

本文选题：中风失语症 + 多角度　；参考：《河南中医药大学》2016年硕士论文

【摘要】：研究背景中风失语症(Apoplexy Aphasia)是中风后出现的语言能力部分或完全丢失,是中风病的主症之一,也是中风病常见的后遗症。是临床常见病和多发病,主要表现为言语謇涩,甚至言语不能,临床医学称之为失语证,常伴发于急性脑血管病,按语言功能的缺失不同主要分为以下几个方面:自发言语的不能,即缺乏积极主动的语言交流;听理解的障碍,主要表现在能听到语言符号,但不能理解其表达的意思;复述的不能,不能够重复表述一句话,甚至几个词;不能命名,患者能够说出一些过去熟悉的物品的用途,但不能准确说出物品的名称;阅读不能,不能朗读和阅读理解句子和文章;书写不能,包括主动书写,被动的听写,抄写和写作能力等方面。大部分学者认为其发病主要由于大脑语言功能区神经细胞被破坏或不同区域的纤维联系中断引起的[1]。也有学者认为小脑参与复杂语言的形成,并观测执行语言流利度时,大脑和小脑同时激活[2]。患者在意识清楚的情况下,对所学习的语言(文字和肢体语言等)运用和识别发生障碍,可涉及视、听、读写及复述等各个方面[3]。失语患者,由于不能正常进行交流,或只能以肢体语言代替,大大增加了医生对患者病情准确判断的难度,由于很多查体无法配合,容易出现误诊和漏诊,也增加了一些检查费用支出,加重了患者的经济负担,同时也影响到了中风其它症状的治疗。影响了疾病的治疗和康复进展。也使如何快速促进患者语言功能的恢复成为当下失语领域研究的一个热点。治疗上,目前临床医学对本病的治疗主要集中在康复医学上,但由于语言训练需要专业的场地和专门语言康复师,且只有大型综合医院配备专业语言康复师,目前临床上只有很小一部分失语的病人接受专业的康复治疗,由于治疗的周期较长,短期内效果不明显,病人依从性较差,药物治疗上,服药比较方便,但大部分药物处在动物实验或临床观察阶段,且目前多为神经递质补充剂和胆碱酯酶抑制剂和一些脑神经保护剂等,如多奈哌齐,多巴胺,苯丙胺,美金刚,丁苯酞等,在药物洗脱期[4,5,6,7,8]大多会出现症状反复和疗效下降。因疗效不稳定,临床无法大面积推广,是目前神经科大夫面临的比较棘手问题,中医在其数千年的发展历程中积累丰富治疗经验,因此对中医治疗中风失语的经验继承应摆在更突出的位置。导师李燕梅教授,著名的脑病专家,硕士研究生导师。业医30余载,学风严谨,医德高尚,精通中西,长期致力于中风失语的理论研究,在中风失语理论研究和治疗上颇有建树,本课题旨在系统而有重点地整理总结导师李燕梅教授多角度多方位辩证治疗中风失语症的宝贵经验及学术精华,探讨其学术思想。
[Abstract]:Background: apoplectic aphasia (Apoplexy Aphasia) is the partial or complete loss of speech ability after stroke, is one of the main symptoms of stroke, and is also a common sequelae of stroke. It is a common and frequent clinical disease, mainly manifested in verbal acerbity, even speech failure, which is called aphasia in clinical medicine and is often accompanied by acute cerebrovascular disease. According to the lack of language function, it is mainly divided into the following aspects: the inability of spontaneous speech, that is, the lack of active language communication, the obstacle of listening and understanding, mainly the ability to hear the language symbols, but the inability to understand the meaning expressed by them; Cannot repeat, cannot repeat a sentence, or even a few words; cannot be named, and the patient can say the purpose of something familiar in the past, but not the exact name of the object; reading cannot, Unable to read and read and understand sentences and articles; not to write, including active writing, passive dictation, copying and writing skills. Most scholars believe that its pathogenesis is mainly caused by the destruction of nerve cells in the language functional regions of the brain or the disruption of fiber connections in different regions [1]. It is also believed that the cerebellum is involved in the formation of complex languages and that the cerebellum and cerebellum are activated simultaneously when the fluency of the executive language is observed [2]. When the patient is conscious, the use and recognition of the language (writing and body language, etc.) can be affected by visual, listening, reading, writing and retelling. Since aphasia patients cannot communicate normally or can only be replaced by body language, it greatly increases the difficulty for doctors to accurately judge the patient's condition. Because many physical examinations cannot cooperate, it is easy to misdiagnose and miss diagnosis. It also increases the cost of testing, increases the financial burden of patients and affects the treatment of other symptoms of stroke. It affects the progress of the treatment and rehabilitation of the disease. It also makes how to accelerate the recovery of language function of patients becomes a hot topic in the field of aphasia. At present, the treatment of this disease in clinical medicine is mainly focused on rehabilitation medicine. However, because language training requires specialized venues and specialized language rehabilitation specialists, only large general hospitals are equipped with professional language rehabilitation specialists. At present, only a small number of aphasia patients receive professional rehabilitation treatment. Because of the long period of treatment, the short-term effect is not obvious, the patient's compliance is poor, and the medication is more convenient in drug treatment. However, most of the drugs are in the stage of animal experiment or clinical observation, and most of them are neurotransmitter supplements, cholinesterase inhibitors and some neuroprotective agents, such as Donepezil, dopamine, amphetamine, methadone, butyphthalide, etc. In the drug elution phase, the symptoms and the curative effect are decreased and repeated in the drug elution phase (4? 5??? Because of the unstable curative effect, the clinical practice can not be popularized in a large area. It is a difficult problem for neurologicians to face at present. Chinese medicine has accumulated rich treatment experience in its thousands of years of development. Therefore, the inheritance of TCM treatment of apoplexy aphasia should be placed in a more prominent position. Tutor Professor Li Yanmei, a famous brain disease expert, master's tutor. More than 30 years of professional medicine, rigorous style of study, high medical ethics, proficient in Chinese and Western, long-term commitment to the theory of apoplexy aphasia research, in the theory of stroke aphasia research and treatment has a lot of achievements. The purpose of this paper is to systematically and emphatically summarize the valuable experience and academic essence of Professor Li Yanmei, professor Li Yanmei, in the treatment of apoplectic aphasia.
【学位授予单位】：河南中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R249;R277.7

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