【作者】 孙青热；

【导师】 王艳君；

【作者基本信息】 河北医科大学 ， 中西医结合临床， 2010， 硕士

【摘要】 目的:脑血管病包括缺血性和出血性,具有高发病率,高致残率,高死亡率,高复发率的特点,据最新资料表明目前我国脑血管病死亡已上升至第二位。缺血性脑血管病(主要脑梗死)是动脉供血不足引起的脑组织缺血性损害,可由于不同病因、发病机制、脑病灶部位大小及不同的侧支循环代偿能力等,使脑功能损害程度差异甚大,造成多种临床表现的综合症,属于中医“中风”范畴,本虚标实之侯,肝肾阴虚,气血亏虚为致病之本,风、火、痰、瘀为发病之标,两者可互为因果,相互转化。本病所致语言障碍与昏迷、半身不遂、口眼歪斜、吞咽障碍一起被成为中风五大主症。临床报道大约有1/3中风患者出现不同程度言语障碍。而失语症为言语障碍的主要形式,在临床上的难治程度更为中外医家所熟知。而正常的言语交流是健康人的重要生存条件之一,一旦丧失会给患者的心里、家庭、社会带来很大的负担。西方医学对失语症的研究已久,分类不一。本课题以北京医科大学《汉语失语成套测验》(ABC)评定患者的语言功能,比较针刺头部顶颞前斜线、顶颞后斜线、顶中线配合梅花针叩刺法结合语言训练和单纯语言训练两种不同方法治疗缺血性中风失语患者的临床疗效,探讨针刺配合梅花针叩刺头穴治疗本病的意义,寻求比单纯语言训练效果更好的方法。方法:根据1996年中华医学会第四届全国脑血管病学术会议第三次修订的《各类脑血管病诊断要点》所拟定的脑血管疾病诊断标准,用北京医科大学《汉语失语成套测验》(ABC)来评定患者的语言功能,采用Benson分类法,即:Broca失语、Wernicke失语、传导性失语、经皮质运动性失语、经皮质感觉性失语、经皮质混合性失语、完全性失语、命名性失语、皮质下失语综合症。其中完全性失语,临床较常见,约占失语症的17%,但因这种患者各种语言功能均已完全或大部丧失,不能与外界交流,不能充分进行语言训练,故排除在本课题之外;而皮质下失语综合症因临床较少见到,入选的病人中也无一例。本题选择60例年龄在30-70岁之间,发病在6个月以内的缺血性中风失语患者。将入选病人按照随机数字表随机分为针刺、叩刺配合语言训练组和单纯语言训练对照组,两组在神经内科常规药物治疗的基础上,治疗组为针刺、叩刺配合语言训练治疗,对照组为单纯语言训练。治疗组取穴为顶颞前斜线、顶颞后斜线、顶中线;语言训练采用刺激促进法(Schuell刺激法)对患者进行专门的语言训练,语言训练分口腔发音器官的训练,口形及声音训练,口语表达训练以及实用交流能力的训练,重点进行表达和理解的训练。一般在专门的康复室进行训练,以尽量避免外界的干扰,严重偏瘫患者在床边进行语言训练,尽量做到“一对一”的康复训练。运动性失语以表达和文字阅读为主;感觉性失语以听理解和复述为主;传导性失语以阅读和理解为主;命名性失语从常用物品开始学习命名,也可同时作字词朗诵训练。在疗程前后以《汉语标准失语症检查表》(ABC法)各作一次语言检测评价。结果:经过治疗后,治疗组和对照组评价患者自发谈话、理解、复述、命名4项语言功能,包括信息量,流利性,复述,词命名,颜色命名,反应命名,是否,听辨认,口头指令等亚项得分均有显著提高,语言功能得到明显改善(P<0.05)。比较两种方法治疗后的信息量,流利性,复述,词命名,颜色命名,反应命名,是否,听辨认,口头指令等各亚项得分以及两种方法治疗前后各亚项的差值,有明显差异(P<0.05),治疗组优于单纯语言训练组。结论:1、无论是针刺、叩刺配合语言训练治疗缺血性中风失语,还是单纯语言训练治疗缺血性中风失语,两组均有效。2、针刺、叩刺配合语言训练治疗缺血性中风失语疗效显著,其效果优于单纯语言训练治疗缺血性中风失语。3、头针、梅花针叩刺、语言训练三者结合是一种积极有效的治疗缺血性中风失语的方法,可提高患者的语言沟通能力,改善失语程度,对缺血性中风失语患者的临床疗效有重要意义。更多还原

