后循环缺血概念的提出及神经耳科的对策

1 后循环缺血(poaterior circulation ischemia, PCI)与椎基底动脉供血不足(vertebrobasilar insufficiency,VBI)的认识与现状 后循环又称椎基底动脉系统,由椎动脉、基底动脉和大脑后动脉组成,主要供血给脑干、小脑、丘脑、枕叶、部分颞叶及上段脊髓.内耳的供血也来自这一系统.VBI的提出是基于颈动脉供血不足推论得出的,经典VBI的含义是,大动脉严重狭窄或闭塞引起的血流动力学性低灌注,临床表现为后循环短暂缺血发作(transient ischemia attack,TIA).     

尼莫地平对正常和椎基底动脉供血障碍时耳蜗血流的影响

目的 :探讨尼莫地平对耳蜗血流的影响。方法 :用激光多普勒血流计对 2 2只正常及椎基底动脉供血障碍时豚鼠耳蜗血流测量。结果 :低浓度、临床常用浓度、高浓度的尼莫地平对内耳正常供血状态下或是椎基底动脉供血不足内耳缺血状态下的耳蜗血流均无增加作用。结论 :尼莫地平不能增加耳蜗血流反而降低耳蜗血流 ,在治疗内耳微循环障碍性疾患时应慎用。     

基底动脉与眩晕

通过磁共振血管图（ＭＲＡ）观察前庭小脑功能失调的血管基础，明确椎基底动脉（ＶＢＡ）系统部分动脉供血不足与眩晕、步态不稳、失协调和平衡障碍等功能失调的关系。被研究者年龄为６０～９０岁，以眩晕为主诉，但排除心源性疾病、直立性低血压、心理性因素及原发性耳性眩晕如梅尼埃病、前庭神经炎、听神经瘤和位置性眩晕。ＭＲＡ显示被研究者５０％出现血管形态学或动脉灌注不足的病变，如：椎动脉直接从主动脉弓发出、颈内动脉发出三叉动脉和舌下动脉、左椎动脉缺如伴左颈动脉栓塞、基底动脉狭窄、罕见的基底动脉长扩张（ｄｏｌｉｃｈｅ…     

椎基底动脉供血障碍时耳蜗血流的变化及其调节

为了研究椎基底动脉供血障碍时耳蜗血流的变化及其调节作用，用激光多普勒血流计观察了３１只豚鼠椎基底动脉部分阻断时耳蜗血流及血压变化。其中５只豚鼠观察了罂粟碱及颈上神经节切除对内耳缺血的影响，发现惟基底动脉部分阻断时耳蜗血流明显减少（Ｐ＜０．００１），血压升高（Ｐ＜０．０５）。颈上神经节切除５分钟，耳蜗血流及血压无明显变化文Ｐ＞０．０５）。罂粟碱应用后２０分钟，耳蜗血流明显改善（Ｐ＜０．０００１）。颈上神经节切除后再次给予罂粟碱，耳蜗血流亦有增加，但较单纯应用罂粟碱时低。耳蜗血流与血压两者间无相关性。提示椎基底动脉供血障碍时耳蜗血流减少比较持续而稳定，罂粟碱明显改善豚鼠耳蜗血流说明肌源性调节的作用，而交感神经对内耳血流调节作用微弱。     

椎基底动脉供血不足患者的听性脑干反应特征

对２７例椎基底动脉供血不足无明显听力减退和中度感音神经性聋的患者，分别用短声重复率每秒２０次与４０次两种给声方式做了听性脑干反应（ＡＢＲ）测试，并以１０例正常人对对照。结果短声重复率增加至４０次时，椎基底动脉供血不足患者的ＡＢＲ波潜伏期和波间期延长，有显著性差异，表明此法可作为检测椎基底动脉供血不足的有效辅助手段；而椎基底动脉供血不足者中，听力正常组与听力减退级比较无显著性差异。说明椎基底动脉供血     

补阳还五汤治疗椎———基底动脉供血不足性眩晕的临床研究

椎－基底动脉供血不足性眩瞎患者服用补阳还五汤煎剂３０天，临床总效率达８６．７％，其中愈显率占４６．７％；血液流变学指标有不同程度改善。结果表明，有效率治疗组与对照组比较有显著性差异（Ｐ〈０．０１）；全血粘度及血浆比粘度均有显著差异（Ｐ〈０．０１，Ｐ〈０．０５）。该方治疗椎－基底动脉供血不足性眩晕有明显功效。     

椎基底动脉供血不足性眩晕患者经颅多普勒超声检查

椎基底动脉供血不足性眩晕患者经颅多普勒超声检查王宁宇谷京城华阳凌晨我们应用经颅多普勒超声（ＴＣＤ）对６８例椎基底动脉供血不足（ＶＢＩ）性眩晕患者进行了检查，并与６０例伴有眩晕症状的其它脑血管病患者进行了对比。一、材料和方法１．ＶＢＩ组：临床诊断为ＶＢ...     

