59例听神经瘤患者脑干听觉诱发电位分析

目的 分析听神经瘤(acoustic neuroma,AN)患者的脑干听觉诱发电位的变化特征及健侧耳峰间期改变.方法 对59例听神经瘤(AN)患者进行脑干听觉诱发电位(BAEP)检测,测定Ⅰ、Ⅲ、Ⅴ波潜伏期(PL)、峰间期(IPL),双耳PL、IPL之间差值(ILD)等数值.结合MRI、CT影象学资料进行分析,并与36例健康者对照.结果 AN组与正常对照组BAEP各波PL、IPL测值比较差异有极显著性(P＜0.01).AN患侧BAEP异常率98.3%(58/59);主要表现:①Ⅰ、Ⅲ、Ⅴ波缺失;②Ⅲ、Ⅴ波PL延长;③Ⅰ～Ⅲ、Ⅲ～Ⅴ、Ⅰ～Ⅴ波IPL延长.AN患者健侧BAEP的异常率69.5%(41/59),主要表现:①Ⅴ波PL延长;②Ⅲ～Ⅴ及Ⅰ～Ⅴ波IPL延长;③Ⅲ～Ⅴ/Ⅰ～Ⅲ波IPL比值＞1.肿瘤直径＞2cm,BAEP的异常率有显著提高.不同大小肿瘤组间健侧BAEP测值比较:健侧Ⅴ波PL差异有显著性(P＜0.05),Ⅲ～Ⅴ及Ⅰ～ⅤIPL差异有极显著性(P＜0.01).结论 BAEP对AN诊断具有重要意义,它为病变提供了定位诊断依据,尤其健侧Ⅲ～Ⅴ/Ⅰ～Ⅲ波IPL比值异常,是脑干受压的敏感指标.     

影响听神经鞘瘤术后有效听力的因素分析

目的分析听神经鞘瘤显微术后影响有效听力的因素。方法 47例听神经鞘瘤在术中听力监护下行枕下乙状窦后入路显微切除术。记录肿瘤的大小、术前听力、肿瘤存内听道的充满程度以及肿瘤与听神经的粘连程度。结果肿瘤均全切,听神经解剖保留75．7％,47例病人有效听力保留率为21．2％。肿瘤直径≤15 mm的28例中有效听力保留率为32．2％,肿瘤直径≥16 mm的19例中有效听力保留率为5．3％。在25例病人中,影像资料显示16例内听道被肿瘤完全充满者有效听力保留率为25％,9例内听道部分充满者有效听力保留率为44．4％。28例肿瘤直径≤15 mm的病人中,16例术前听力为Ⅰ级者术后有效听力保留率为37．5％,12例Ⅱ级以上者(包括Ⅱ级)术后有效听力保留率为 25％。肿瘤大小与内听道充满程度可作为术后有效听力独立影响因素(P<0．001,P=0．027)。而术前听力无统计学意义(P=0．233)。结论肿瘤不完全充满内听道以及其直径小于15 mm有利于有效听力保留,良好的术前听力似乎更有利于有效听力保留,但却没有统计学意义。肿瘤与听神经没有完整界面, 这一点会影响术后有效听力的保留。     

听神经鞘瘤显微手术治疗63例

目的总结听神经鞘瘤手术切除的经验,为进一步提高肿瘤全切率和面、听神经保留率,预防并发症和降低死亡率。方法回顾性分析枕下-乙状窦后入路63例听神经鞘瘤显微手术,并对手术要点、肿瘤大小与肿瘤全切率和面、听神经保留率之间的关系进行了讨论。结果12例小于2cm的肿瘤均全切;29例2~4cm的肿瘤,全切23例;22例大于4cm的肿瘤,仅12例全切。肿瘤全切除率74.6%(47/63),面神经解剖保留率58.7%(37/63),功能恢复率50.8%(32/63),术前有听力者听神经保留率46.4%(13/28),本组死亡一例,死亡率1.6%。结论肿瘤大小与肿瘤全切率及面、听神经保留率密切相关,熟练的显微手术技巧和手术前后正确处理是保留面神经及降低死亡率的关键。     

