脑干听觉诱发电位和脑血流动力学对脑瘫的临床评估探讨

Clinical evaluation of brainstem auditory evoked potential and cerebral hemodynamics for cerebral palsy

目的探讨脑干听觉诱发电位和脑血流动力学变化对脑瘫(CP)的临床评估价值。方法收集脑瘫患儿70例,分为轻型组、中型组、重型组三组。采用脑干听觉诱发电位检测Ⅰ波、Ⅲ波、Ⅴ波的潜伏期,Ⅰ~Ⅲ波、Ⅳ~Ⅴ波、Ⅰ~Ⅴ波的波峰间潜伏期,并采用经颅多普勒超声技术检测脑内动脉平均血流速度(Vm)、动脉搏动指数(PI)、血管阻力指数(RI)的变化。结果脑瘫患儿重型组和中型组的脑干听觉诱发电位异常表现以潜伏期或波峰间潜伏期延长明显,分别为13例(18.6%)和16例(22.9%),与轻型组比较,差异有统计学意义(P<0.05);同时,中型组和重型组Vm均降低,与轻型组比较,差异有统计学意义(P<0.05或0.01);中型组和重型组PI、RI均升高,与轻型组比较,差异有统计学意义(P<0.05或0.01)。结论脑干听觉诱发电位联合脑血流动力学检测对CP的早期诊断、病情判断和预后等可提供有价值的参考。

Objective To explore clinical evaluation of brainstem auditory evoked potentials( BAEP) and cerebral hemodynamics for cerebral palsy( CP). Methods 70 children with CP were collected and divided into mild degree group,middle degree group and severe degree group. And then BAEP was used to detect peak latency( PL) of wave Ⅰ,wave Ⅲ and wave Ⅴas well as interpeak latency( IPL) of waveⅠ ~ Ⅲ,wave Ⅳ ~ Ⅴ and waveⅠ ~ Ⅴ. In addition,mean flow velocity of cerebral artery( Vm),arterial pulsation index( PI) and vascular resistance index( RI) were detected through transcranial Doppler( TCD). Results Abnormal BAEP was found in 13 cases( 18. 6%) in severe degree group and 16 cases( 22. 9%)in middle degree group,which showed that they obviously prolongated in PL and IPL,and difference was statistically significant when comparing to those in mild degree group( P < 0. 05). In addition,Vm of middle degree group and severe degree group decreased,and there was statistically significant difference when comparing to those of the mild degree group( P < 0. 05 or 0. 01). However,PI and RI in both severe degree group and middle degree group increased,difference was statistically significant when comparing to those in mild degree group( P < 0. 05 or 0. 01). Conclusion BAEP combined with cerebral hemodynamics can provide valuable reference for early diagnosis,condition judgment and prognosis of CP.