【作者】 张彦敏；

【导师】 刘青蕊； 刘名顺；

【作者基本信息】 河北医科大学 ， 神经病学， 2004， 硕士

【摘要】 目的：通过对椎基底动脉系统短暂性脑缺血发作（TIA）患者治疗前后的脑干听觉诱发电位(BAEP)及脑电地形图(BEAM)检查，探讨其早期诊断价值，明确受损部位，判断病情严重程度，观察疗效，以指导临床，选择最佳治疗。方法：选择我院收治的符合1995 年全国第四次脑血管病学术会议诊断标准的椎基底动脉系统TIA 患者60 例（患者组），男32 例，女28 例，年龄35～65 岁之间，平均 47.18±8.14 岁，有类发作史50 例，病程1 月～16 年。35例年龄、性别比例与患者组相近的健康人35 名（对照组），男19 例，女16 例，年龄30～65 岁，平均46.46±9.70 岁，均无耳疾。在25℃的隔音室内安静状态下行BAEP 检查，受检者坐位，全身肌肉放松，闭目，Cz 作参考点，A1、A2 分别作记录点，Fz 接地，电极与皮肤间阻抗低于5kΩ，听觉刺激为变换极性的“喀嗒”声，先测主观听阈，大于60dB者不纳入本研究范围。双耳分别给予主观听阈加60dB click 刺激，平均叠加1500 次，每侧最少重复两次，选重复性好的波形，滤波后标出BAEP 各波。游标测量Ⅰ、Ⅲ、Ⅴ各波峰潜伏期（PL）和峰间潜伏期（IPL），采用t 检验对两组检查结果进行比较。对椎基底动脉系统TIA 组行BEAM 检查，应用随机所带的电极帽，按国际10/20 系统安放21 个电极，双耳垂为参考电极，Fpz 为接地电极，描记安静闭目<WP=4>2脑电图3 分钟，取30 秒无干扰脑电进行快速傅立叶转换（FFT）显示频带功率分布图，得出α、β、θ、δ频带功率分布地形图进行分析，并与BAEP 检查结果相比较，结合患者临床表现，分析其病情与BAEP、BEAM 异常程度之间的关系。BAEP 与BEAM 检查均在患者入院后即刻完成，异常者治疗一周后复查BAEP、BEAM。对椎基底动脉系统TIA 组治疗前后及对照组两两比较，计量资料均以x ±s 表示，采用t 检验，比较其差异。检验水准取a=0.05。结果：（1）60 例椎基底动脉系统TIA 患者BAEP 异常45 例占75%，其中脑干型异常28 例占62.2%，内耳型7 例占15.6%，混合型10 例占22.2%。（2）椎基底动脉系统TIA组Ⅰ、Ⅴ波PL、Ⅲ-ⅤIPL、及Ⅲ-Ⅴ/Ⅰ-Ⅲ比值均较对照组增大，经t 检验，P <0.01，差异均有非常显著性，Ⅲ波PL、Ⅰ-ⅤIPL 与对照组比较P <0.05 差异均有显著性，Ⅰ-ⅢIPL与对照组比较P >.05 差异无统计学意义。（3）椎基底动脉系统TIA 组BAEP 各指标的异常率中以Ⅲ-Ⅴ/Ⅰ-Ⅲ>1 最常见，占48.3%，其次是Ⅲ-Ⅴ和Ⅰ-ⅤIPL 的延长，分别占35%和30%。Ⅰ、Ⅲ、Ⅴ波波形分化不良较相应PL 延长和波幅下降多见。（4）60 例椎基底动脉系统TIA 患者BEAM 异常48 例占80%，表现为α频带功率分布地形图上枕颞区功率值降低，和/或在θ、δ频带相应部位功率值增高。（5）在同一患者中，BAEP、BEAM 均异常者38 例占63.3%，仅BEAM异常而BAEP 正常者占10 例占16.7%，仅BAEP 异常而BEAM正常者7 例占11.7%，二者均正常者5 例占8.3%。（6）椎基底动脉系统TIA 患者治疗后第７天BAEP 的异常率为10%。45 例异常BAEP 患者治疗前后BAEP 均有不同程度改善，Ⅰ、<WP=5>Ⅲ、Ⅴ波PL 经t 检验，P <0.01，差异均有非常显著性。与正常对照组比较，经t 检验，P >.05，差异无统计学上意义。（7）异常BEAM 复查均有不同程度改善，表现为原病变侧α频带相应部位功率值增高或慢波功率不同程度下降。（8）椎基底动脉系统TIA 患者发作症状越重越频繁，BAEP表现波形分化、潜伏期、波间期异常越明显，BEAMα频带功率分布地形图上枕颞区功率值越低。结论：（1）BAEP 能从电生理角度早期反映内耳迷路及脑干听觉传导通路上的异常，对椎基底动脉系统TIA 早期诊断具有重要价值，并有助于缺血早期定位。（2）BAEP 中Ⅰ、Ⅲ、Ⅴ是最稳定可靠的3 个主要反应波，Ⅲ-Ⅴ/Ⅰ-Ⅲ>1 是反映脑干缺血的敏感指标，Ⅴ波波形分化不良可作为脑干功能损害的早期指标之一。（3）BEAM 可作为椎基底动脉系统TIA 早期诊断较灵敏的检查方法，主要反映枕颞部供血不足。（4）BAEP 与BEAM 联合检测可明显提高椎基底动脉系统TIA 的诊断率（91.7％），并有助于缺血定位。（5）两项检查结果异常程度能准确反映椎基底动脉系统TIA 患者病情严重程度，可用于临床指导治疗。（6）两项检查对椎基底动脉系统TIA 病情的动态评估、疗效观察具有重要价值。更多还原

