音乐和语言治疗在卒中后非流畅性失语症患者中的疗效观察

Therapeutic effect of music therapy and speech language therapy on post-stroke patients with non- fluent aphasia

目的评估音乐和语言治疗在卒中后非流畅性失语症患者中的疗效。方法收集2012年6月至2014年5月在石河子大学第一附属医院诊断为卒中后非流畅性失语的患者84例，按照随机数字表法随机分为音乐治疗组和语言治疗组（均包括慢性组和急性组）各42例[每组患者按照发病至治疗时间分为急性组（38例）和慢性组（46例）]。在神经内科常规用药的基础上，分别给予1个月的音乐治疗和语言治疗。治疗前后用中文版西部失语症成套测试的部分指标评估两组患者的失语情况。结果慢性组和急性组在音乐治疗和语言治疗前后自发言语、听理解、复述、命名和失语商分值的变化差异无统计学意义。慢性组在音乐治疗和语言治疗前后复述[32．00（15．00，53．75）分与48．50（24．50，72．00）分，Z=2．147，P=0．032；33．00（14．50，49．25）分与48．50（18．50，63．75）分，Z=2．018，P=0．038]、命名[20．00（8．50，34．75）分与37．50（12．50，64．75）分，Z=2．298，P=0．022；19．50（7．00，31．25）分与34．50（15．00，52．75）分，Z=2．039，P=0．041]和失语商[24．50（10．50，37．50）分与43．00（18．00，64．75）分，Z=2．432，P=0．015；22．50（10．00，34．50）分与36．00（14．00，54．00）分，Z=2．027，P=0．043]分值差异有统计学意义，并且音乐治疗前后听理解[62．00（30．50，88．75）分与89．50（46．50，112．00）分，Z=1．998，P=0．046]分值差异有统计学意义。急性组在音乐治疗和语言治疗前后复述[24．50（11．00，38．75）分与46．50（24．50，67．75）分，Z=2．038，P=0．043；26．50（9．50，36．25）分与42．50（19．00，64．25）分，Z=1．972，P=0．048]分值差异有统计学意义，并且音乐治疗前后自发言语[2．00（1．00，3．75）分与8．00（4．00，12．75）分，Z=2．012，P=0．036]、听理解[51．00（17．50，73．75）分与85．00（48．00，101．00）分，Z=2．298，P=0．022]、命名[17．50（6．00，29．00）分与37．50（16．00，58．75）分，Z=2．161，P=0．031]和失语商[18．00（7．50，31．25）分与42．50（20．50，63．75）分，Z=2．256，P=0．024]分值差异有统计学意义，而语言治疗前后自发言语、听理解、命名和失语商分值差异均无统计学意义。结论音乐治疗和语言治疗两种治疗方式在慢性卒中后非流畅性失语患者中均具有一定疗效，音乐治疗在急性卒中后非流畅性失语患者中同样具有疗效。

Objective Estimating the therapeutic effect of music therapy and speech language therapy on post-stroke patients with non-fluent aphasia. Methods Eighty-four post-stroke patients diagnosed with non-fluent aphasia who came from the First Affiliated Hospital of Medical College of Shihezi University were collected between June 2012 and May 2014, then they were randomly divided into music therapy group （ n = 42） and speech language therapy group （ n = 42 ; including chronic （ n = 46） and acute groups （ n = 38 ） ） based on table of random numbers. On the basis of conventionally using neurologicaldrugs, music therapy and speech language therapy were given to the patients for one month, respectively. And language function was assessed by partial items of Chinese Version-Western Aphasia Battery before and after therapy. Results No significant changes were found in spontaneous speech, comprehension, repetition, naming and aphasia quotient in chronic and acute group patients through the music therapy and speech language therapy. Significant improvements were revealed in repetition （32. 00 （15.00,53.75） vs 48.50 （24. 50,72. 00）, Z = 2. 147, P = 0. 032 ;33.00 （ 14. 50, 49. 25 ） vs 48.50 （ 18.50,63.75 ）, Z = 2. 018, P=0.038）, naming （20.00 （8.50,34.75） vs 37.5（12.50,64.75）, Z=2.298, P=0.022; 19.50 （7.00,31.25） vs 34. 50 （ 15.00,52. 75 ）, Z = 2. 039, P = 0. 041 ） and aphasia quotient （ 24. 50 （ 10. 50, 37.50） vs 43.00（ 18. 00,64. 75） ,Z =2. 432,P =0. 015; 22. 50（ 10. 00,34. 50） vs 36. 00（ 14. 00,54. 00）, Z = 2. 027, P = 0. 043 ）through music therapy and speech language therapy in chronic group patients. Comprehension was significantly improved through music therapy in chronic group patients. Repetition （24. 50 （ 11.00,38.75 ） vs 46. 50 （ 24. 50,67. 75 ）, Z = 2. 038, P = 0. 043 ; 26. 50 （ 9. 50,36. 25 ） vs 42. 50 （ 19. 00, 64. 25 ）, Z = 1. 972, P = 0. 048 ） was significantly improved through music therapy and speech language therapy in acute group patients. And spontaneous speech （2. 00 （ 1. 00, 3.75 ） vs 8. 00 （4. 00, 12. 75 ） ,Z = 2. 012 ,P = 0. 036）, comprehension （51.00 （ 17.50, 73.75 ） vs 85.00 （48.00,101.00）, Z = 2. 298, P = 0. 022）, naming （ 17.50 （6.00, 29. 00） vs 37. 50 （ 16. 00,58.75）, Z = 2. 1 61, P = 0.031 ） and aphasia quotient （ 18.00（7. 50,31.25） vs 42. 50（20. 50,63.75） ,Z =2. 256, P =0. 024） were significantly improved through music therapy in acute group patients. However, no significant improvements were found in the speech language therapy group of acute patients. Conclusion The two therapies are effective in the chronic patients with non-fluent aphasia, and music therapy is also effective in acute patients with non-fluent aphasia.