本文選題：低頻重復(fù)經(jīng)顱磁刺激 + 外側(cè)裂周失語(yǔ)癥�。� 參考：《瀘州醫(yī)學(xué)院》2013年碩士論文

【摘要】：近年來(lái)，腦卒中的發(fā)病率正以每年近9%的速度上升，隨著我國(guó)腦卒中患者日益增多，卒中后失語(yǔ)癥的發(fā)生也在逐年增加。世界衛(wèi)生組織(WHO)的調(diào)查資料顯示，失語(yǔ)癥的恢復(fù)往往需要2年以上的時(shí)間，且僅有20%的患者可以完全恢復(fù)[1]。由此可見，失語(yǔ)癥不僅康復(fù)過(guò)程緩慢，而且預(yù)后也不盡人意，絕大部分患者長(zhǎng)期遺留程度不等的言語(yǔ)功能障礙，嚴(yán)重者甚至完全喪失與外界的語(yǔ)言交流能力，嚴(yán)重影響了其社會(huì)交際能力，降低了日常生活質(zhì)量，還帶給家庭和社會(huì)巨大的負(fù)擔(dān)。因此對(duì)卒中后失語(yǔ)患者的治療越來(lái)越受到國(guó)內(nèi)外學(xué)者的重視。 失語(yǔ)癥的種類很多，預(yù)后也各不相同。依據(jù)Benson法，失語(yǔ)癥可分為三大類：皮質(zhì)下失語(yǔ)綜合征、分水嶺區(qū)失語(yǔ)綜合征及外側(cè)裂周失語(yǔ)綜合征。資料顯示，皮質(zhì)下失語(yǔ)一般能自行恢復(fù)，預(yù)后好；外側(cè)裂周失語(yǔ)綜合征預(yù)后相對(duì)較差。后者的共同特征是在復(fù)述方面都有程度不等的障礙，且病灶都位于外側(cè)裂周。根據(jù)言語(yǔ)障礙的特征以及病變部位的不同又可分為：（１）Broca失語(yǔ)；（２）Wernicke失語(yǔ)；（３）傳導(dǎo)性失語(yǔ)。其中，傳導(dǎo)性失語(yǔ)預(yù)后相對(duì)較理想，而Wernicke失語(yǔ)的預(yù)后最差[2,3]。 目前國(guó)內(nèi)外仍以傳統(tǒng)的語(yǔ)言訓(xùn)練為主要治療手段，但療效難以肯定。近年來(lái)有報(bào)道認(rèn)為低頻重復(fù)經(jīng)顱磁刺激刺激大腦非優(yōu)勢(shì)半球有利于卒中后失語(yǔ)癥患者的康復(fù)，但這些研究并沒(méi)有將失語(yǔ)癥進(jìn)行分類，并且樣本量小，無(wú)隨機(jī)試驗(yàn)，故rTMS對(duì)各類失語(yǔ)癥的具體療效還有待證明。 目的：本研究通過(guò)臨床病例，旨在觀察低頻重復(fù)經(jīng)顱磁刺激在早期干預(yù)治療卒中后外側(cè)裂周失語(yǔ)癥患者的療效，探討該方法的治療價(jià)值。 方法：本研究納入24例急性腦卒中后外側(cè)裂周失語(yǔ)癥患者。隨機(jī)分為rTMS治療組和空白對(duì)照組（每組12例）。rTMS治療組患者采用重復(fù)經(jīng)顱磁刺激,刺激頻率為1Hz,每個(gè)序列10次脈沖，每次80個(gè)序列，序列間隔10秒，平均刺激強(qiáng)度40%~90%不等（具體根據(jù)患者年齡、病情、耐受程度調(diào)整），共10次。并分別于入組前、rTMS治療2周末、入組12周末對(duì)其漢語(yǔ)失語(yǔ)成套檢查（ABC評(píng)分），，以判定其療效。 結(jié)果：1. rTMS治療組與對(duì)照組在入組時(shí)ABC評(píng)分差異無(wú)統(tǒng)計(jì)學(xué)意義（P＞0.05）。2. rTMS治療組與對(duì)照組在rTMS治療2周末與入組時(shí)ABC評(píng)分差異無(wú)統(tǒng)計(jì)學(xué)意義（P＞0.05）；入組12周末兩組間差異有統(tǒng)計(jì)學(xué)意義（P＜0.05）。3.入組12周末，rTMS治療組與對(duì)照組ABC評(píng)分較入組時(shí)都有明顯改善，且差異有統(tǒng)計(jì)學(xué)意義（P＞0.05），但rTMS治療組改善更為明顯。4. rTMS治療組與對(duì)照組在入組12周末的圖命名、聽理解、復(fù)述、自發(fā)言語(yǔ)較入組時(shí)都有所改善，其中圖命名改善最明顯，自發(fā)性言語(yǔ)次之，聽理解和復(fù)述較差。 結(jié)論：1.早期采用低頻重復(fù)經(jīng)顱磁刺激干預(yù)治療可能對(duì)卒中后外側(cè)裂周失語(yǔ)癥患者的預(yù)后有一定幫助。2.在rTMS治療中患者并未出現(xiàn)明顯的并發(fā)癥或不良反應(yīng)，故該治療方法不但有效而且較為安全。
[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.
【學(xué)位授予單位】：瀘州醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：R749.13

