重复经颅磁刺激联合多奈哌齐治疗脑梗死失语的疗效观察

Rehabilitation of aphasia after cerebral infarction using repetitive transcranial magnetic stimulation and donepezil

目的评价低频重复经颅磁刺激联合多奈哌齐治疗脑梗死失语的疗效。方法将43例急性脑梗死失语患者分为治疗组和对照组。所有患者接受规范化脑血管病治疗，并且所有患者于发病后7d予多奈哌齐5mg／d治疗12周。治疗组于发病后7d接受2个疗程低频rTMS对右侧大脑半球语言镜像区的治疗，1次／d，每个疗程10d，两疗程中间休息3d。分别于治疗前、每个疗程结束后以及治疗12周末采用西部失语成套测验（WAB）评定疗效。结果经1个疗程治疗后，治疗组患者的WAB各项及失语指数（AQ）得分均较基线值提高，但与对照组比较，差异无统计学意义（P〉0．05）；经2个疗程治疗后以及治疗后12周，治疗组患者WAB各项及AQ得分均明显高于对照组，差异均有统计学意义（P〈0．05）；治疗组的AQ改善程度得分比对照组更为显著[（39．62±17．03）分比（29．98±17．26）分，P=0．017]，差异有统计学意义。结论早期低频rTMS联合多奈哌齐治疗有助于急性脑梗死失语患者的语言恢复。

Objective To evaluate the effectiveness of using low-frequency repetitive transcranial magnetic stimulation （rTMS） along with donepezil in the rehabilitation of aphasia after cerebral infarction. Methods Fortythree aphasic patients with acute cerebral infarction were assigned into a treatment group or a control group. Both groups received standard basic treatment for acute cerebral infarction. From day 7 on, both groups received oral donepezil hydrochloride （5 mg/d） for 12 consecutive weeks. The treatment group received in addition 2 sessions of low frequency rTMS on the language center of the right hemisphere. The first session started at day 7 after onset, and each session consisted of rTMS on 10 consecutive days （once per day）. There was a resting interval of 3 d between the two sessions. The rehabilitation of the aphasia was assessed prior to and after each session, and at the end of the entire 12 weeks of treatment using the western aphasia battery （WAB） scoring system and the aphasia quotient （AQ）. Results There was no significant difference between the two groups after the first session in terms of the WAB or AQ results. However, the difference in improvement became statistically significant after the s：econd session, as well as at the end of the entire 12 weeks. The average change in AQ was significantly greater in the treatment group, Conclusion Donepezil combined with rTMS early in the acute phase of cerebral infarction is helpful for the rehabilitation of aphasia.