针刺结合计算机辅助言语训练治疗卒中后运动性失语症疗效分析及机制研究

Clinical efficacy and mechanism study on motor aphasia patients with stroke treated by acupuncture combined with computer-assisted speech training

目的 观察针刺结合计算机辅助言语训练对脑卒中后运动性失语症患者的临床疗效。方法 将我院符合入选标准的83例脑卒中后运动性失语患者随机分为训练组(42例,脱落2例)和综合组(41例,脱落1例),所有患者均接受传统康复训练、常规药物治疗及计算机辅助语言训练,综合组在此基础上增加针刺治疗,1次/d,每周治疗5d,治疗周期为6周。在治疗前和治疗6周后对所有患者进行语言功能评定及磁共振波谱成像(MRS)检查,测定Broca区N-乙酰天门冬氨酸(NAA)/肌酸(Cr)、胆碱(Cho)/Cr的比值。结果 治疗6周后,两组患者语言障碍诊治系统训练大部分评分较训练前提高(P<0.05);综合组语言功能指标改善情况优于训练组,大部分评分差异有统计学意义(P<0.05);两组NAA/Cr均较治疗前升高(P<0.05),Cho/Cr较治疗前下降(P<0.05),且与训练组相比,综合组大部分变化更为明显(P<0.05)。结论 头针结合计算机辅助言语训练能够显著改善脑卒中后运动性失语患者语言功能,且疗效优于单纯计算机辅助训练。

Objective To observe the clinical efficacy of acupuncture combined with computer-assisted speech training in treatment of motor aphasia patients with stroke,and explore its possible mechanism of action. Methods Eighty-three stroke patients with motor aphasia were randomly divided into experimental group(42 cases,2 case dropped off),and comprehensive group(41 cases,1 case dropped off). Both groups were intervened by the regular exercise training of rehabilitation,the conventional drug treatment and the computer-assisted speech training. In addition,comprehensive group was intervened by acupuncture intervention. The frequency of the treatment was once a day,five times a week,the treatment cycle was six weeks.Both groups were assessed with the Language function assessment and the MRS of the brain before and after the intervention.The ratio of NAA/Cr and Cho/Cr in the Broca area were also detected and calculated. Results Six weeks after treatment,most of the scores of language impairment diagnosis and treatment system in both groups were higher than those before treatment(P<0.05);the change of language function indicators was higher in comprehensive group than in experimental group,most of the differences were statistically significant;NAA/Cr ratios in both groups increased after treatment(P<0.05),Cho/Cr ratios were lower than those before treatment(P<0.05);the changes in comprehensive group were more obvious than in experimental group(P<0.05). Conclusion Acupuncture combined with computer-assisted speech training helps to significantly improve the language function of motor aphasia patients with stroke,and the curative effect is superior to the simple computer-assisted speech training.