动态观察急性脑卒中后听觉诱发电位的变化

Dynamic observe of the changes of auditory evoked potentials in acute brain apoplexy patients

目的：观察急性脑卒中患者脑干听觉诱发电位（BAEP）的改变特点，评价其对脑功能监测的价值。方法：对96例脑卒中（58例脑梗死、27例脑出血和11例蛛网膜下腔出血）患者，检测发病后不同时期（1～12d）BAEP和血清神经元特异性烯醇化酶（NSE）改变，结合中国卒中量表（CSS）评分、巴塞尔指数、格拉斯哥-匹兹堡昏迷量表（GPCS）评分以及颅脑影像学检查结果，分析与临床神经功能缺失的关系。以25例年龄和性别相匹配的正常人作为对照。结果：脑卒中患者BAEP的Ⅰ、Ⅲ、Ⅴ波峰潜伏期（PL）和Ⅰ-Ⅲ、Ⅰ-Ⅴ峰间潜伏期（IPL）较正常对照组显著延长（P〈0．01）；幕下脑出血和后循环脑梗死患者BAEP-V波PL与其病灶大小呈正相关（P〈0．01）；脑出血和脑梗死患者BAEP—V波PL与其血清NSE水平、CSS评分呈正相关（P〈0．01）；各型脑卒中患者BAEP—V波PL与其GPCS评分呈负相关（P〈0．01）。结论：急性脑卒中患者BAEP各波的改变与病灶部位有关，V波PL改变客观反映了脑出血和脑梗死患者病情的严重程度。

Objective： To observe the characteristics of brain-stem auditory evoked potential（BAEP） changes and to evaluate its value in the assessment of brain function in acute brain apoplexy patients. Methods： BAEP and serum neuron-specific enolase（NSE） were measured 1-12 d after the oncet of apoplexy in 58 cases of cerebral infarction（CI）, 27 cerebral hemorrhage（CH） and 11 subarachnoid hemorrhage（SAH） patients. Twenty-five.normal suhiects matched with the patients in age and sex served as controls. Neural function was evaluated in all patients through the test of Chinese stroke scale（CSS）, Barthel index（BI） and Glasgow-Pittsburgh coma scale. Brain imaging was made by CT scan in all patients. The relationship between changes of BAEP and neural function defecits in the patients was ana- lysed. Results： The peak latency（PL） of Ⅰ,Ⅲ,Ⅴ and the inter-peak latency（IPL） of Ⅰ-Ⅲ,Ⅰ-Ⅴ waves of BAEP was significantly prolonged in the apoplexy patients compared with that in the normal subjects（P〈0.01）. The PL of BAEP-V was positively correlated with the volume of the lesion in the subtentorium CH and the vertebral-basilar artery CI patients（P〈0.01）, the level of serum NSE in brain hemorrhage and infarction patients（P〈0.01）, and the score of CSS in CH and CI patients （P〈0.01）. The PL of BAEP-V was negatively correlated with the score of Glasgow-Pittsburgh coma scale in all apoplexy patients（P〈0.01）. Conclusion： The change of BAEP is related to the position of lesion in acute apoplexy patients. The change of the PL of V wave can reflect the severity of the patient＇s condition in CI CH .