不同形式重复经颅磁刺激治疗卒中后非流利性失语症的疗效观察

Different forms of repetitive transcranial magnetic stimulation on post-stroke non-fluent aphasia:efficacy observation

目的探究不同形式重复经颅磁刺激(rTMS)治疗卒中后非流利性失语症的疗效。方法纳入2021年1月至2022年10月于海军军医大学(第二军医大学)第一附属医院脑血管病中心住院治疗的卒中后非流利性失语症患者45例,根据随机数字表法分为伪刺激组、单侧rTMS治疗组和双侧rTMS治疗组,每组15例。伪刺激组患者予常规语言训练,单侧rTMS治疗组患者在常规语言训练基础上予单侧rTMS治疗,双侧rTMS治疗组患者在常规言语训练基础上予双侧rTMS治疗。比较治疗前后3组患者西方失语成套测验(WAB)自发语言评分、听理解评分、命名评分、复述评分及失语商。结果治疗前,3组患者的WAB自发语言评分、听理解评分、命名评分、复述评分和失语商差异均无统计学意义(P>0.05)。治疗后,3组患者的WAB自发语言评分、听理解评分、命名评分、复述评分和失语商均较治疗前提高(P<0.05)。治疗后,单侧rTMS治疗组、双侧rTMS治疗组的WAB自发语言评分、听理解评分、命名评分、复述评分和失语商均高于伪刺激组(P<0.05),但单侧rTMS治疗组和双侧rTMS治疗组上述指标差异均无统计学意义(P>0.05)。结论常规语言训练联合rTMS治疗可有效改善卒中后非流利性失语症患者的语言功能,但双侧rTMS治疗的效果并不优于单侧rTMS治疗。

Objective To explore the efficacy of different forms of repetitive transcranial magnetic stimulation(rTMS)on post-stroke non-fluent aphasia.Methods A total of 45 patients with post-stroke non-fluent aphasia who were hospitalized in Neurovascular Center of The First Affiliated Hospital of Naval Medical University(Second Military Medical University)from Jan.2021 to Oct.2022 were randomly assigned(1∶1∶1)to pseudo-stimulus group,unilateral rTMS treatment group,or bilateral rTMS treatment group.Patients in the pseudo-stimulus group received conventional language training,patients in the unilateral rTMS treatment group received unilateral rTMS therapy on the basis of conventional language training,and patients in the bilateral rTMS treatment group received bilateral rTMS therapy on the basis of conventional language training.The spontaneous speech score,listening comprehension score,naming score,retelling score and the aphasia quotient(AQ)in the Western aphasia battery(WAB)of the 3 groups were compared before and after treatment.Results Before treatment,there were no significant differences in WAB scores(spontaneous speech,listening comprehension,naming,or retelling)or AQ among the 3 groups(all P>0.05).After treatment,the WAB scores(spontaneous speech,listening comprehension,naming,or retelling)and AQ of the 3 groups were significantly increased(all P<0.05);the WAB scores(spontaneous speech,listening comprehension,naming,or retelling)and AQ of the 2 treatment groups were significantly higher than those of the pseudo-stimulus group(all P<0.05),but there were no significant differences in the above indexes between the unilateral or bilateral rTMS treatment groups(all P>0.05).Conclusion Conventional language training combined with rTMS therapy can significantly improve the language function of patients with post-stroke non-fluent aphasia,but the effect of bilateral rTMS is not superior to that of unilateral rTMS.