中风后遗失语的规范化治疗

Standardized treatment of post-stroke aphasia

目的探讨不同语言背景对于中风后失语康复训练的影响,并制定有效的失语康复原则。方法将112例中风后失语患者分为2组,其中沪语组68例和普通话组44例,分别进行语言功能评定和康复。结果语言康复能明显改善中风后失语症状(P<0.001)。沪语组在口语表达方面改善更显著(P=0.03);普通话组在书写方面效果更佳(P=0.03);听理解和阅读能力方面,沪语组或普通话组的康复效果差异不明显(P值分别为0.88和0.20)。各种可能影响失语恢复的因素中,失语的严重程度和开始康复距离中风发生的时间极大影响恢复效果;受教育程度显著影响沪语组和普通话组的阅读及书写的康复(P值均<0.001);失语类型对听理解和阅读康复的影响显著(P值为0.02);年龄和初始中风严重程度(以日常生活能力评价)对不同语言背景失语康复的影响不明显。结论对中风后失语患者语言康复训练能极大地改善症状,使用患者日常用语结合恰当的康复训练手段效果会更理想。

[Objective] To evaluate the influence of differently regional dialects, and make principles for rehabilitation of aphasia. [Methods] 112 patients were divided into two groups, 68 patients with Shanghai dialect, and 44 patients with Mandarin Chinese langue. We assessed their competence of language, and used different dialects to train them. [Results] Rehabilitation can markedly improve the symptoms of post-stroke aphasia （P 〈0.001）. Shanghai dialect as training language can more markedly increase scores of oral speech than Mandarin Chinese language training （P =0.03）. Mandarin Chinese as training language significantly improved writing function as compared to Shanghai dialect （P =0.03）. We found no significant difference in recovery between listening comprehension and reading subtests （P =0.88 and 0.20）. The initial severity of aphasia and time between onset of aphasia and admission to treatment influenced the efficacy on four subtests （P 〈0.001）. The type of aphasia made more remarkable influence on listening comprehension （P =0.02） and reading （P =0.02） subtests. The initial severity and age of stroke were not key factors of rehabilitation. [ Conclusions] Training can markedly improve the function of language in the poststroke aphasic patients. The efficacy of rehabilitation will be better on condition that we combine relevant dialect and proper instruments.