卒中后失语的药物治疗

卒中后失语是由卒中导致的获得性语言障碍,严重影响患者的社交能力并降低其生活质量,给社会和家庭都带来很大负担.传统的治疗方法没有肯定的疗效,因此失语的药物治疗备受关注.文章就卒中后失语的药物治疗研究进展进行了综述.     

卒中后失语的药物治疗

卒中是引起失语的最常见病因.传统的言语-语言治疗仍是失语的主要治疗手段,但是其疗效并不肯定.尽管已开展了许多研究观察药物在治疗失语中的作用,但结论并不一致.文章就卒中后失语的药物治疗状况进行了综述.     

卒中失语患者命名功能与非语言认知功能的相关性分析

目的探讨卒中后失语患者命名功能与非语言认知功能的相关性。方法连续回顾性纳入2018年9月至2020年12月复旦大学附属华山医院康复医学科收治的卒中后失语症患者53例,用西方失语症成套测验(WAB)量表评估言语功能,非语言性神经心理测验(NLCA)量表分析失语症患者的非语言认知功能。失语商93.8定义为失语。采用Pearson或Spearman检验方法评估卒中后失语症患者命名功能(物体命名、自发命名、完成句子和反应命名)与逻辑推理(逻辑图形和逻辑图片)和视空间(直线成角和重叠图案)的相关性。相关性强弱用|r|确定:|r|0.4为弱相关,|r|0.4～0.7为中等相关,|r|0.7为强相关。类多次比较,选用Bonferroni方法进行多重比较校正,P值小于0.05除以比较次数[P0.004(0.05/12)]被认为差异具有统计学意义。结果 (1)53例卒中后失语症患者中,运动性失语18例,感觉性失语7例,经皮质运动性失语6例,传导性失语1例,经皮质感觉性失语2例,经皮质混合性失语4例,命名性失语3例,完全性失语12例;失语商为4.06～90.50,平均为42±27。(2)53例卒中后失语症患者中,NLCA量表评分11～80分,中位评分为63.75(50.13,72.75)分。(3)经Bonferroni方法进行多重比较校正后,物体命名、自发命名、完成句子和反应命名与逻辑推理均无相关性(|r|分别为0.340、0.007、0.296、0.300,均P0.004)。(4)经Bonferroni校正后,自发命名与视空间呈中度正相关(|r|=0.429,P=0.0010),其中自发命名与直线成角呈中度正相关(|r|=0.465,P=0.0004),反应命名与直线成角呈弱相关(|r|=0.395,P=0.0030),余命名功能与视空间无相关性(均P0.004)。结论初步分析表明,卒中后失语症患者命名功能与视空间存在一定的相关性。     

针刺治疗脑卒中后失语症临床研究进展

失语症是脑卒中常见的并发症和后遗症之一,卒中伴失语的发病率为21%～38%[1,2],卒中后存活患者10%～18%[3]遗留不同程度的言语功能障碍.     

重复性经颅磁刺激治疗卒中后失语的研究进展

失语是脑卒中后常见的并发症,严重影响患者的生活质量。通常卒中后失语的治疗以药物、语言康复训练和中医理疗为主,但疗效不佳或个体差异大。越来越多的研究证实作为一种非侵入性大脑刺激技术———重复性经颅磁刺激技术（rTMS）可为卒中后失语患者语言功能的康复提供一种新的治疗手段。本文就rTMS治疗卒中后失语的可能性,rTMS治疗卒中后失语的现状以及rTMS治疗卒中后失语的可能机制展开综述。着重阐述了目前国内外开展rTMS治疗卒中后失语的治疗模式、刺激参数和治疗效果,并从神经重塑的角度探讨了双侧半球,特别是非优势半球在接受rTMS治疗后发生的变化及其对卒中后失语患者语言能力的影响。旨在为rTMS治疗卒中后失语的进一步应用及对其作用机制的进一步研究提供参考。     

卒中失语症的药物治疗

失语是脑卒中后神经缺陷的表现之一，绝大多数是优势半球的病变。部分患者随着卒中病灶的吸收，缺血区的血供改善，其知语症状也相应好转，国一些则留有持续的各种失语。实验和部分临床研究已证实，采用特异性药物治疗，可以改善拟胆碱能的神经递质，增加外源性儿茶酚胺的浓度；同时对语言训练结合，可促使失语症的恢复。     

姜亚军治疗中风后失语经验

失语症是中风恢复期三大后遗症之一,罹患率高,严重影响病人日常生活质量。目前西医治疗以治疗原发卒中,促进神经功能恢复为主。中医学病证相参,治疗中风后失语由来已久、收效不俗。初步整理姜亚军教授治疗中风后失语,着眼脾肾、注重痰瘀、巧妙应用虫类药,获效良多。     