听神经瘤显微手术治疗的体会

目的总结38例听神经瘤显微手术切除的体会及并发症的防治,以提高患者的疗效和术后生存质量。方法回顾性分析38例听神经瘤患者的临床资料。结果肿瘤全切32例(84.21%),次全切6例(15.79%),术后面神经保留33例(86.84%),听神经保留10例(26.32%),2例听力有所改善(5.26%),无死亡病例。结论听神经瘤大小与肿瘤全切除及面听神经保留等密切相关。熟练掌握显微解剖结构及娴熟细致的显微手术操作,积极预防术后并发症是提高听神经瘤手术效果的关键。     

3DSlicer软件弥散张量成像纤维束追踪技术在听神经瘤手术中的应用

目的评价3DSlicer软件进行弥散张量成像纤维束追踪在听神经瘤术中的应用价值,探索一种有效的辅助听神经瘤术中保护面神经功能的方法。方法随机选取2020年3月至2020年8月河北医科大学神经外科收治的听神经瘤患者43例按患者志愿分为观察组(21例)与对照组(22例),观察组患者术前完善FIESTA、DTI等影像学检查,并利用3DSlicer软件重建肿瘤与面神经纤维并预判肿瘤与面神经的位置关系,术中联合神经电生理检测辅助听神经瘤手术切除,并记录术中面神经的实际位置;对照组仅利用神经电生理检测辅助定位面神经走行来指导手术完成。计算术前重建面神经位置与术中实际情况的符合率;比较两组患者术后1 w面神经功能(House-Brackmann标准)与听力保留率的差异。结果利用3DSlicer软件弥散张量成像纤维束追踪技术为观察组21例听神经患者重建面神经成功20例,重建失败1例;20例患者中17例术前重建的面神经位置与其术中实际位置一致,符合率为85%;观察组患者术后1 w面神经功能明显优于对照组(P0.05),听力保留率也高于对照组(P0.05)。结论应用3DSlicer软件弥散张量成像纤维束追踪技术可有效辅助听神经瘤术中面神经的精准定位,有利于术中寻找与保护面神经,提高听神经瘤患者术后面神经的功能保留率和听力保留率。     

囊性听神经瘤显微手术治疗:36例报告

目的探讨经枕下乙状窦后入路开颅囊性听神经鞘瘤的肿瘤全切率,面、听神经保留率。方法 2002年8月至2009年7月对36例经枕下乙状窦后入路开颅囊性听神经鞘瘤手术进行系统回顾,同时对33例患者以信函或复诊两种方式进行了术后随访,并对结果进行统计学分析。结果囊性听神经鞘瘤手术全切率为64%(23例),次全切除率为25%(9例),部分切除率为11%(4例),面神经解剖保留27例(75%),功能保留5例,听神经解剖保留2例(5.6%),功能保留2例,较实质性肿瘤全切率及面、听神经保留率明显降低。结论应把囊性听神经鞘瘤作为一种特殊类型来处理。     

听神经瘤显微手术保留听神经功能及影响因素分析

目的　探讨听神经瘤显微手术保留听神经功能及其影响因素。方法　收集我院近 2年来 2 3例经枕下乙状窦后入路显微手术的初发听神经瘤资料 ,其中包括肿瘤大小、术前术后听力、肿瘤内听道底侵蚀及术后小脑损伤情况。结果　耳蜗神经解剖保留 1 9例 ,保留有效听力 2例 (占术前存在有效听力患者的 33 3 % ) ,有效听力丧失保留可测听力 1 0例。听力的保留与肿瘤大小、术前听力水平、肿瘤内听道底侵蚀、小脑损伤相关。结论　肿瘤的大小、术前听力水平、肿瘤内听道底侵蚀和小脑损伤是听神经瘤术后听神经功能保留的影响因素。     

脑干听觉诱发电位（BAEP）对听神经瘤筛选诊断的临床意义

520例具有Ⅷ颅神经症状和患有神经纤维瘤病的患者接受了BAEP筛选检查,49例BAEP异常,提示为CPA病变,其中43例经CT程序检查,40例被诊断为CPA占位性病变。经手术和病理证实,4例是小型AN(≤2cm),29例为大、中型,7例CPA其它肿瘤。小型AN(最小的仅0.3cm)被及时手术,获得良好的疗效。 文章阐述了AN的BAEP异常表现,制定出AN的BAEP诊断标准。本组的CPA肿瘤的阳性率为100％,假阳性率为4.7％,无一例假阴性,从而说明BAEP是筛选诊断AN的最佳方法。     

