CAJ | 학술논문

目的利用血氧水平依赖性功能性磁共振成像(BOLD-fMRI)技术观察脑卒中失语症患者针刺联合语言康复训练治疗前和治疗后语言中枢激活脑区的变化,并比较单纯语言康复训练与联合治疗两种任务态下患者的言语功能恢复情况及激活脑区功能性磁共振成像(fMRI)差异.方法选取20例脑卒中失语症患者,所有患者均为右利手,按随机数字表法将其分为单一治疗组和联合治疗组,每组10例.单一治疗组采用语言康复训练,联合治疗组在此基础上增加针刺治疗,分别于入院当日及治疗1个月后采用BOLD-fMRI技术对患者的中枢激活脑区进行评定,并于治疗1个月后应用汉语失语成套测验(ABC)评价患者的言语功能恢复情况.结果治疗过程中,单一治疗组有1例患者再发脑卒中,未能复查fMRI.治疗后,单一治疗组和联合治疗组的有效率分别为55.56％和100.00％,联合治疗组言语功能恢复状况优于单一治疗组(P＜0.05).单一治疗组和联合治疗组患者的激活体素和激活强度变化与组内治疗前比较,差异均有统计学意义(P＜0.05),其中联合治疗组右侧激活脑区明显多于左侧,且其激活脑区较单一治疗组更为显著、广泛(P＜0.05),主要包括双侧额叶、楔叶、后扣带回、舌回、枕叶、胼胝体压部、小脑半球,左侧中央前后回、中央旁小叶、颞叶、角回、楔前叶,右侧海马、海马旁回.结论针刺联合语言康复训练可引起患者相应脑功能激活区产生变化,而这些特异性激活区可能与患者的言语功能恢复有关.
목적 이용혈양수평의뢰성공능성자공진성상(BOLD-fMRI)기술관찰뇌졸중실어증환자침자연합어언강복훈련치료전화치료후어언중추격활뇌구적변화,병비교단순어언강복훈련여연합치료량충임무태하환자적언어공능회복정황급격활뇌구공능성자공진성상(fMRI)차이.방법 선취20례뇌졸중실어증환자,소유환자균위우리수,안수궤수자표법장기분위단일치료조화연합치료조,매조10례.단일치료조채용어언강복훈련,연합치료조재차기출상증가침자치료,분별우입원당일급치료1개월후채용BOLD-fMRI기술대환자적중추격활뇌구진행평정,병우치료1개월후응용한어실어성투측험(ABC)평개환자적언어공능회복정황.결과 치료과정중,단일치료조유1례환자재발뇌졸중,미능복사fMRI.치료후,단일치료조화연합치료조적유효솔분별위55.56％화100.00％,연합치료조언어공능회복상황우우단일치료조(P＜0.05).단일치료조화연합치료조환자적격활체소화격활강도변화여조내치료전비교,차이균유통계학의의(P＜0.05),기중연합치료조우측격활뇌구명현다우좌측,차기격활뇌구교단일치료조경위현저、엄범(P＜0.05),주요포괄쌍측액협、설협、후구대회、설회、침협、변지체압부、소뇌반구,좌측중앙전후회、중앙방소협、섭협、각회、설전협,우측해마、해마방회.결론 침자연합어언강복훈련가인기환자상응뇌공능격활구산생변화,이저사특이성격활구가능여환자적언어공능회복유관.
Objective To observe and compare the effects of acupuncture and acupuncture plus speech therapy on activation of the brain areas in aphasic patients by use of oxygenation level dependent-functional magnetic resonance imaging (BOLD-fMRI).Methods Twenty patients with aphasia caused by stroke were randomized into two groups by use of random number table (10 cases in each group):an experimental group subject to acupuncture treatment combined with speech therapy,and a control group subject to speech therapy only.All the cases were dextromanuality.On admission and after 1 month of treatment,BOLD-fMRI was used to test signals of the activated brain areas of both group,and Aphasia Battery of the Chinese (ABC) was employed to evaluate the changes of speech ability of the patients.Results During the study,1 case from control group was unable to do the post-intervention evaluation due to onset of the second stroke.The effective rates of the control and experimental group were 55.56％ and 100.00％,respectively,and recovery of verbal ability in experimental group was significantly better than in control group (P ＜ 0.05).The active volume and extent in brain were significantly increased in both groups (P ＜0.05),and a comparison between the two groups showed that the changes in activation volume and extent of the brain were significantly greater extensive in experimental group than in the control group,especially in bilateral frontal lobe,cuneus,posterior cingulate gyrus,lingual gyrus,occipital lobe,splenium of corpus callosum,cerebellar hemisphere,and the left precentral gyrus,post-central gyrus,paracentral lobule,temporal lobes,angular gyrus,precuneus,and the right hippocampus,parahippocampus gyrus.Conclusion Acupuncture combined with speech therapy could cause changes in activation patterns of the brain areas,which may contribute to the improvement of verbal ability of the aphasic patients.