中国神经再生研究(英文版)

中国神经再生研究(英文版) ›› 2015, Vol. 10 ›› Issue (3): 490-497.doi: 10.4103/1673-5374.153701

• 原著:脑损伤修复保护与再生 • 上一篇    下一篇

康复干预可促进中枢性吞咽功能障碍者神经功能中枢代偿性重组现象

  

  • 收稿日期:2014-10-28 出版日期:2015-03-20 发布日期:2015-03-20

Compensatory recombination phenomena of neurological functions in central dysphagia patients

Xiao-dong Yuan 1, Li-fu Zhou 1, Shu-juan Wang 1, Yan-sheng Zhao 2, Xiao-jie Wang 1, Li-li Zhang 1, Shou-hong Wang 2, Ya-jie Zhang 2, Li Chen 2   

  1. 1 Department of Neurology, Affiliated Kailuan General Hospital of Hebei United University, Tangshan, Hebei Province, China
    2 Department of MRI Room, Affiliated Kailuan General Hospital of Hebei United University, Tangshan, Hebei Province, China
  • Received:2014-10-28 Online:2015-03-20 Published:2015-03-20
  • Contact: Xiao-dong Yuan, yxd68@sohu.com

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摘要：

假设脑梗死导致中枢性吞咽功能障碍患者在给予吞咽活动刺激任务时可激活脑相关皮质中枢区域，实验拟采用血氧水平依赖脑功能性成像检测验证其皮质变化的功能影像学特征。发现正常对照者吞咽时，大脑初级运动皮质（BA4区）、岛叶（BA13区）、运动前区皮质（BA6/8区）、缘上回（BA40区）和前扣带皮质（BA24/32区）域被激活，左侧激活体积大于右侧；而左侧和右侧复发性脑梗死中枢性吞咽障碍患者吞咽时大脑BA4区、BA13区、BA40区和BA6/8区被激活，BA24/32区激活程度下降，还出现新的激活区域后扣带回皮质（BA23/31区）、视觉联合皮质（BA18/19区）、初级听皮皮质（BA41区）和旁海马回（BA36区）。其中左侧复发性脑梗死后中枢性吞咽障碍患者双侧体感相关皮质（BA7区）和小脑也被激活。结果提示吞咽时大脑皮质存在明显的优势半球偏侧化特点，且复发性脑梗死后中枢性吞咽障碍患者存在神经功能中枢代偿性重组现象，提示在进行康复治疗时，可以给予患者以往喜欢的食物通过视觉和听觉等神经传导途径对其吞咽活动相关进行刺激，从而促进皮质中枢功能的代偿性重组。

关键词: 神经再生, 血氧水平依赖脑功能性成像, 脑缺血, 吞咽障碍, 功能重建, 大脑皮质

Abstract:

We speculate that cortical reactions evoked by swallowing activity may be abnormal in patients with central infarction with dysphagia. The present study aimed to detect functional imaging features of cerebral cortex in central dysphagia patients by using blood oxygen level-dependent functional magnetic resonance imaging techniques. The results showed that when normal controls swallowed, primary motor cortex (BA4), insula (BA13), premotor cortex (BA6/8), supramarginal gyrus (BA40), and anterior cingulate cortex (BA24/32) were activated, and that the size of the activated areas were larger in the left hemisphere compared with the right. In recurrent cerebral infarction patients with central dysphagia, BA4, BA13, BA40 and BA6/8 areas were activated, while the degree of activation in BA24/32 was decreased. Additionally, more areas were activated, including posterior cingulate cortex (BA23/31), visual association cortex (BA18/19), primary auditory cortex (BA41) and parahippocampal cortex (BA36). Somatosensory association cortex (BA7) and left cerebellum in patients with recurrent cerebral infarction with central dysphagia were also activated. Experimental findings suggest that the cerebral cortex has obvious hemisphere lateralization in response to swallowing, and patients with recurrent cerebral infarction with central dysphagia show compensatory recombination phenomena of neurological functions. In rehabilitative treatment, using the favorite food of patients can stimulate swallowing through visual, auditory, and other nerve conduction pathways, thus promoting compensatory recombination of the central cortex functions.

Key words: nerve regeneration, blood oxygen level-dependent functional magnetic resonance imaging, cerebral ischemia, dysphagia, function restructuring, cerebral cortex, neural regeneration