【Abstract】 Objective: To explore the early diagnostic value ofbrainstem auditory evoked potential(BAEP) and brainelectrical activity mapping(BEAM) in patients withvertebrobasilar systemic transient ischemicattack(TIA). To identify the damaged position andjudge the severity of patient’s condition. We triedto investigate the curative effect and to instructclinical treatment and select the best therapy.Methods: We selected 60 inpatients(patientsgroup)with vertebrobasilar systemic TIA diagnosed byclinical standards referred to the fourth nationalcerebrovascular diseases meeting in 1995 in ourhospital, including male 32 cases, female 28 cases,ages were from 35 to 65 years old, average was 47.18±8.14 years old. 50 cases had the same similarsymptoms in the past. The course of disease was fromone month to 16 years old. 35 health controls whoseages and gender were similar to the patients group,including male 19 cases, female 16 cases, ages were<WP=7>5from 30 to 65 years old, average was 46.46±9.70 yearsold. BAEP were performed on both groups in quiet statein 25℃ room with sound insulation. Subjects sat insoft chair, loosen, closed eyes. Cz was referencepoint, A1A2 was record point respectively. Fz wasground electrode. The resistance of electrodes on skinwas less than 5 kΩ. Auditory stimulation wasalternative click sound. Subjective threshold wasexamined first. Those went beyond 60dB were excludedfrom this study. Two ears was given 60dB click oversubjective threshold respectively. We overlapped 1500repeatedly. Two times every side at least. The twobetter overlapping waves were selected and werefiltered, then we marked every wave and measured peaklatency(PL) and interpeak latency(IPL) of Ⅰ Ⅲ Ⅴwith cursor. The data of two group were compared byt test. BEAM was performed in vertebrobasilar systemicTIA patients. BEAM examination used electrode cap withthe machine. It had 21 electrodes laying according tointernational 10/20 systerm. We traced EEG 3 minuteswith the earlobes as reference electrodes, and 30seconds EEG without confusion was input computer toFTT exchange to obtain power ofαβθδ distributionimages.The results were compared with BAEP, and wecombined the patient’s manifestation to analyzed therelationship between the condition and the abnormal<WP=8>6degree of BEAM and BAEP. BEAM and BAEP were performedinstantly after admission. The patients with abnormalresults were checked again after a week’s treatment.We compared the results among control group,pre-treatment and post-treatment vertebrobasilarsystemic TIA group. Measurement data were expressedwith x ±s and dealt with t test. The size of test tooka=0.05.Results: (1) 45 cases were abnormal in 60vertebrobasilar systemic TIA patients. The abnormalrate of BAEP was 75﹪, including 62.2% brainstemtype(28 cases), 15.6% (7 cases) internal ear type and22.2%(10 cases) mixed type. (2) Ⅰ Ⅴ PL,Ⅲ-ⅤIPL andⅢ-Ⅴ/Ⅰ-Ⅲ were increased very significantly invertebrobasilar systemic TIA group as compared withcontrol group(P<0.01). Ⅲ PL,Ⅰ-Ⅴ IPL wereincreased significantly(P<0.05).Ⅰ-ⅢIPL was nosignificance statisticly(P>.05). (3) In the BAEPindexes, the abnormal rate of Ⅲ-Ⅴ/Ⅰ-Ⅲ>1 wasthe highest(48.3%), then was the prolongation of Ⅲ-Ⅴand Ⅰ-Ⅴ IPL. The abnormal rate was 35%,30%respectively. The bad form of Ⅰ Ⅲ Ⅴ wave was morethan PL prolongation and Amp drop. (4) The abnormalrate of BEAM was 80% in vertebrobasilar systemic TIAgroup. BEAM showed power decreased in occipital or/andtemporal area of the α distribution images or/and<WP=9>7power increased in the same area of the θδdistribution images. (5) The abnormal rate in bothBAEP and BEAM was 63.3% (38 cases) in a same patient.Abnormal BEAM accounted for 16.7% (10 cases). Onlyabnormal BAEP accounted for 11.7%(7 cases). NormalBAEP and BEAM accounted for 8.3%(5 cases). (6) Theabnormal rate after seven days therapy in patientswith vertebrobasilar systemic TIA更多还原