摘要目的 研究枕叶梗死偏盲患者急性期的视觉空间注意能力.方法 采用“提示-靶”的视觉试验范式,对2013年12月至2015年2月已确诊的8例急性右侧枕叶梗死所致双眼左侧同向偏盲的老年患者(试验组)和10名健康老年人(对照组)分别进行视觉空间注意能力检查.结果 分组、提示范围这两个因素在反应时间、正确率分析中主效应均显著,靶刺激位置在反应时间分析中主效应显著.试验组与对照组相比,反应时间延长[分别为(1 628.26±183.97) ms、(839.79±61.29)ms,F(1,16)=163.706,P＜0.05],正确率降低[分别为73.40％±3.12％、92.99％±0.76％,F(1,16) =371.850,P＜0.05].试验组在大范围提示下的正确率较小范围提示降低[分别为71.38％±3.35％、75.42％ ±4.23％,F(1,7)=6.706,P＜0.05],而对照组在不同范围提示下的正确率差异没有统计学意义[分别为93.01％±0.50％、92.96％±1.42％,F(1,9)=0.010,P＞0.05].试验组中靶刺激出现在偏盲侧的反应时间较健侧延长[分别为(1 664.17±196.57) ms、(1 594.35±174.45) ms,F(1,7)=14.157,P＜0.05],而对照组中靶刺激出现在左右两侧的反应时间差异无统计学意义[分别为(839.67±60.41) ms、(839.91±73.54)ms,F(1,9)=0.000,P＞0.05].此外,试验组的平均反应时间与患者双眼视野指数呈负相关(r=-0.824,P＜0.05).结论 枕叶梗死偏盲患者急性期的偏盲程度可以反映视觉空间注意能力的损害程度,康复训练应着重提高偏盲侧大范围提示下的空间注意能力.

abstractsObjective To investigate the visual spatial attention of occipital stroke patients with hemianopia during the acute phase.Methods Eight occipital stroke patients with homonymous hemianopia of left side in the acute stage and 10 age-matched healthy controls were recruited to examine the capability of visual spatial attention.The cue-target paradigms were applied in this behavioral research.Results In the repeated measures analysis of variance,the difference of group and cue range had distinct main effect in reaction time and accuracy rate,while the difference of target location only had main effect in reaction time.Compared with the control group,the patients exhibited longer reaction time ((1 628.26 ± 183.97) ms vs (839.79±61.29) ms,F(1,16) =163.706,P＜0.05) and lower accuracy rate (73.40％ ±3.12％ vs 92.99％ ±0.76％,F(1,16) =371.850,P ＜ 0.05).The patients displayed lower accuracy rate under large cue than small cue (71.38％ ±3.35％ vs 75.42％ ±4.23％,F(1,7) =6.706,P ＜0.05),while that of healthy controls did not vary under different cue range(93.01％ ± 0.50％ vs 92.96％ ± 1.42％,F(1,9) =0.010,P ＞ 0.05).The patients showed longer reaction time in blind-side target than healthy-side target ((1 664.17±196.57) msvs (1 594.35±174.45) ms,F(1,7) =14.157,P＜0.05),while that of control group in two target location had no statistically significant difference ((839.67 ± 60.41) ms vs (839.91 ±73.54) ms,F(1,9) =0.000,P ＞0.05).Furthermore,the mean reaction time of stroke patients had a negative correlation with the binocular vision field index (r =-0.824,P ＜ 0.05).Conclusions The extent of vision field loss in occipital stroke patients with hemianopia can reflect impairment of visual spatial attention during the acute phase.The rehabilitation training should emphasize promoting recovery of visual spatial attention in the blind side under large cue.