脑干听觉诱发电位和经颅多普勒超声在后循环缺血诊断中的临床价值

Application of brainstem auditory evoked potential and transcranial Doppler on diagnosis of posteriorcirculation ischemia

目的研究脑干听觉诱发电位(BAEP)和经颅多普勒超声(TCD)检测在后循环缺血(PCI)诊断的价值。方法对180例临床诊断为PCI患者和160例健康者进行脑干听觉诱发电位的检测,测量I、III、V波峰潜伏期(PL)和Ⅰ～Ⅲ、Ⅲ～Ⅴ、Ⅰ～Ⅴ峰间潜伏期(IPL);同时采用经颅多普勒探测基底动脉(BA)、椎动脉(VAS)、大脑中动脉(MCA)、大脑前动脉(ACA)、大脑后动脉(PCA)的血供情况、血管壁的弹性和顺应性,记录BA、VAS的收缩期速度(Vp)、平均速度(Vm)及血管搏动指数(PI)。结果①PCI组V波潜伏期,Ⅲ～Ⅴ及Ⅰ～Ⅴ峰间期均较对照组延长,差异有统计学意义(P<0.05);②PCI组LVA、RVA、BA 3条血管Vp和PI值高于对照组,Vm低于对照组,差异有统计学意义(P<0.05);③180例PCI患者中TCD和BAEP均异常者94例,异常率52.22%;BAEP异常者124例,异常率68.89%;TCD异常者138例,异常率76.67%。与TCD和BAEP异常者比较差异有统计学意义(P<0.01)。④对PCI组患者LVA、RVA、BA 3条血管的Vp分别与BAEP的V波潜伏期和Ⅰ～Ⅴ峰间期进行相关分析显示存在负相关(P<0.05)。结论 BAEP和TCD对PCI的诊断相互补充,分别从神经电生理和血流动力学方面为PCI的诊断和定位提供了客观依据,具有一定的临床应用价值。

Objective To research the clinical value of the transcranial Doppler and the brainstem auditory evoked potentials in the vertebro-basilar artery inadequate blood（PCI）.Methods Totally 180 patients with PCI and 60 healthy persons was studied by transcranial Doppler（TCD） and brainstem auditory evoked potential（BAEP）,and detected the flow pattern of vertebral artery（VA） and basilar artery（BA）,the computer calculated the artery systolic velocity（Vp）,average velocity（Vm） and pulsatility index（PI）.To measure the peak latency（PL） of waves I,III,V,and the interpeak latency（IPL） of waves I-III,III-V,I-V from BAEP.Results The Vp and Vm of the three vascular（LVA,RVA,BA） from PCI group is lower than the normal control group（P0.05）,but the PI values is higher（P0.05）.The PI of V-wave and the IPL of III-V and I-V from PCI were longer than the control group（P0.05）.There was 94 cases that TCD and BAEP of patients were abnormal,the abnormal rate was 42.5%.There was a significant difference compared with patients that the BAEP or TCD was abnormal（P0.01）.It showed a negative correlation that the Vp of the three vascular（LVA.RVA.BA） from PCI group compared with the PI of V-wave and the IPL of I-V（P0.05）,that was show that the velocity is lower but the latent period is longer.Conclusions TCD and BAEP reflect the blood supply and nerve conduction in the brain stem from the two anti-hemodynamic and electrophysiological,are a reliable diagnostic examinations of PCI,improve the positive rate of diagnosis,have certain clinical value to the diagnosis of PCI.