针刺通里穴结合言语康复训练对脑梗死后运动性失语患者言语功能的影响

目的观察针刺通里穴对脑梗死后运动性失语症患者言语功能的影响,探讨通里穴治疗脑梗死后运动性失语症的临床疗效,并试图探索其可能的作用机制。方法将30例患者随机分为对照组(15例)和治疗组(15例)。两组均给予常规药物及言语康复训练治疗。在此基础上,治疗组配合针刺通里穴治疗。观察治疗前后患者失语症评分、失语严重程度分级的变化。结果两组患者失语严重程度均有改善,治疗组改善程度优于对照组(P0.05)。治疗后两组失语症总分、复述、说及读得分均有增高(P0.01);治疗组失语症评分说及读得分增高幅度明显优于对照组(P0.05)。结论刺激通里穴能明显改善脑梗死后运动性失语患者语言功能,通里穴是治疗脑梗死后运动性失语症有效的穴位。     

低频重复经颅磁刺激治疗缺血性卒中后失语

失语是缺血性卒中的一种常见临床表现,低频重复经颅磁刺激对卒中后不同时期失语的治疗效果和机制不完全相同.文章对低频重复经颅磁刺激治疗缺血性卒中后失语的研究进展进行了综述.     

失语症的药物治疗

文章就失语症药物治疗的实验研究及临床研究状况做一回顾,阐述了治疗失语的药物、疗效、可能的机理,以及药物治疗研究中存在的问题,指出在轻、重失语病人中,药物疗法为行为语言治疗的辅助措施还是有意义的。     

卒中后失语患者的功能磁共振成像

失语是脑损害所致语言受损或丧失.卒中是失语的常见原因之一.无论是否经过语言康复治疗,大部分失语患者的语言功能都会有不同程度的恢复.近年来,功能磁共振成像(functional magnetic resonance imaging,fMRI)技术已被广泛应用于神经语言学研究中.文章埘探讨卒中后失语恢复机制的fMRI研究进展进行了综述.     

卒中后失语患者抑郁问卷(医院版)在卒中后失语患者中应用的信度和效度检验

目的 建立标准化的中文版卒中后失语患者抑郁问卷(医院版)(Stroke Aphasic Depression Questionnaire Hospital Version,SADQ-H),并评价其在卒中后失语患者中应用的信度和效度.方法 在取得英文版卒中后失语患者抑郁问卷原作者授权同意书后,将SADQ-H修订成中文版本;以符合纳入标准的住院卒中后失语患者为试验组,以卒中后非失语患者为对照组;经过汉语失语检查法(Aphasia Battery of Chinese,ABC)评测,将试验组再分为听理解障碍组和非听理解障碍组;由经过培训的医护人员对所有患者进行SADQ-H评测,非听理解障碍组同时行Hamilton抑郁量表(Hamilton Depression Rating Scale,HAMD)和Beck抑郁问卷(Beck Depression Iventory,BDI)检查;部分患者1周后复测SADQ-H.结果 信度检验显示,重测信度为0.840,内部一致性检验Cronbach α系数为0.787;效度检验显示,效标效度为0.590(以HAMD为效标)和0.495(以BDI为效标),结构效度的因素累积方差贡献率为77.123%,区分效度为2.078.结论 SADQ-H中文修订版具有良好的信度和效度,可作为中国卒中后失语患者抑郁情绪评定的有效工具.     

缺血性卒中患者的睡眠障碍：病理生理学机制和治疗

睡眠障碍是缺血性卒中的一种常见并发症,如不及时诊断和治疗,可影响卒中的康复和复发。根据梗死部位的不同,睡眠障碍的表现形式多样。对于卒中后睡眠障碍的治疗,目前临床上多采取药物和物理治疗相结合的方法。近年来,随着多导睡眠监测技术的广泛应用,卒中后睡眠障碍已能得到明确和细致的诊断。针对卒中后睡眠障碍的治疗可明显改善患者的预后。     

A physician survey of poststroke aphasia diagnosis and treatment in China: SPEECH study