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 吳小麗;王冰雁;吳宏勝;謝德豐;李朝健;;經(jīng)顱磁刺激治療腦梗死最佳方案的研究[J];廣東醫(yī)學(xué);2010年17期

2 吳睿;;燈盞細(xì)辛聯(lián)合重復(fù)經(jīng)顱磁刺激治療腦梗死后失語(yǔ)癥的療效觀察[J];中國(guó)實(shí)用神經(jīng)疾病雜志;2008年09期

3 顧正天;盧建新;張守成;郭學(xué)建;周威;徐蓉貞;徐珊珊;;不同頻率重復(fù)經(jīng)顱磁刺激對(duì)急性腦梗死患者靜脈溶栓治療的影響[J];臨床神經(jīng)病學(xué)雜志;2011年05期

4 高素榮;匡培根;;腦血管病失語(yǔ)癥研究進(jìn)展[J];國(guó)外醫(yī)學(xué)(腦血管疾病分冊(cè));1993年01期

5 陳芳;王曉明;詹成;楊玲;王寅旭;孫祥榮;趙曉瓊;黃慧;胡建秀;;重復(fù)經(jīng)顱磁刺激治療腦梗死失語(yǔ)及其對(duì)腦血流的影響[J];川北醫(yī)學(xué)院學(xué)報(bào);2012年04期

6 程亦男;汪潔;宋為群;屈亞萍;;低頻重復(fù)經(jīng)顱磁刺激治療卒中后失語(yǔ)癥的臨床應(yīng)用進(jìn)展[J];中國(guó)腦血管病雜志;2012年11期

7 周潔茹;苗玲;;失語(yǔ)癥[J];神經(jīng)病學(xué)與神經(jīng)康復(fù)學(xué)雜志;2005年04期

8 陳卓銘,黃舜韶,李巧薇;基于計(jì)算機(jī)運(yùn)算特點(diǎn)的語(yǔ)言障礙分類[J];中國(guó)臨床康復(fù);2003年07期

9 丘衛(wèi)紅;構(gòu)音障礙的評(píng)價(jià)及語(yǔ)言治療[J];中國(guó)臨床康復(fù);2004年28期

10 汪潔;吳東宇;;經(jīng)顱磁刺激與語(yǔ)法研究和語(yǔ)言治療[J];中國(guó)康復(fù)醫(yī)學(xué)雜志;2008年08期

本文編號(hào)：1748372