76例听神经瘤手术的面、听神经保护

目的 探讨听神经瘤手术中面、听神经的保护方法及手术技巧.方法 76例首发听神经瘤患者,行枕下-乙状窦后入路显微手术切除,术中行神经电生理监测及药物保护(尼莫地平),分别于术前、术后1周及1年行面神经HB功能分级评估及听力评估.结果 76例患者中,肿瘤全切71例(93%),面神经解剖保留74例(97%),听神经解剖保留16例(21%).术后1周面神经功能评估,Ⅰ级25例,Ⅱ级32例,Ⅲ级11例,Ⅳ级4例,Ⅴ级2例,Ⅵ级2例.术后1年面神经功能评估,Ⅰ级37例,Ⅱ级24例,Ⅲ级9例,Ⅳ级3例,Ⅴ级1例,Ⅵ级2例.术后1年时听力保留者16例,占21%.结论 听神经瘤手术中进行面神经电生理监测、药物治疗及娴熟的显微外科技巧是面、听神经功能保护的关键.     

听神经瘤瘤体大小对患者术后面神经功能的影响

目的探讨听神经瘤瘤体大小对患者术后面神经功能(H-B)的影响。方法对2011-01—2013-12在面肌肌电图和耳蜗神经监测下,经乙状窦后入路显微手术切除的118例大型听神经瘤手术患者进行回顾性分析,依据听神经瘤瘤体直径分为30mm组、30~39mm组、40~49mm组和≥50mm组,比较不同组别面神经功能情况。结果本组患者中,面神经功能总体优秀率为89.8%(106/118),其中在瘤体30mm患者中,分别有3例患者面神经功能分级为H-BI和H-BⅡ,面神经功能优秀率到达100%。瘤体直径30~39 mm组、40~49 mm组和≥50 mm组患者面神经功能优秀率分别为96.7%、91.1%和80.5%。与瘤体直径30~39 mm的患者比较,瘤体直径≥50 mm的患者听力功能显著减弱(χ2=5.241,P=0.022)。进一步的相关分析提示,随着听神经瘤瘤体直径的增大,患者远期听神经功能呈下降趋势(P=0.001)。结论听神经瘤瘤体大小与患者术后面神经功能密切相关,是影响患者术后远期面神经功能的重要因素之一。     

脑创伤后长期意识障碍患者脑干听觉诱发电位表现与预后清醒的关系

目的 探讨重型创伤性颅脑损伤(TBI)后长期意识障碍患者脑干听觉诱发电位(BAEP)表现与预后清醒的关系.方法 分析63例重型TBI后意识障碍超过2周患者的BAEP表现,主要为BAEP中Ⅰ、Ⅲ、Ⅴ波各波峰潜伏期(PL),Ⅰ～Ⅲ、Ⅲ～Ⅴ波峰间潜伏期(IPL)及Ⅰ波与Ⅴ波波幅比.预后以TBI后6个月患者是否清醒为标准,分为清醒组与未清醒组,组间运用两独立样本t检验以筛选出有意义的指标.结果 本组患者清醒率为34.9%(22/63),BAEP指标异常率为66.7%(42/63).双侧Ⅰ、Ⅲ、Ⅴ波PL,Ⅰ～Ⅲ波、Ⅲ～Ⅴ波IPL及Ⅰ/Ⅴ波幅比均正常的21例中有16例清醒(清醒率为76.2%),双侧Ⅴ波PL异常的8例及双侧Ⅲ～Ⅴ波IPL异常的7例均未清醒,单侧Ⅴ波消失的2例未清醒.清醒组与未清醒组间比较发现双侧差异均有统计学意义的指标为Ⅴ波PL及Ⅲ～Ⅴ波IPL.结论 BAEP的Ⅴ波PL及Ⅲ～Ⅴ波IPL变化可客观、准确地反映脑损伤的程度及预测患者的预后.