经颅多普勒超声对椎基底动脉供血不足性眩晕患者的监测与鉴别

眩晕是一种常见的临床症状，其表现形式多样，病因繁多。其中血管性病变是其主要病因之一。为探讨多普勒超声检查对椎基底动脉供血不足性病人的诊断价值，本文对68例诊断为基底动脉供血不足（verte－brobasilarinsufficiency，VBI）的眩晕病人进行了经颅多普勒（transcranialdoppler，TCD）超声检查和分析，并同60例伴有眩晕症状的其他脑血管病病人进行了对比，报道如下。1材料与方法VBI组：临床诊断为VBI者68例，诊断符合标准[1]。男40例，女28例，年龄23～65岁，其中23～45岁22例，46岁～60岁34例，61岁～65岁12例。眩晕病史从3小时…     

前庭学

供血不足,此种占大多数,少数流速、PI及RI增高;二.脑血管机能紊乱,多见于女性中、青年,可伴有恶心、呕吐、多汗、心悸等,TCD血流速度加快或/及不稳定或/及双侧不对称,推测为植物神经功能紊乱导致血管舒缩机能紊乱引起,三.颈性眩晕,颈椎病由于骨刺等刺激颈交感神经纤维引起血管痉挛,流速加快,TCD可见椎、基底动脉流速加快。当椎动脉穿行横突孔过程中受压则流速减慢。对流速正常临床可疑的患者可行转颈试验确诊。TCD为头晕患者的诊断提供了新的无创手段,根据不同血流动力学改变进行治疗,可观察治疗效果。参2(方都)9515”经烦多普勒超声…     

补阳还五汤治疗椎─基底动脉供血不足性眩晕的临床研究

椎一基底动脉供血不足性眩晕患者服用补阳还五汤煎剂30天，临床总效率达86．7％，其中愈显率占46．7％；血液流变学指标有不同程度改善。结果表明，有效率治疗组与对照组比较有显著性差异（P＜0．01）；全血粘度及血浆比粘度均有显著差异（P＜0．01，P＜0．05）。该方治疗椎一基底动脉供血不足性眩晕有明显功效。     

The effect of prostaglandin E1 on brainstem blood flow disturbance in an animal model of vertebrobasilar insufficiency

Using an animal model of vertebrobasilar insufficiency (VBI), in which brainstem circulatory disturbance was induced in rats, we examined how prostaglandin E₁ (PG-E₁) affects brainstem blood flow (BBF) to clarify whether it is effective against VBI. Fifteen healthy male Wister rats that displayed positive responses to Preyer’s reflex were used. Their BBF was continuously measured on the left side of the midline of the brainstem using laser Doppler flowmetry. A rat model of VBI, a pathological condition that presents with decreased BBF, was prepared by applying a vertebral artery clamp ipsilateral to the BBF measuring site and inducing hypotension of 60–70 mmHg by blood withdrawal. Saline as a control (n = 5), 5 ng/kg/min (n = 5) or 10 ng/kg/min (n = 5) PG-E₁ at a dose was continuously administered to the rats using a motor-driven syringe pump. The effects of the drugs on the rats’ BBF were evaluated. BBF, which was decreased by the unilateral vertebral artery clamping combined with blood withdrawal-induced hypotension, recovered in a dose-dependent manner after the administration of 5 or 10 ng/kg/min PG-E₁, and complete recovery to the baseline level was achieved by 60 min treatment; however, no such effect was observed for intravenous saline. These results suggest that PG-E₁ acts on local vessels and improves blood flow insufficiency in the brainstem in our animal model of VBI. PG-E₁ might be useful as a cerebral vasodilator for VBI.     

169例急性前庭性眩晕的临床研究

目的了解各种急性前庭病(眩晕)的发病情况,重点鉴别急性单发性眩晕中的椎基底动脉供血不足导致的眩晕和偏头痛性眩晕。方法回顾分析169例各种急性前庭病(眩晕)的发病率,重点分析神经耳科学检查在急性单发性眩晕中因椎基底动脉供血不足导致的眩晕和偏头痛性眩晕的鉴别诊断中的作用。结果各种急性前庭病的发病率依次为:梅尼埃病、椎基底动脉供血不足、良性阵发性位置性眩晕、偏头痛伴眩晕、前庭神经炎、突聋伴眩晕和迟发性膜迷路积水、外淋巴漏。椎基底动脉供血不足导致的眩晕和偏头痛性眩晕在病史、神经耳科学检查方面有诸多不同。结论在临床上,椎基底动脉供血不足与偏头痛相关的急性前庭病的鉴别诊断可能是鉴别的重点。鉴别的方法目前主要依靠详细的病史、神经耳科学检查、易患因素的特点以及其它必要的辅助检查。椎基底动脉供血不足更多出现在中年以上,一般都有心-脑血管方面的异常;而偏头痛性眩晕的发病平均年龄明显早于前者,均有一项或几项下列现象:偏头痛家族史,运动敏感,声、光敏感。     

