汉语卒中后失语症失语类型的诊断、鉴别诊断流程图和卒中后失语症的治疗

A flowchart for the diagnosis and differential diagnosis of post-stroke aphasia types in the Chinese language and treatment of post-stroke aphasia

本文对汉语卒中后失语症(PSA)的概念、病因、分类及经典大脑皮质定位、评估、汉语PSA失语症类型的诊断与鉴别诊断流程、治疗、康复、PSA产生及恢复的机制、预后及影响因素做了全面的阐述.本文强调了脑和血管的神经影像学评估及神经心理学评估对汉语PSA诊断与鉴别诊断的必要性和意义;提出并提倡基于脑和血管解剖定位与语言区和语言障碍之间关系的"内外、前后二分法"为出发点,制定的汉语PSA的分类更适合指导脑卒中的临床治疗;以"四要素"作汉语PSA的诊断、分型和鉴别诊断,制定出的流程图使汉语PSA失语类型的确定不再困难.有益于给患者制定有针对性的、个体化的康复训练方案,使患者受益.介绍了美金刚、吡拉西坦、多奈派齐等药物在PSA治疗中的应用,美金刚治疗PSA的国内外临床研究及作用机制,康复训练治疗的疗效机制.美金刚、吡拉西坦、多奈派齐等药物结合非药物疗法和康复训练,针对卒中后失语症治疗的临床研究和应用值得推荐.

This article aims to comprehensively review the concept,etiology,classification,classical cortical mapping,assessment,a proposed flowchart for the diagnosis and differential diagnosis,treatment,rehabilitation,mechanisms of development and recovery,prognosis,and influencing factors for post-stroke aphasia(PSA)types in the Chinese language.We emphasize the necessity and significance of neuroimaging assessment of the brain and blood vessels and neuropsychological assessment in the diagnosis and differential diagnosis of PSA in Chinese.We also recommend and encourage the use of the dichotomies of internal us.external and anterior ts.posterior as a starting point,based on the association of anatomical locations of the brain and blood vessels with brain language areas and language disorders.A classification system of PSA in Chinese developed from this approach in the form of a flowchart is well-suited for guiding the clinical treatment of cerebral stroke.Incorporating the"four elements",the flowchart enables convenient diagnosis,classification and differential diagnosis of PSA in Chinese and facilitates targeted and personalized rehabilitation planning to benefit the patient.This article introduces the use of memantine,piracetam,donepezil and otherdrugs for PSA treatment,evaluates clinical trials on memantine conducted in China and abroad and its mechanisms of action for the treatment of PSA,and discusses how rehabilitation therapy achieves therapeutic effects.For the treatment of PSA,clinical research and practice using drugs such as memantine,piracetam and donepezil in combination with non-pharmacotherapy and rehabilitation training should be promoted.