Abstract：

Objective To explore the correlation between brainstem auditory evoked potential (BAEP) findings and outcome in long-term unconscious patients with severe traumatic brain injury (TBI).Methods BAEP findings were recorded and analyzed in 63 patients suffering from severe TBI with duration of disturbance of unconsciousness for more than 2 weeks. The peak latency (PL) of wave Ⅰ, Ⅲ and Ⅴ, the interpeak latency (IPL) of wave Ⅰ-Ⅲ and Ⅲ-Ⅴ and the amplitude ratio of wave Ⅰ and Ⅴ were analyzed. Conscious or unconscious at 6 months after the injury was considered as the outcome criterion,and based on these, the patients were divided into conscious and unconscious groups; the significant indicators were chosen in the 2 groups using independent-sample t test. Results The probabilities of awakening in these patients were 34.9% (22/63) with abnormal index of BAEP indicators reaching 66.7%. Sixteen patients were sober at last in 21 patients with normal PL of wave Ⅰ, Ⅲ and Ⅴ, IPL of wave Ⅰ-Ⅲ and Ⅲ-Ⅴ, and amplitude ratio of wave Ⅰ and Ⅴ in bilateral side (the probabilities of awakening were 76.2%); 8 patients having abnormal PL of wave Ⅴ in bilateral side and 7 having abnormal IPL of wave Ⅲ-Ⅴ in bilateral side were unconscious; 2 patients having disappeared wave Ⅴ in unilateral side were unconscious. PL of wave Ⅴ and IPL of wave Ⅲ-Ⅴ in bilateral side were significantly different between the conscious group and the unconscious group. (P＜0.05). Conclusion BAEP findings (PL of wave Ⅴ and IPL of wave Ⅲ-Ⅴ in bilateral side) can objectively and accurately demonstrate the cerebral dysfunction and predict the outcome of the patients.     

前庭阵发症脑干听觉诱发电位的特点

目的探讨前庭阵发症(VP)脑干听觉诱发电位(BAEP)的特点。方法对51例VP患者的BAEP结果进行回顾性分析。结果 BAEP异常者40例,异常率为78.4%。与Ⅰ-Ⅲ波峰间期正常的患者相比,Ⅰ-Ⅲ波峰间期延长的患者男性比例高(χ2=4.763,P=0.029),病程显著延长(t=2.469,P=0.021),而平均年龄差异无统计学意义。与Ⅲ-Ⅴ波峰间期正常的患者比较,Ⅲ-Ⅴ波峰间期延长的患者男性比例、平均病程、平均年龄差异均无统计学意义。与Ⅰ-Ⅲ波峰间期耳间差正常的患者比较,Ⅰ-Ⅲ波峰间期耳间差延长的患者病程相对较长(P=0.055),男性有增多趋势(P=0.058),但差异无统计学意义。结论 VP患者BAEP异常以Ⅰ-Ⅲ波峰间期延长为主,且以男性更多见。病程越长,蜗神经越易受累。     

脑干听觉诱发电位分级对脑创伤长期意识障碍患者清醒预测的价值

目的 探讨脑干听觉诱发电位(BAEP)分级标准对脑创伤后长期意识障碍患者清醒预测的价值.方法 分析93例脑创伤后长期意识障碍患者的BAEP表现,将BAEP分为3级:Ⅰ级为各波均正常;Ⅲ级为双侧V波PL异常、双侧Ⅲ～Ⅴ波IPL异常、单侧或双侧V波消失;Ⅱ级为除Ⅲ级之外的任何异常BAEP表现.以脑创伤后6个月作为判断是否清醒的时间标准.结果 Ⅰ级、Ⅱ级、Ⅲ级的清醒率分别为:79％、18％和0％.分级与清醒差异有统计学意义(r=-0.662,P＜0.001),分级越高,清醒越困难.BAEP分级标准对清醒预测的ROC曲线下面积为0.859,95％可信区间为(0.781～0.937).结论 BAEP分级能客观、准确地反映脑功能损伤程度和预测清醒的概率.     

