经颅直流电联合持续θ短阵快速脉冲刺激语言双模通路治疗脑卒中后非流畅性失语症的疗效观察

Observation of curative effect of transcranial direct current combined with cTBS stimulating language bimodal pathway on non-fluent aphasia after stroke

目的观察经颅直流电(tDCS)联合持续θ短阵快速脉冲刺激(cTBS)语言双模通路治疗脑卒中后非流畅性失语症疗效。方法将绵阳市第三人民医院康复医学科自2017年1月至2019年6月收治入院的64例非流畅性失语症患者采用随机数字表法分为治疗组32例,对照组32例。2组患者均使用常规言语康复训练,治疗组增加tDCS联合cTBS刺激,对照组采用假刺激,假刺激部位、治疗模式、治疗时间都与治疗组相同。2组患者均治疗1次/d,每周6次,连续5周。治疗前后均使用汉化版西方失语成套量表及功能独立性量表进行评估,观察2组患者在治疗前后的失语商(AQ)、操作商(PQ)和大脑皮质商(CQ)评分变化及功能独立性评分变化。结果2组治疗前后对比,治疗后AQ、PQ、CQ评分均显著优于治疗前,差异有统计学意义(P<0.05),2组治疗都有效,但治疗组治疗后的AQ、CQ评分优于对照组(P<0.05),差异有统计学意义,PQ评分比较差异无统计学意义(P>0.05);治疗后,2组的功能独立性评分均较治疗前升高,差异有统计学意义(P<0.05),但2组改善程度对比差异无统计学意义(P>0.05)。结论tDCS联合cTBS刺激语言双模通路能显著改善脑卒中后非流畅性失语症患者的语言功能。

Objective To observe the effect of transcranial direct current stimulation(tDCS)combined with continuous theta-burst stimulation(cTBS)on dual-mode speech stimuli for non-fluent aphasia after stroke.Methods Sixty-four patients with non-fluent aphasia admitted to Rehabilitation Medicine Department of the Third People’s Hospital of Mianyang City from January 2017 to June 2019 were divided into a treatment group of 32 cases and a control group of 32 cases by random number table.Both groups used conventional speech rehabilitation training,the treatment group added tDCS combined with cTBS stimulation,and the control group used false stimulation.Which the site,treatment mode,and treatment time were the same as the treatment group.Both treatment were once a day,6 times a week,for 5 consecutive weeks,the Chinese version of the Western Aphasia Set and functional independence scale were used to evaluate before and after the course of treatment.The changes of aphasia quotient(AQ),performance quotient(PQ),cerebral cortex quotient(CQ)and functional independence score were observed before and after treatment.Results After treatment,AQ,PQ and CQ scores of the two groups were significantly better than those before treatment(P<0.05).The two groups of treatments were effective,but the comparison between the two groups after treatment showed that the efficacy of AQ and CQ was better than the control group(P<0.05),there was no significant difference in PQ scores between the two groups(P>0.05).After treatment,the functional independence scores of the two groups were higher than before,the difference was statistically significant(P<0.05),but there was no significant difference in the degree of improvement between the two groups(P>0.05).Conclusion The combination of tDCS and cTBS to stimulate language bimodal pathway can significantly improve the language function of patients with non-fluent aphasia after stroke.