经颅多普勒联合脑干听觉诱发电位对老年眩晕患者的病因诊断价值

目的 探讨经颅多普勒（TCD）联合脑干听觉诱发电位（BAEP）对老年眩晕患者的病因诊断价值.方法 选取50例临床确诊为眩晕的老年患者作为眩晕组;同期门诊就诊的48例无眩晕发作史、无神经系统定位体征,包括头痛、周围神经病、睡眠障碍等的老年患者作为对照组.眩晕组患者在发作间歇期同时进行BAEP、TCD检查.TCD颅外探测双侧锁骨下动脉（SUBA）、颈总动脉、颈内动脉、颈外动脉,颅内检测双侧大脑中动脉（MCA）、大脑前动脉（ACA）、大脑后动脉（PCA）,双侧椎动脉、基底动脉,双侧眼动脉（OA）、颈内动脉虹吸段（SCA）.自动记录收缩峰值血流速度（Vs）、舒张期血流速度（Vd）、平均血流速度（Vm）、脉动指数、阻力指数.BAEP测量参数：Ⅰ、Ⅲ、Ⅴ各波的波幅、峰潜伏期,Ⅰ～Ⅲ、Ⅲ～Ⅴ、Ⅰ～Ⅴ峰间潜伏期.记录所有试验数据并与对照组进行比较.结果 TCD检查结果：眩晕组TCD异常40例（80.0％）;其中一侧椎动脉狭窄21例,基底动脉狭窄6例,双侧椎动脉狭窄4例,一侧椎动脉合并基底动脉狭窄2例,前循环血管狭窄致基底动脉代偿1例,一侧椎动脉发育不良6例.对照组,异常12例（25.0％）;其中一侧椎动脉狭窄7例,基底动脉狭窄2例,一侧椎动脉合并基底动脉狭窄2例,一侧椎动脉发育不良1例.BAEP检查结果眩晕组异常患者为42例（84.0％）,主要表现为Ⅴ波峰潜伏期延长及Ⅲ～Ⅴ波峰间潜伏期延长;其中脑干型为25例、内耳型8例、混合型9例.对照组BAEP异常18例,占37.5％,主要表现为Ⅰ波及Ⅲ波峰潜伏期延长;其中脑干型为2例、内耳型10例、混合型6例.2组间患者检查异常率差异有统计学意义（P＜0.05）.结论 BAEP联合TCD检测有利于老年眩晕患者的病因诊断,有利于后循环缺血的诊断.

Etiological diagnosis of vertigo in elderly patients with transcranial cerebral doppler and brainstem auditory evoked potential

Objective To inverstigate the etiological diagnosis value of transcranial cerebral doppler （TCD） and brainstem auditory evoked potential（BAEP） in the elderly vertigo suffers.Methods Totally 50 cases of elderly patients with clinical diagnosis of vertigo as vertigo group were enrolled ; there were 48 cases elderly patients without history of vertigo,neurological signs including headache,peripheral neuropathy and sleep disorders.The extracranial arteries including both sides of common carotid artery,internal carotid artery,external carotid artery and subclavian artery（SUBA） were detected by TCD; the date of Vm,Vs,Vd,pulse index,resistance index were recorded.The data of BAEP including the altitude and peak latency of wave Ⅰ,Ⅲ,Ⅴ and the interpeak latency of wave Ⅰ-Ⅲ,Ⅲ-Ⅴ,Ⅰ-Ⅴ was recorded.Results The abnormal rate of TCD and BAEP was 80.0%（40/50） and 84.0% （42/50） in the vertigo group ; the abnormal rate of TCD and BAEP was 25.0% （12/48） and 37.5% （18/48） in the control group.There were 21 patients with one vertebral artery（VA） stenosis,6 patients with basilar artery（BA） stenosis,4 patients with both sides VA stenosis,2 patients with 1 VA and BA stenosis,1 patient with anterior circulation artery stenosis and BA compensation.There were 7 patients with 1 VA stenosis,2 patients with BA stenosis,2 patients with 1 VA and BA stenosis,1 patient with 1 vertebral artery hypoplasia in the control group.The abnormalty of BAEP mainly showed the prolonging peak latency of wave V and the prolonging of interpeak latency of wave Ⅲ-Ⅴ.There were 25 patients with brain stem type,8 patients with 1 nner-ear type,9 patients with mixed type in the vertigo group.There were 2 patients with nrain stem type,10 patients with inner-ear type and 3 patients with mixed type.The difference between two groups was statistical significant （P 〈0.05）.Conclusion The joint inspection of TCD and BAEP helps the etiological diagnosis of elderly vertigo suffers including posterior circulation isch