The current status of the diagnosis and management of poststroke aphasia (PSA) in China is unknown.To analyze the physicians’ strategy and knowledge about the management of PSA in clinical practice and the needs for standardization of diagnosis and treatment.This survey was conducted in March-August 2019 at 32 tertiary hospitals in 16 provinces/municipalities in China. The attending physicians from the Neurology and Neuro-rehabilitation/Rehabilitation Departments were included. The online questionnaire inquired about patient information, physicians’ diagnosis and treatment behavior for PSA, and physicians’ understanding of PSA.A total of 236 physicians completed the survey. Regarding PSA assessment, 99.2% of the physicians reported using medical history and physical examination, 93.2% reported using neuroimaging, and 76.3% reported using dedicated scales. Most physicians used a combination of drug and non-drug treatment. Neuro-regenerators/cerebral activators and anti-dementia drugs were the most common pharmacotherapies; butylphthalide, edaravone, and memantine were most frequently prescribed. Six months poststroke was rendered as a spontaneous language recovery period, and a ≥6-month treatment for PSA was suggested by many physicians. The lack of standardized treatment regimen/clinical guidelines and the limited number of approved drugs for PSA were the primary challenges encountered by physicians during practice. The majority of the physicians agreed with the necessity of guidelines or consensus for the diagnosis and treatment of PSA.The knowledge gaps exist among physicians in China regarding the assessment and management of PSA. The improved awareness of the available guidelines/consensus could improve the performance of the physicians.     

Efficacy and safety of massage in the treatment of poststroke depression: A systematic review and meta-analysis of protocols

Background:Poststroke depression (PSD) is a severe problem; it will significantly increase the mortality of patients after stroke, and affect the quality of life of patients after discharge. For stroke patients without noticeable adverse reactions, massage can effectively improve the patient''s mood, thereby treating poststroke depression. But so far, there is still no systematic research to provide reliable evidence that massage can effectively treat poststroke depression. Therefore, the purpose of this study is to comprehensively summarize and evaluate the effectiveness and safety of massage therapy for poststroke depression.Methods:We conduct a detailed search regardless of publication grade and language status. The search databases include the Web of Science, the Cochrane Library search, EMBASE, PubMed, CNKI, Chinese biomedical literature database, Chongqing VIP, and Wanfang. All randomized controlled trials and cohort studies on massage therapy for poststroke depression are published, as of November 15, 2020. The team consists of 2 experienced researchers who will select the retrieved documents and extract data. Later they used RevMan V.5.3 software for data analysis and data synthesis.Results:The effectiveness and safety of massage therapy intended for poststroke depression will be subject to a systematic evaluation under this program.Conclusion:It will be substantiated in this review whether massage therapy is a reliable intervention for poststroke depression by examining the evidence collected.INPLASY registration number:INPLASY2020110085.     

卒中后抑郁的治疗

卒中的发生率逐年上升,30%以上的卒中患者合并卒中后抑郁(PSD),严重影响卒中患者的康复,增加了卒中后的致残率。近20余年来,PSD的治疗日益受到重视。文章主要介绍PSD的药物治疗,并简要介绍了电惊厥疗法、心理治疗和康复治疗情况。     

卒中后认知障碍

卒中后认知障碍包括卒中后非痴呆认知障碍和卒中后痴呆,是卒中后由血管因素、神经变性或混合因素导致的认知功能障碍.卒中后认知障碍的慨念虽未被普遍接受,但值得进一步探讨.文章介绍了卒中后认知障碍的流行病学、危险因素、发病机制、临床表现和防治措施.     

卒中后认知障碍

卒中后认知障碍包括卒中后非痴呆认知障碍和卒中后痴呆,是卒中后由血管因素、神经变性或混合因素导致的认知功能障碍.卒中后认知障碍的慨念虽未被普遍接受,但值得进一步探讨.文章介绍了卒中后认知障碍的流行病学、危险因素、发病机制、临床表现和防治措施.     

Acupuncture-related therapies for the poststroke cognitive impairment patients: A protocol for systematic review and network meta-analysis

Background:To compare and rank the clinical effects of different acupuncture and acupuncture-related therapies on patients with poststroke cognitive impairment.Methods:We evaluated the direct and indirect evidence from relevant studies using network meta-analysis. Eight databases were examined in order to find randomized controlled trials of acupuncture-related therapies for individuals with poststroke cognitive impairment. After 2 researchers independently scanned the literature, extracted the data, and assessed the risk of bias in the included studies, the data were analyzed using RevMan5.4, Stata15.0, and WinBUGS1.4.3 software.Results:We assess the benefits and drawbacks of various acupuncture-related therapies, rank the efficacy of various acupuncture-related therapies in the treatment of poststroke cognitive impairment, and describe the best acupuncture intervention approaches or combinations based on the available data.Conclusion:This study will contribute to the existence of data on the safety and efficacy of acupuncture-related therapies in the treatment of poststroke cognitive impairment, and it may aid clinical guideline makers in selecting the best acupuncture treatment for poststroke cognitive impairment.Registration Number:INPLASY2021120117.