解语丹联合经颅磁刺激治疗卒中后失语症的疗效及对事件相关电位N400的影响

Efficacy of Jieyudan Combined with Transcranial Magnetic Stimulation in the Treatment of Post-stroke Aphasia and Influence on Event-Related Potential N400

目的探讨解语丹联合经颅磁刺激(Transcranial magnetic stimulation,TMS)治疗卒中后失语症(Post-stroke aphasia,PSA)的疗效及对事件相关电位N400的影响。方法选取2019年8月—2020年12月期间我院收治的PSA患者82例。根据随机数字表法分为对照组和研究组,每组各41例。对照组给予TMS治疗,研究组给予解语丹联合TMS治疗。两组患者治疗4周后,观察比较临床疗效,治疗前后应用汉语言标准失语症检查量表(China rehabilitation research center aphasia examination,CRRCAE)评分,波士顿诊断性失语检查法(Boston diagnostic aphasia exmination,BDAE)分级,脑卒中失语症生活质量量表(Stroke and aphasia quality of life scale,SAQOL-39 g)评分,事件相关电位N400潜伏期与波幅差值及不良反应情况。结果治疗后研究组好转率92.31%(36/39)明显高于对照组73.68%(28/38),差异有统计学意义(P<0.05)。两组患者治疗后CRRCAE各项评分均较治疗前升高,差异有统计学意义(P<0.05);且研究组均明显高于对照组,差异有统计学意义(P<0.05)。两组患者治疗后BDAE分级均较治疗前改善,差异有统计学意义(P<0.05);且研究组改善明显优于对照组,差异有统计学意义(P<0.05)。两组患者治疗后生理、沟通、心理社会评分均较治疗前升高,差异有统计学意义(P<0.05);且研究组较对照组明显升高,差异有统计学意义(P<0.05)。治疗后研究组额中线点、枕中线点、左中央、右中央等位点N400潜伏期与波幅差值均高于对照组,差异有统计学意义(P<0.05)。治疗期间,两组患者均未出现严重的不良反应。结论解语丹联合TMS治疗在改善PSA患者语言功能、失语严重程度分级、生活质量方面更有优势,疗效佳且安全性高。

Objective To investigate the efficacy of Jieyudan combined with transcranial magnetic stimulation(TMS)in the treatment of post-stroke Aphasia(PSA)and its effect on event-related potential N400.Methods A total of 82 PSA patients admitted to our hospital from August 2019 to December 2020 were selected.According to the random number table method,they were divided into control group and study group,with 41 cases in each group.The control group was given TMS treatment,and the study group was given Jieyudan combined with TMS treatment.The two groups were treated for 4 weeks.The occurrent of side reaction,clinical efficacy,the scores of CRRCAE,the scores of BDAE classification,the SAQOL-39 g score,and the difference between event-related potential N400 latency and amplitude of the two groups were compared.Results After treatment,the improvement rate of the study group was 92.31%(36/39),which was significantly higher than that of the control group,73.68%(28/38),and the difference was statistically significant(P<0.05).After treatment,the CRRCAE scores in the two groups were all higher than those before treatment,and the difference was statistically significant(P<0.05).After treatment,the BDAE grades of the two groups were improved compared with those before treatment,and the difference was statistically significant(P<0.05).The physical,communication,and psychosocial scores of the two groups of patients after treatment were all higher than those before treatment,and the difference was statistically significant(P<0.05);and the study group was significantly higher than that of the control group,and the difference was statistically significant(P<0.05).After treatment,the differences of N400 latency and amplitude at frontal midline,occipital midline,left central and right central points in the study group were higher than those in the controlgroup,and the difference was statistically significant(P<0.05).During the treatment period,there were no serious adverse reactions in the two groups.Conclusion Jieyudan combined with TMS therapy has more advantages in improving the language function,the severity of aphasia,and the quality of life of PSA patients,with good curative effect and high safety.