喉部按摩法治疗功能性嗓音障碍的临床研究

目的探讨喉部按摩法在功能性嗓音障碍治疗中的意义。方法对33名功能性嗓音障碍患者进行喉部按摩治疗,比较分析其治疗前后平均言语基频（MSFF）、基频标准差（SD）,基频微扰（Jitter）．振幅微扰（shimmer）、标准化噪声能量（NNE）5个参数的变化和症状改善情况。结果治疗后患者的平均言语基频,基频标准差、基频微扰．振幅微扰与治疗前相比均有极显著性差异（P〈0．01）。并达到正常值范围;而标准化噪声能量与治疗前相比无显著性差异（P〉O．05）。结论喉部按摩法对大多数功能性嗓音障碍有较好疗效;嗓音治疗中应将现代化的客观测量技术与传统治疗手段相结合。     

Magnetic resonance angiography evaluation of basilar artery stenosis in patients with vertebrobasilar insufficiency

To assess the usefulness of evaluating basilar arterial flow by magnetic resonance angiography (MRA), MRA results for patients with vertebrobasilar insufficiency (VBI) were compared with those for age-matched individuals with no vestibular disorders. The presence of stenosis in the basilar artery, its severity and the presence of complications associated with atherosclerosis in the two groups were statistically compared. Analyses revealed significant differences in the incidence of stenosis, its severity, and the incidence of complications between the two groups. These findings suggest that MRA is valuable for the estimation of vertebrobasilar hemodynamics. MRA evaluation of basilar artery stenosis appears to be suitable for identifying a high-risk group among VBI patients, since basilar artery stenosis can result in serious disabilities. Received: 20 January 2000 / Accepted: 23 March 2000     

Rupture of the internal carotid artery pseudoaneurysm resulting from fungal sinusitis

Although vasculitis due to infection with fungi, including Aspergillus, causes aneurysm formation, reports of internal carotid artery aneurysm formation resulting from fungal sinusitis are few. We report on a patient who experienced massive epistaxis from rupture of an internal carotid artery pseudoaneurysm, caused by fungal sinusitis. We treated the aneurysm with endovascular coil embolization, followed by endoscopic sinus surgery to remove the fungal mass. Intraoperative findings included a torn internal carotid artery and exposure of the coil to the sinus. Performing endoscopic sinus surgery before the embolization procedure would have increased the risks of massive intraoperative bleeding and mortality. Even after achieving hemostasis, serious sequelae, such as cerebral infarction, might occur. In this type of case, otorhinolaryngologists and neurosurgeons should collaborate, and an aneurysm should be treated before endoscopic sinus surgery. Although the treatment strategy for fungal internal carotid artery aneurysms is controversial, this case suggested the use of the embolization procedure followed by endoscopic debridement and antifungal therapy to treat a pseudoaneurysm of the internal carotid artery caused by fungal sinusitis.     

The efficiency of magnetic resonance angiography (MRA) in the diagnosis and vertigo--prediction of vertebrobasilar insufficiency (VBI) and atherosclerosis]

