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目的:探讨重复经颅磁刺激(repetitive transcranial magnetic stimulation,rTMS)对急性期脑梗死运动性失语的治疗作用、安全性及其对脑血流的影响。方法:选取左半球脑梗死后运动性失语右利手的患者随机分为对照组和治疗组(n=12),对照组予常规药物和语言康复治疗;治疗组在对照组治疗基础上予低频rTMS治疗,rTMS治疗方法:频率1 Hz、强度为运动阈值(movement threshold,MT)的80%、部位为右侧大脑半球语言运动区、每序列50次脉冲、每天10个序列、序列间隔120 s,共10 d。治疗组和对照组在治疗前、疗程后2周、疗程后2个和疗程后6个月均行汉语失语检查表(aphasia battery in chinese,ABC)评价其语言功能;同时两组在治疗前、疗程后2周行单光子发射计算机断层(single-photon emission computed tomography,SPECT)检测脑血流改变。结果:治疗前两组ABC评分值比较无统计学意义(P>0.05),疗程后2周、疗程后2个月、疗程后6个月治疗组其值均高于对照组和治疗前(均P<0.05);两组治疗前和疗程后2周左额下回缺血灶明显大于对侧镜像区;疗程后2周治疗组左额下回缺血灶明显小于治疗前和对照组,其摄取值高于对照组(均P<0.05)。结论:1 Hz、rTMS对急性脑梗死运动性失语患者有一定的康复作用且安全;可能与通过远隔效应增加了语言区局部血流量及改善脑代谢,抑制右侧半球相应区域的兴奋性等有关。
Objective: To investigate the therapeutic effect and safety of repetitive transcranial magnetic stimulation (rTMS) on exercise-induced aphasia in cerebral infarction and its effect on cerebral blood flow. Methods: Patients with exercise-induced aphasia right atrium after left hemisphere cerebral infarction were randomly divided into control group and treatment group (n = 12), and control group received conventional drug and language rehabilitation therapy. The treatment group was given low frequency rTMS treatment, rTMS treatment: Frequency 1 Hz, intensity 80% of the movement threshold (MT), part of the right hemisphere locomotor area, 50 pulses per sequence, 10 sequences per day, sequence interval 120 s , A total of 10 d. The aphasia battery in chinese (ABC) was used to evaluate the language function of the treatment group and the control group before treatment, 2 weeks after the course of treatment, 2 after the course of treatment and 6 months after the course of treatment. At the same time, Two weeks after the course of treatment, single-photon emission computed tomography (SPECT) was performed to detect changes of cerebral blood flow. Results: There was no significant difference in ABC score between the two groups before treatment (P> 0.05), two weeks after the course of treatment, two months after the course of treatment, and six months after the course of treatment, the values in the treatment group were higher than those in the control group and before treatment P <0.05). Before the treatment and after 2 weeks of treatment, the ischemic foci of the left inferior frontal gyrus in the two groups were obviously larger than those in the contralateral mirror. The ischemic foci of the left inferior frontal gyrus of the two weeks after the treatment were obviously smaller than those before treatment and the control group The intake value is higher than the control group (all P <0.05). CONCLUSIONS: rTMS at 1 Hz has certain rehabilitation and safety in patients with motor aphasia of acute cerebral infarction. It may be related to the increase of local blood flow in the language area and improvement of brain metabolism by remote effect, and the excitability of the corresponding region in the right hemisphere, etc. related.