沈修姝 高天昊 邱晓 华艳 甄丽君 姜从玉

摘 要 目的：观察经颅磁刺激结合偏侧注意训练的康复治疗对1例右侧半球脑梗死后左侧忽略伴偏盲患者的偏侧忽略纠正和肢体功能恢复的效果。方法：采用经颅磁刺激、偏侧注意训练和常规康复治疗方法治疗脑卒中后偏侧忽略伴偏盲患者，5 d/周共2周。治疗前、后分别通过绘图试验、字母删除试验、星星删除试验、Albert线段划消试验、Schenkenberg二等分线段测验、高声朗读试验和听觉、触觉测试来评价患者的偏侧忽略症状，通过Brunnstrom量表、Fugl-Meyer运动功能评定量表、Berg平衡功能量表、改良的Barthel指数量表来评价患者的运动、感觉、平衡功能和日常生活能力。结果：治疗2周后，患者的偏侧忽略症状较前明显改善，主要体现在绘图、朗读、删除星星和字母试验，以及触觉、听觉测试方面。患者的偏盲症状、Brunnstrom量表、Fugl-Meyer运动功能评定量表、Berg平衡功能量表和改良的Barthel指数量表评价结果也较前略有好转。结论：经颅磁刺激等康复治疗能明显改善患者的偏侧忽略症状，但其功能恢复仍需进行长期的康复锻炼。

关键词 脑卒中 脑梗死 偏侧忽略 偏盲 经颅磁刺激

中图分类号：R493； R743.3 文献标志码：B 文章编号：1006-1533（2021）07-0013-04

Effect of transcranial magnetic stimulation-based comprehensive therapy for a patient with unilateral neglect and hemianopia after stroke

SHEN Xiushu*， GAO Tianhao， QIU Xiao， HUA Yan， ZHEN Lijun， JIANG Congyu**

（Department of Rehabilitation， Huashan Hospital， Fudan University， Shanghai 200040， China）

ABSTRACT Objective： To observe the effects of transcranial magnetic stimulation （TMS）-based comprehensive therapy for a patient with unilateral neglect and hemianopia after stroke in the right hemisphere. Methods： This stroke patient was treated by TMS， unilateral attention training and conventional rehabilitation for a total of 2 weeks （5 days a week）. Before and after treatment， the patients lateral neglect symptoms were evaluated by drawing test， letter and star deletion test， Albert line segment cancellation test， Schenkenberg bisecting line test， loud reading test， and hearing and touch tests and the movement， sensation， balance function and daily living ability were evaluated by Brunnstrom scale， Fugl-Meyer Motor Assessment， Berg Balance Scale and modified Barthel Index. Results： After 2 weeks of treatment， the symptoms of neglect were significantly improved， especially in drawing test， reading test， letter and star cancellation test， auditory and tactile tests. The degree of hemianopia and the scores of functional assessments were slightly improved. Conclusion： TMS-based comprehensive therapy can significantly improve the unilateral neglect symptoms， however long-term rehabilitation is still needed for further functional recovery in stroke patients.

KEy WORDS stroke； cerebral infarction； unilateral neglect； hemianopia； transcranial magnetic stimulation

偏侧忽略（unilateral neglect）是指患者对大脑病灶对侧（偏瘫侧）的物体、声音、活动、自身感觉和运动等刺激存在注意力减弱或缺失，主要表现为注意力障碍和认知功能障碍[1]。偏侧忽略是脑卒中后患者的常见功能障礙之一[2]，对患者的生活质量有一定的负面影响[3]。

近年来，国内外对偏侧忽略的研究逐渐增多，可能有效的治疗方法包括单眼遮蔽[4]、经颅磁刺激[5]、棱镜矫正[6]、镜像疗法[7]、视动训练[8-9]和药物治疗[10]等。……