【Abstract】 Objective: Cerebrovascular disease, ischemic and hemorrhagic, with the characteristics of high morbidity, high mortality, and high recurrence, has risen to second place in the current death in China, according to the latest information. Ischemic cerebrovascular disease (mainly cerebral infarction) is an ischemic brain tissue damage caused by arterial insufficiency. The extent of brain dysfunction varies greatly due to different causes, pathogenesis, brain lesion sizes and different compensatory ability of collateral circulation, resulting in a variety of clinical manifestations of the syndrome, which belongs to "apoplexy" category in Chinese medicine, with syndromes of deficiency in origin and excess in superficiality, the former caused by deficiency of liver-yin and kidney-yin, deficiency of qi and blood, the latter by wind, fire, phlegm and stasis, both reinforcing each other, converting into each other. Aphasis caused by the disease, coma, hemiplegia, deviation of the eye and mouth, dysphagia, are known as the five main symptoms of apoplexy. It is reported that about 1/3 of patients with apoplexy have varying degrees of speech disturbance. Aphasia as the main form of speech disturbance is well known to Chinese and foreign physicians for being far more refractory in clinical practice. Whereas the normal verbal communication is one of the important healthy living conditions, and the loss of it will give great burden to the patient, their family and the society. Western medicine has studied aphasia for a long time, and classification varies.This research is to assess the language function in patients, in accordance with“Chinese Aphasia Test Battery”by Beijing Medical University, with two different approaches to treatment of ischemic aphasia from apoplexy (needling mid-line, anterior and posterior oblique line of vertex-temporal, with plum-blossom needle combined with language training, and simple language training), to explore the significance of the acupuncture methods in treating the disease, and to seeking a better way than the simple language training.Methods: According to the diagnostic criteria in“Points of Various Types of Cerebral Vascular Disease Diagnosis”revised at the 4th National Cerebrovascular Disease Academic Council by Chinese Medical Association in 1995,“Aphasia Battery of Chinese”by Beijing Medical University was used to evaluate the speech function of patients with Benson classification, namely: Broca aphasia, Wernicke aphasia, conduction aphasia, transcortical motor aphasia, transcortical sensory aphasia, transcortial mixed aphasia, complete aphasia, anomic aphasia, subcorticalaphasia syndrome, among which complete aphasia is commonly seen in clinical practice, accounting for about 17% of aphasia, but such patients were excluded since they have lost all or most of the speech function, cannot communicate with the outside world, and cannot fully carry our language training; and so did the patients with subcortical aphasia since it is rarely seen in clinic. In this research, 60 cases of ischemic apoplectic aphasia, aged 30– 70 and attacked within 6 months, were randomly divided into treatment group of acupuncture and tapping with language training and control group of the simple language training. Treatment group selected points on mid-line, anterior and posterior oblique line of vertex-temporal; Schuell Stimulation was used to give specific language training to patients, including oral pronunciation trainings, lip and voice training, oral expression training and practical communicative skill training with emphasis on training of expressing and understanding, usually in a special rehabilitation room away from distractions. Severe patients were taken training at the bedside. Motor aphasia attached importance to expressing and text-based reading; sensory aphasia to listening comprehension and repeating; conduction aphasia to reading and understanding; anomic aphasia began with learning to name and read aloud at the same time. Before and after treatment, the patients were evaluated on language function with“Aphasia Battery of Chinese”(ABC ).Results: After treatment, four language features of spontaneous conversation, understanding, restating and naming, including the amount of information, fluency, repeating, word naming, color naming, reaction naming, auditory discrimination, verbal instruction, all the above in treatment group were significantly improved compared to control group (p<0.05). There were significant differences between all the sub-item scores before and after treatment (p<0.05). Treatment group was superior to control group.Conclusion: 1. both methods were declared valid in treating ischemic apoplectic aphasia. 2. Acupuncture with language training is more effective than simple language training in treatment. 3. the combination of scalp acupuncture, plum-blossom needle, and language training is a positive and effective treatment for ischemic apoplectic aphasia, which can improve the patient’s communicative skill and aphasia degree, with important clinical significance in treating ischemic apoplectic aphasia.更多还原