右侧卒中患者的视空间注意加工特点分析

Analysis of characteristics of visual spatial attention processing in patients with right-hemisphere stroke

目的通过比较右侧卒中后视空间忽略(VSN)患者与无VSN患者事件相关电位(ERP)行为学检查结果和各成分(P1、N1、P2、N2、P300)的波幅及潜伏期,研究VSN患者的视空间注意加工特点,进一步探索VSN的发生机制。方法回顾性连续纳入首都医科大学宣武医院康复医学科自2016年2月至2017年2月收治的右侧卒中后VSN患者9例(VSN组),右侧卒中经忽略行为学量表筛查无VSN患者10例(非VSN组)。利用ERP记录2组受试者执行视觉Oddball范式任务时的脑电变化。分析比较2组靶刺激出现在左侧(左靶)、右侧(右靶)时的反应时及正确率;对靶刺激出现在左侧、右侧的ERP各成分(P1、N1、P2、N2、P300)的波幅及潜伏期进行重复测量的多因素方差分析。结果 VSN组左靶、右靶的正确率[分别为(17.7±7.8)%、(88.5±2.2)%]明显低于非VSN组[分别为(92.4±7.8)%、(96.7±2.2)%,均P<0.05],VSN组右靶反应时[(586±119)ms]明显长于非VSN组[(483±60)ms,P=0.025]。两组之间P1、N1、P2、N2各波的波幅差异无统计学意义(均P>0.05);靶刺激出现在左靶时,VSN组P300波幅[(1.2±0.6)μV]小于非VSN组[(4.6±0.6)μV,P=0.001]。右半球VSN组P1潜伏期[(135.7±3.8)ms]较非VSN组[(128.2±2.8)ms]明显延长(P=0.021),而N1、N2、P300潜伏期两组间差异无统计学意义(均P>0.05)。结论与右侧卒中非VSN患者相比,VSN患者主要表现为空间注意加工的晚期过程受损。

Objectives To study the characteristics of visual spatial attention processing in patients with visual spatial neglect（VSN） by comparing VSN after right-hemisphere stroke,the behavioral test results of event-related potentials（ERP） in patients without neglect and the amplitude and latency of each component（P1,N1,P2,N2,P300） and to further explore the mechanism of VSN. Methods Nine consecutive patients with VSN after right-hemisphere stroke（VSN group） and 10 patients without VSN after right-hemisphere stroke（non-VSN group） admitted to the Department of Rehabilitation,Xuanwu Hospital,Capital Medical University from February 2016 to February 2017 were enrolled retrospectively.ERP was used to record the EEG changes in 2 groups of subjects performing visual Oddball paradigm tasks.The response time and accuracy of 2 groups of target stimuli on the left side（left target） and right side（right target） were analyzed and compared; the amplitudes and latency of ERP components（P1,N1,P2,N2,P300） appeared on the left and right sides were analyzed by multifactor analysis of variance of repeated measurements. Results The correct rates of left target and right target in the neglect group [17. 7 ±7. 8% and 88. 5 ± 2. 2% respectively] were significantly lower than those of the non-neglect group（left target [92. 4 ± 7. 8% and 96. 7 ± 2. 2% respectively]; all P 0. 05）. The right target response time of the neglect group（586 ± 119 ms） was significantly longer than that of the non-neglect group（483 ± 60 ms,P =0. 025）. There were no significant differences in each amplitude of P1,N1,P2,and N 2（all P〈0. 05）.The P300 amplitude of the neglect group（1. 2 ± 0. 6 μV） was less than that of non-neglect group（4. 6 ±0. 6 μV,P = 0. 001）. The P1 latency of the right-hemisphere neglect group（135. 7 ± 3. 8 ms） was significantly longer than that of the non-neglect group（128. 2 ± 2. 8 ms,P = 0. 021）,while there were no significant differences in the N1,N2,and P300 latencies（all P〉0. 05）. Conclusion Compared with the patients with non-neglect in right-hemisphere stroke,the patients with neglect were mainly manifested as the late process damage of spatial attention processing.