CAJ | 학술논문

目的探讨低频重复经颅磁刺激(repetitive transcranial magnetic stimulation,rTMS)右侧半球对急性脑梗死失语患者语言功能恢复的影响.方法 40例急性左侧半球脑梗死伴失语的右利手患者,其中治疗组20例,对照组20例.两组患者年龄无显著差异,均接受常规药物治疗和适当的语言训练,治疗组在此基础上还在发病7 d后接受1个疗程低频rTMS对右侧大脑半球语言区的治疗,1次/d,为期10 d.两组患者分别在rTMS治疗前、治疗后和发病后90 d进行汉语失语检查表(Aphasia Battery in Chinese,ABC)评价其语言功能,应用美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)和Barthel指数(Barthel Index,BI)评价其整体神经功能和日常生活能力.结果治疗组rTMS前和rTMS后ABC、NIHSS和BI评分均与对照组无显著差异;发病后90 d时治疗组ABC评分显著改善(P＜0.05),但NIHSS和BI与对照仍无显著差异.治疗组rTMS治疗前、后ABC评分有显著差异(P＜0.01),而NIHSS和BI评分均无显著差异,但发病后90 d时3项评分均较治疗前、后显著改善(P＜0.01).对照组治疗前、后3项评分均无显著差异,而发病后90 d时3项评分均较rTMS治疗前、后显著改善(P＜0.01).结论早期低频rTMS右侧大脑半球有助于急性脑梗死失语患者的语言功能恢复.
목적 탐토저빈중복경로자자격(repetitive transcranial magnetic stimulation,rTMS)우측반구대급성뇌경사실어환자어언공능회복적영향.방법 40례급성좌측반구뇌경사반실어적우리수환자,기중치료조20례,대조조20례.량조환자년령무현저차이,균접수상규약물치료화괄당적어언훈련,치료조재차기출상환재발병7 d후접수1개료정저빈rTMS대우측대뇌반구어언구적치료,1차/d,위기10 d.량조환자분별재rTMS치료전、치료후화발병후90 d진행한어실어검사표(Aphasia Battery in Chinese,ABC)평개기어언공능,응용미국국립위생연구원졸중량표(National Institutes of Health Stroke Scale,NIHSS)화Barthel지수(Barthel Index,BI)평개기정체신경공능화일상생활능력.결과 치료조rTMS전화rTMS후ABC、NIHSS화BI평분균여대조조무현저차이;발병후90 d시치료조ABC평분현저개선(P＜0.05),단NIHSS화BI여대조잉무현저차이.치료조rTMS치료전、후ABC평분유현저차이(P＜0.01),이NIHSS화BI평분균무현저차이,단발병후90 d시3항평분균교치료전、후현저개선(P＜0.01).대조조치료전、후3항평분균무현저차이,이발병후90 d시3항평분균교rTMS치료전、후현저개선(P＜0.01).결론 조기저빈rTMS우측대뇌반구유조우급성뇌경사실어환자적어언공능회복.
Objective To investigate the effect of low-frequency repetitive transcranial magnetic stimulation (rTMS) of right hemisphere on the rehabilitation of aphasia in patients with acute cerebral infarction. Methods Forty right-handed patients with acute cerebral infarction on the left hemisphere complicated with aphasia were randomly allocated into either a treatment group (n=20) or a control group (n=20). There was no significant difference in the ages between the patients in both groups. They all received routine drug treatment and appropriate language training. The patients in the treatment group also received a course of low frequency rTMS at language area of right hemisphere 7 days after the symptom onset, once a day for 10 days. Their language function was evaluated by the Aphasia Battery in Chinese (ABC) before and after the treatment, and at day 90 after the onset. The National Institutes of Health Stroke Scale (NIHSS) and Barthel Index (BI) were used to evaluate their overall neurological function and activities of daily living. Results There were no significant differences in the ABC, NIHSS and BI scores between the control group and the treatment group before and after rTMS; at day 90 after the onset, the ABC scores were improved significantly in the treatment group (P＜ 0.05), however, there was still no significant difference between the NIHSS and BI scores.There were significant differences between the ABC scores before and after the rTMS in the treatment group (P＜0.01), and there was no significant difference between the NIHSS and ABC scores, however, the 3 scores were improved more significantly than those before and after the treatment at day 90 after the onset (P ＜0.01). There were no significant difference in the 3 scores before and after the treatment in the control group, and at day 90 after the onset the 3 scores were improved more significantly than those before and after rTMS (P＜0.01).Conclusions The early low-frequency rTMS of the right hemisphere contributes to the rehabilitation of language function in patients with acute cerebral infarction complicated with aphasia.