本文選題：BOLD-fMRI　切入點：腦梗死　出處：《河北聯(lián)合大學》2014年碩士論文　論文類型：學位論文

【摘要】：目的研究正常成人吞咽相關皮層中樞的分布與特征；研究急性腦梗死所致中樞性吞咽功能障礙患者腦吞咽相關中樞損害和功能代償重組的特征，分析中樞性吞咽功能障礙的臨床康復機制，從而為有效地進行吞咽康復治療提供理論依據(jù)。 方法選取10名健康右利手志愿者及經MRI(T1和T2)證實為兩側大腦或橋腦多發(fā)性腦梗死，但DWI證實僅其中一個為新發(fā)急性腦梗死灶；同時，患者首次出現(xiàn)吞咽障礙，并經臨床證實為中樞性吞咽障礙的患者10例，在吞咽水的同時進行BOLD-fMRI掃描采集原始數(shù)據(jù)，，應用SPM5進行后處理，獲得腦功能區(qū)的激活坐標、體積和強度等參數(shù)，利用Spss13.0對腦功能區(qū)激活體積和強度的變化進行統(tǒng)計分析。 結果1.對照組進行自主吞咽試驗時主要激活BA4區(qū)、BA13區(qū)、BA6/8區(qū)、BA40區(qū)BA24/32區(qū)等區(qū)域。對照組左側半球激活體積大于右側（P＜0.05），其LI值為15.22％，其中的中央前回(BA4)LI值為13.49％，島葉19.02％，緣上回10.89％。2.病例組激活區(qū)域主要有雙側的BA4、13、40區(qū)和BA6/8區(qū)，而雙側的BA24/32區(qū)激活減少，同時BA23/31、BA18/19、BA41、BA36區(qū)被激活，左側再發(fā)腦梗死組還可見雙側BA7區(qū)以及小腦明顯被激活，與對照組相比，病例組病灶同側皮質BA4區(qū)、BA6/8區(qū)激活體積、激活強度減小(P＜0.05），右側再發(fā)腦梗死組病灶對側BA6/8區(qū)及左側再發(fā)腦梗死組病灶對側BA4、MA6/8區(qū)激活體積增大（P＜0.05）而激活強度與對照組無統(tǒng)計學差異。 結論1吞咽運動的大腦皮層中樞調控具有明顯的優(yōu)勢半球偏側性特征。食欲相關的愉快情境刺激可以激活前腦島和前扣帶皮層等吞咽運動啟動中樞，進而激活緣上回和輔助運動區(qū)等吞咽運動規(guī)劃中樞以及吞咽運動的執(zhí)行中樞，而且激活執(zhí)行中樞的體積是進行正常吞咽運動的重要條件。2再發(fā)腦梗死急性期所致中樞性吞咽障礙，吞咽運動的規(guī)劃和執(zhí)行中樞具有激活反應，但急性病變同側吞咽相關中樞的激活強度降低，而對側吞咽相關中樞的激活強度無明顯變化；但出現(xiàn)后扣帶回、前額葉和視、聽皮層等吞咽啟動中樞的代償性中樞功能重組。通過視覺和聽覺等途徑給予患者食欲刺激，可以促進皮層吞咽啟動中樞的代償性功能重組，從而促進吞咽功能的恢復，提高吞咽障礙的康復治療效果。
[Abstract]:Objective to study the distribution and characteristics of swallowing associated cortical centers in normal adults, and to study the characteristics of swallowing related central lesions and functional compensatory recombination in patients with central swallowing dysfunction caused by acute cerebral infarction. To analyze the clinical rehabilitation mechanism of central dysphagia, so as to provide theoretical basis for effective rehabilitation therapy. Methods Ten healthy right-handedness volunteers and multiple cerebral infarction were confirmed by MRI(T1 and T2, but only one of them was confirmed by DWI as a newly developed acute cerebral infarction, and the patients had dysphagia for the first time. In addition, 10 patients with central dysphagia were examined by BOLD-fMRI scanning while swallowing water. The parameters of activation coordinate, volume and intensity of brain functional area were obtained by post-processing with SPM5. The changes of activation volume and intensity of brain functional area were statistically analyzed by Spss13.0. Results 1. In the control group, the active volume of the left hemisphere was larger than that of the right side (P < 0.05), and the Li value of the left hemisphere was 15.22. The Li of the precentral gyrus was 13.49 and 19.022.In the control group, the activation volume of the left hemisphere was greater than that of the right side (P < 0.05), and the LI of the precentral gyrus was 13.49. The activation areas in the case group were mainly bilateral BA4M1340 and BA6/8. The activation of bilateral BA24/32 was decreased, and BA23 / 31BA18 / 19BA41mBA36 was activated. Bilateral BA7 and cerebellum were also significantly activated in the left recurrent cerebral infarction group. Compared with the control group, the ipsilateral BA4 area of the lesion in the case group was activated by the activation volume of BA6 / 8. The activation intensity decreased (P < 0.05), and the activation volume increased in the contralateral BA6/8 area in the right recurrent cerebral infarction group and in the contralateral BA4 / MA6 / 8 area in the left recurrent cerebral infarction group (P < 0.05), but there was no significant difference in the activation intensity between the right recurrent cerebral infarction group and the control group. Conclusion (1) the central regulation of the cerebral cortex in swallowing motion has obvious hemispheric hemispheric characteristics. The stimulation of appetite-related pleasant situation can activate the activation center of swallowing movement such as forebrain island and anterior cingulate cortex. Furthermore, the supramarginal gyrus and auxiliary motor area were activated in the planning center of swallowing motion and the executive center of swallowing movement. Moreover, the volume of activation of the executive center is an important condition for normal swallowing. 2. The central swallowing disorder caused by recurrent cerebral infarction in acute stage, and the planning and execution of swallowing movement have activation response. However, the activation intensity of ipsilateral swallowing related center was decreased in acute lesion, while that of contralateral swallowing related center was not changed, but the posterior cingulate gyrus, prefrontal lobe and vision were found. The compensatory central function recombination of the auditory and other swallowing initiation centers. By stimulating the patient's appetite through visual and auditory channels, it can promote the recombination of the compensatory function of the cortical swallowing initiation center, thus promoting the recovery of the swallowing function. To improve the effect of rehabilitation treatment for dysphagia.
【學位授予單位】：河北聯(lián)合大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R743.3

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