局灶性脑损伤患者注意网络功能受损的特点

The characteristics of the attention networks impairment in patients with localized brain injury

目的研究局灶性脑损伤患者注意网络功能受损的特点，探讨额叶、顶叶、颞叶与3个独立的注意网络功能的关系。方法应用注意网络测验，测试23例额叶损伤、18例颞叶损伤和18例顶叶损伤患者以及53名健康对照的注意网络功能。结果与对照组相比，额叶损伤组的执行控制网络效率显著减低，额叶损伤组、对照组分别为（143．7±46．6）、（91．6±46．4）ms，Z值为-4．714，P〈0．01；而顶、颞叶损伤组的执行控制网络效率的差异无统计学意义；顶叶损伤组的定向网络效率显著减低，顶叶损伤组、对照组分别为（34．9±25．2）、（55．1±21．8）ms，Z=-2．418，P〈0．05；额叶损伤组的定向网络效率增高，额叶损伤组、对照组分别为（71．2±35．2）、（55．1±21．8）ms，Z=-2．125，P〈0．05；而颞叶损伤组的定向网络效率的差异无统计学意义；额、顶、颞叶损伤组的警觉网络效率与对照组相比差异均无统计学意义。结论神经心理学证据提示，额叶与执行控制功能密切相关，顶叶在注意的定向网络中起关键作用，而颞叶损伤患者的注意网络功能基本不受影响。

Objective To determine attention networks impairmnet in patients with localized brain injury and to examine the characteristics of the impairment. Methods The attention network test was used to compare patients （n = 59 ） with controls （n = 53 ） on the efficiency of 3 anatomically defined attention networks： alerting, orienting, and executive control. Results Firstly, patients with frontal lobe injury showed a significant deficit in the executive network （frontal lobe injury, controls： （143.7 ± 46. 6 ）, （91.6 ± 46. 4） ms, Z = - 4. 714, P 〈 0. 01 ） and also a significant deficit in the orienting network （ frontal lobe injury, controls ： （71.2 ±35.2） , （55. 1 ±21.8） ms,Z = -2. 125 ,P 〈0.05）. There was no deficit in the alerting network （ Z = - 0. 901, P 〉 0.05 ）. Secondly, the orienting network effect was significantly lower in patients with parietal lobe injury （ （ 34.9 ± 25. 2 ） ms ） than in normal controls （ （ 55.1± 21.8） ms,Z = -2. 418,P 〈 0. 05）. However, there were no significant differences between the other two networks and between the patients and the controls （Z = - 1. 873, -0. 186,P 〉 0. 05）. Thirdly, patients with temporal lobe injury showed no deficit in the three networks（ Z= -0. 037, - 1. 224, -0. 718, all P 〉 0. 05 ） as well as in overall RT and accuracy （ Z = - 1. 385, - 0. 699, all P 〉 0. 05 ）. Conclusions These results suggest that there are selective impairments of the orienting and executive networks in patients with the frontal lobe and the parietal lobe injury, while the alerting network is spared. Furthermore, the frontal lobe plays a key role in the executive control, meanwhile, the orienting network is closely related with the parietal lobe.