Major causes of vertigo in patients who attend Otolaryngology clinics are peripheral vestibular disorders (PVD) and vertebrobasilar insufficiency (VBI). The purpose of this study was to see whether MRA findings can distinguish VBI from PVD to evaluate the efficiency of MRA in the diagnosis of vertigo. A total of 185 vertigo patients were examined by MRA with the 3D-Phase Contrast method. Three kinds of abnormalities of vessels, that is, (a) disappearance, (b) meandering, and (c) stoppage were found in MRA imaging. Therefore, we classified the MRA patterns into four types with two subtypes: type I; normal, type II-R; right hypoform of the vertebral artery, II-L; left hypoform of the vertebral artery, III; meandering form of the vertebrobasilar artery, IV-1; stoppage form of the basilar artery, IV-2; hypoform of the bilateral vertebral and basilar arteries. Diagnosis of the MRA patterns in each patient was camed out by a radiologist and neurosurgeon with the cooperation of an otolaryngologist. In 185 vertigo patients, 139 patients were clinically diagnosed as having PVD, 41 patients as having VBI, and 5 patients as having cerebellar and brainstem infarctions. The numbers of patients in MRA patterns I, II-R, II-L, III and IV were 140, 17, 12, 8, and 8 cases, respectively. The total number of VBI patients who demonstrated type III or IV patterns in MRA was significantly higher than that of type I, II-R and II-L (P < 0.005). All of the 8 cases with cerebellar and brainstem infarction belonged to type IV. Cerebral angiography was performed in nine cases with type II-R, II-L, III or IV-1, and the number of patients in each group was 3, 3, 1 and 2 cases, respectively. All of the type II-R and II-L cases revealed hypoform of the vertebral artery. The appearance of type III was restricted to type III's view was only meandering and type IV-1 showed severe stenotic changes in the union area. These data show that MRA findings in the diagnosis of vertigo patients are very effective in distinguishing VBI and cerebellar and brainstem infarction from PVD and that some pattern of MRA may correspond to atherosclerosis of the vertebrobasilar artery. We think MRA examination of vertigo patients is useful not only to assist in the diagnosis of the etiology but also to predict the stage of atherosclerosis in each patient.     

Effect of a glutamate blocker, ipenoxazone hydrochloride on the hypoxia-induced firing in the medial vestibular nucleus

To elucidate the effectiveness of the drug in the treatment of vertebrobasilar insufficiency (VBI), we performed an electrophysiological study to examine the effects of ipenoxazone hydrochloride, a glutamate blocker, on hypoxia-induced firing in the medial vestibular nucleus (MVN) neuron, using alpha-chloralose-anesthetized cats. The single neuronal activity of the MVN was recorded extracellularly with a glass-insulated silver wire microelectrode attached along a seven-barrel micropipette. The firing rate of MVN neurons showed a transient increase [hypoxic depolarization (HD)] during 5% O(2) inhalation, followed by a gradual decrease and disappearance. HD and the time to disappearance of firing induced by hypoxia were inhibited by iontophoretic application of ipenoxazone hydrochloride. These results suggest that ipenoxazone hydrochloride protects against hypoxic neuronal dysfunction, and may be an effective drug for vertigo caused by VBI.     

助听器配戴者音调、音质异常干预的个案研究

目的本研究通过对音调异常的测量和实时矫治,探索男声女调的有效矫治方法。方法采用喉部按摩、降调训练、哈欠叹息法、重读治疗法等方法进行矫治,每周一次,并在矫治前后对其音调和音质进行测量,监控对比疗效。采用单一被试法进行统计分析。结果经过两个月的矫治,患者的音调降至成年男性正常范围,音质恢复正常。结论本矫治方法是有效的,不仅能大大降低男声女调患者的音调,而且可以改善其音质的异常;可以将喉部按摩和发声训练的方法相结合,对男声女调患者进行综合治疗。     

悬雍垂腭咽成形术后持续正压通气治疗

观察悬雍垂腭咽成形术（ｕｖｕｌｏｐｌａｔｏｐｈａｒｙｇｏｐｌａｓｔｙ,ＵＰＰＰ）后疗效不佳的阻塞性睡眠呼吸暂停综合征（ｏｂｓｔｒｕｃｔｉｖｅｓｌｅｅｐａｐｎｅａｓｙｎｄｒｏｍｅ,ＯＳＡＳ）患者为手术组行持续正压通气（ｃｏｎｔｎｕｏｕｓｐｏｓｉｔｉｖｅａｉｒｗａｙｐｒｅｓｓｕｒｅ,ＣＰＡＰ）治疗的效果。方法１５例ＵＰＰＰ术后呼吸暂停低通气指数（ａｐｎｏｅａ－ｈｙｐｏｎｏｅａｉｎｄｅｘ,ＡＨＩ）仍大于     

鼠神经生长因子治疗视网膜色素变性的临床观察

目的 观察鼠神经生长因子（mNGF）治疗视网膜色素变性（RP）的临床效果。方法 对RP患者22例44眼给予mNGF肌肉注射治疗,观察治疗前后的最佳矫正视力、视野、三种视觉电生理指标（EOG、F-ERG、P-VEP）改变。结果 治疗后绝大多数病例中心视力提高、视野改善。暗适应F-ERG呈熄灭型的眼数减少（P<0.05）,非熄灭型者波幅升高、潜时缩短。用棋盘格翻转法刺激全视野,可记录到P-VEP波形的眼数增加（P<0.05）,P100振幅升高（P<0.05）、潜时缩短。EOG曲线变得起伏,Arden比值和Gliem比值升高（P<0.05）。治疗过程无并发症发生。结论 肌肉注射鼠神经生长因子治疗RP有效、可行。