【摘要】：運動性失語又稱Broca aphasia綜合征,口語表達障礙及電報式語言是其最大特征,是所有失語癥當中發(fā)病率最高的失語類型,廣義上講是大腦額葉皮質、皮質下和基底節(jié)區(qū)的言語功能障礙綜合征,狹義上講是大腦優(yōu)勢半球的額下回后部和中央前回下部的病變(即Broca語言區(qū))引起的語言表達障礙綜合征。運動性失語多由血管病、炎癥、腫瘤、外傷及術后等原因導致,病變累及左下額前語言功能區(qū),而以腦血管意外所致運動性失語最為常見�，F(xiàn)代醫(yī)學對其機制研究已非常深入,治療方式也在不斷探索,但治療上仍是難題,仍然存在言語功能恢復速度慢及恢復不完全等難題。目的:采用調神理氣針刺及舌三針配合言語康復鍛煉治療腦卒中后運動性失語癥,并與常規(guī)針刺對照,觀察調神理氣針刺及舌三針對腦卒中后運動性失語患者的影響。方法:將60例符合納入標準的研究對象,按照隨機數字表法分為治療組和對照組,每組30例,均予基礎治療(常規(guī)藥物治療+言語康復訓練),治療組在基礎治療上予調神理氣針刺及舌三針治療,對照組在基礎治療上予常規(guī)針刺治療;每周針刺5次,4周為一個療程,2個療程后觀察療效。治療前后均采用北京醫(yī)科大學漢語失語成套試驗(ABC)和功能性語言溝通能力檢查法(CFCP)對患者進行評分比較。結果:2個療程結束后,兩組患者功能性語言溝通能力檢查法(CFCP)評分比較:干預前,組間比較差異無統(tǒng)計學意義(P0.05),具有可比性。干預后,兩組均與干預前組內比較,均有顯著性差異(P0.01),干預后組間比較差異有統(tǒng)計學意義(P0.05),治療組較對照組改善更顯著;干預前后差值比較,差異有統(tǒng)計學意義(P0.05),說明兩組治療均能改善患者的功能性語言溝通能力,但是治療組較對照組改善更明顯。兩組患者漢語失語成套試驗(ABC)評分比較:干預前比較,差異均無統(tǒng)計學意義(P0.05),具有可比性。兩組患者自發(fā)談話流利性、信息量、聽理解、閱讀、復述、命名、書寫七項言語功能與干預前比較,差異均有統(tǒng)計學意義(P0.01);經比較兩組患者干預后評分及干預前后差值,自發(fā)談話流利性、復述、聽理解三項與對照組比較,均有顯著性差異(P0.05),信息量、命名、閱讀、書寫四項經比較,均無顯著性差異(P0.05),治療組總有效率86.66%,對照組總有效率80%,差異無顯著性。說明治療組在改善患者流利性、復述、聽理解三項上,療效優(yōu)于對照組,在總臨床療效上無顯著性差異。結論:綜上所述,兩種治療方式都能改善患者言語功能,調神理氣針刺及舌三針治療方案對患者功能性語言溝通能力及言語流利性、復述、聽理解,臨床療效優(yōu)于常規(guī)針刺;信息量、命名、閱讀、書寫四項兩組均有改善,但兩組療效無顯著性差異。治療中風后失語癥針灸顯效,而研究表明調神理氣針刺及舌三針療法對運動性失語有一定臨床使用價值。
[Abstract]:Motor aphasia, also known as Broca aphasia syndrome, is characterized by dysfunctional spoken language and Telegraph language, the most common aphasia type of all aphasia, and broadly speaking the frontal cortex of the brain. The speech dysfunction syndrome in subcortical and basal ganglia regions is, in a narrow sense, a language expression disorder syndrome caused by the lesions in the posterior part of inferior frontal gyrus and the lower part of precentral gyrus (i.e., Broca language area) in the dominant hemisphere of the brain. Motor aphasia is mostly caused by vascular disease, inflammation, tumor, trauma and postoperative causes. The lesions involve the left prefrontal language area, and cerebral vascular accident is the most common cause of motor aphasia. In modern medicine, the research on its mechanism has been very deep, and the treatment method has been explored constantly. However, the treatment is still a difficult problem, and there are still some problems such as slow recovery rate and incomplete recovery of speech function. Objective: to observe the effect of regulating spirit and regulating qi acupuncture and tongue three acupuncture combined with speech rehabilitation exercise on motor aphasia after stroke, and to observe the effect of regulating spirit and regulating qi acupuncture and tongue three acupuncture on motor aphasia after stroke. Methods: sixty patients who met the standard were divided into treatment group and control group according to random digital table method. 30 cases in each group were treated with basic therapy (routine drug therapy speech rehabilitation training). The treatment group was treated with acupuncture of regulating spirit and regulating qi and three acupuncture of tongue on basic treatment, while the control group was treated with routine acupuncture on basic treatment. Acupuncture 5 times a week, 4 weeks as a course of treatment, 2 courses of treatment to observe the efficacy. The scores of the patients were compared before and after treatment with the Chinese aphasia test of Beijing Medical University (ABC) and the functional language communication ability test (CFCP). Results: after two courses of treatment, the (CFCP) score of functional language communication ability test was compared between the two groups: before intervention, there was no significant difference between the two groups (P0.05), which was comparable. After intervention, there was significant difference between the two groups compared with the pre-intervention group (P0.01), the difference between the two groups after intervention was statistically significant (P0.05), the treatment group was more significant than the control group. The difference before and after intervention was statistically significant (P0.05), indicating that both groups could improve the functional language communication ability of patients, but the treatment group improved more obviously than the control group. Comparison of (ABC) scores of Chinese aphasia test between the two groups: before intervention, the differences were not statistically significant (P0.05), comparable. There were significant differences in spontaneous speech fluency, information content, listening comprehension, reading, retelling, naming and writing between the two groups (P0.01). Compared with the control group, there were significant differences between the two groups in score and difference before and after intervention, spontaneous speech fluency, repetition, listening comprehension (P0.05), information content, naming, reading and writing. There was no significant difference (P0.05). The total effective rate was 86.66 in the treatment group and 80 in the control group. The results showed that the curative effect of the treatment group was superior to that of the control group in improving the fluency, repetition and listening comprehension of the patients, but there was no significant difference in the total clinical effect. Conclusion: to sum up, both of the two treatments can improve the speech function of the patients. The therapeutic effects of regulating the spirit, regulating the qi and acupuncture of tongue on the functional language communication ability and speech fluency, repetition, listening comprehension, clinical effect of acupuncture are better than those of routine acupuncture. The information content, naming, reading and writing were all improved, but there was no significant difference between the two groups. Acupuncture and moxibustion are effective in the treatment of aphasia after apoplexy, but the research shows that acupuncture of regulating spirit and regulating qi and three acupuncture of tongue have certain clinical value for motor aphasia.
【學位授予單位】：廣州中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R246.6
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本文編號：2366360