不同部位脑梗死患者抉择加工研究

Decision-making processing on patients with cerebral infraction in different regions

目的探讨不同部位脑梗死患者抉择加工的变化。方法将脑梗死患者分为额叶梗死组（21例）、颞叶梗死组（11例）、内侧颞叶梗死组（19例）、基底节梗死组（25例）；大脑前梗死组（25例）、大脑后梗死组（51例）、抑郁组（62例）、焦虑组（64例）；正常对照组（125例），所有被试均完成6种抉择情境问题的测试，应用简易智能精神状态量表（MMSE）评价认知功能，汉密尔顿抑郁和焦虑量表评价情绪。结果所有脑梗死患者（脑梗死组）与正常对照组比较，在低风险与无风险损失情境（抉择情境2）、高风险与无风险收益及损失情境（抉择情境3，4）、高风险与低风险收益及损失情境（抉择情境5，6），其保守性收益及损失方案选择概率均显著增高，均差异有统计学意义（均P〈0．05）。在抉择情境3，基底节梗死组与额叶梗死组、内侧颞叶梗死组比较，其保守性收益方案选择概率均显著增高，均差异有统计学意义（P〈0．01，P〈0．05）；在抉择情境5，大脑后梗死组较大脑前梗死组选择保守性收益方案的概率显著增高，差异具有统计学意义（P〈0．05）。在抑郁组和焦虑组中的基底节梗死组与额叶梗死组和内侧颞叶梗死组比较，其在抉择情境3的保守性收益方案选择概率均显著增高，均差异有统计学意义（P〈0．01，P〈0．05）；而大脑后梗死组较大脑前梗死组在抉择情境5选择保守性收益方案的概率亦显著增高，均差异具有统计学意义（均P〈0．05）。结论脑梗死患者存在抉择加工异常，表现为收益保守与损失风险规避。基底节梗死以及大脑后梗死患者，无论是否伴有抑郁、焦虑情绪，更加倾向于收益保守。

Objective To explore the decision-making processing changes of patients with cerebral infarction in different regions. Methods The patients with cerebral infarction were divided into 21 cases of frontal lobe infarction, 11 cases of temporal lobe infarction, 19 cases of the medial temporal lobe infarction, 25 cases of basal ganglia infarction ;25 cases of the anterior infarction,51 cases of the posterior infarction,62 cases of depression,64 cases of anxiety ;and there were 125 cases in normal control group. All subjects completed the test of the six kinds of choice situational problems, and used MMSE to evaluate cognitive function, the Hamilton Depression and anxiety Scale Evaluation to evaluate emotion. Results All cerebral infarction patients （ CI group） and normal control group in low-risk and no-risk of loss situation（ choice scenario 2）, high-risk and the no-risk of gain or loss situation（ choice scenario 3 and 4）, high-risk and low-risk of gain or loss situation（ choice scenario 5 and 6） tended to choose conservative scheme, and the selection probability of conservative scheme were obviously higher than that of the normal group, and the differences were statistically significant （P 〈 0.05 ）. In choice scenario 3, the basal ganglia infarction group with frontal lobe infarction group, the medial temporal lobe infarction group comparison, the conservative income scheme selection probability increased significantly, all difference were statistically significant （P 〈 0.01, P 〈 0.05 ）. In choice scenario 5 of the posterior infarction group, a higher probability of conservative income scheme was selected than the anterior infarction, and the difference was statistically significant （P 〈 0.05）. Accompanied with depression and anxiety , the basal ganglia infarction tended to select more conservative income program than the frontal lobe infarction group and the medial temporal lobe infarction group in choice scenario 3 , and the program infarction group selected a higher probability comparative differences were statistically significant （P〈 0.01, P〈 0.05 ）. The posterior infarction group selected a higher probability of conservative income scheme than the anterior infarction in choice scenario 5, and the difference was statistically significant （P 〈 0.05 ）. Conclusion Cerebral infarction in patients exist decision-making processing abnormally, and perform as income conservative and loss risk averse. Whether associated with depression, anxiety, the basal ganglia infarction and posterior cerebral infarction patients are inclined to income conservative.