大鼠脑桥、中脑电损伤后脑干听觉诱发电位的敏感性研究

目的 探讨大鼠脑桥、中脑电损伤后脑干听觉诱发电位(BAEP)的敏感指标.方法 SD大鼠80只,分别于左侧脑桥面丘和中脑上下丘之间深部给予电损伤,按照电流刺激量的不同各分为小剂量组(1 mA)、中剂量组(3 mA)、高剂量组(6 mA)、对照组(0 mA),每组10只,记录和比较各组电损伤前后的BAEP各指标的变化.每组取2只行病理学检查.结果 电损伤后,脑组织均有不同程度的神经元坏死等改变,损伤程度随电流量加大而增加.脑桥小剂量组BAEP的V波的PL、Ⅲ～Ⅴ、Ⅰ～Ⅴ波IPL延长,中剂量组的Ⅲ、V波的PL、Ⅰ～Ⅲ、Ⅲ～Ⅴ、Ⅰ～Ⅴ波IPL延长,高剂量组的Ⅲ、Ⅴ波的PL、Ⅰ～Ⅲ、Ⅲ～Ⅴ、Ⅰ～Ⅴ波IPL延长,伴Ⅲ、Ⅴ波的波幅下降;中脑中剂量组、高剂量组V波PL延长,Ⅰ～Ⅴ、Ⅲ～Ⅴ波IPL延长,损伤前后的差值与对照组比较,有统计学意义.结论 (1)BAEP的Ⅴ波PL可能为反映脑桥和中脑损伤的敏感指标;(2)BAEP反映中脑损伤不如脑桥敏感.

Abstract：

Objective To explore the sensitive indexes of brainstem auditory evoked potentials(BAEP)in rats exposed to electric injury in the pons and the midbrains.Methods The pones and midbrains of 80 rats were electric injured beneath the left facial colliculus and quadrigeminal bodies.In the pone group or the midbrain group,the animals were further divided into 4 groups:controls(0 mA),low (1 mA),middle(3 mA)and high electric current(6 mA)respectively,according to the amount of electrical stimulation.The indexes of BAEP were recorded and analyzed before and after injury.Results It was shown that electric injury resulted in neuronal necrosis,the extent of which tended to be designated as much more severe according to the amount of electrical stimulation.In the pone groups,the peak lantency(PL)of waves Ⅴ and the interpeak lantency(IPL)of waves Ⅰ～Ⅴ,Ⅲ～Ⅴ were prolonged at low electric current. However,the PL of waves Ⅲ,Ⅴ and the IPL of waves Ⅰ～Ⅲ,Ⅲ～Ⅴ,Ⅰ～Ⅴ were prolonged at middle and high electric current,and the amplitudes of waves V were decreased at high electric current significantly compared with the controls.In the midbrain groups,the PL of waves Vand the IPL of waves Ⅲ～Ⅴ,Ⅰ～Ⅴ at middle and high electric current were prolonged significantly compared with the controls.Conclusions The peak lantency of the waves V may be the most sensitive indexes of BAEP as to the pons and midbrains injured,but the changes of BAEP is less sensitive in midbrain than in pons.     

Characteristics of brainstem auditory evoked potential of neonates with mild or moderate hyperbilirubinemia

BACKGROUND: Brainstem auditory evoked potential (BAEP) has been widely used to evaluate the functional integrity and development of injured auditory system and brain, especially to objectively evaluate the function of auditory system and brain stem of very young babies, such as neonates and sick babies. OBJECTIVE: To observe the changes of BAEP of neonates with hyperbilirubinemia, and to investigate the relationship of bilirubin concentration and BAEP. DESIGN: An observation experiment. SETTING: Department of Pediatrics, the 309 Clinical Division, General Hospital of Chinese PLA. PARTICIPANTS: Fifty-eight neonates with mild or moderate hyperbilirubinemia exhibiting jaundice within 24 hours after born, who received the treatment in the Department of Pediatrics, the 309 Clinical Division, General Hospital of Chinese PLA between January 2004 and May 2007, were recruited in this study. The involved neonates, 31 boys and 27 girls, had gestational age of 37 to 46 weeks. They had no history of birth asphyxia, and were scored 8 to 10 points when born. Written informed consents of examination and treatment were obtained from the guardians of the neonates. This study was approved by the Hospital Ethics Committee. According to serum total bilirubin value, the neonates were assigned into 3 groups: low-concentration bilirubin group (n =16), moderate-concentration bilirubin group (n =27) and high-concentration bilirubin group (n =15). According to mean daily bilirubin increase, the subjects were sub-assigned into bilirubin rapid increase group (n =39) and bilirubin slow increase group (n =19). METHODS: After admission, all the neonates received drug treatment. Meanwhile, their 116 ears were examined with a myoelectricity evoked potential equipment (KEYPOINT) in latency, wave duration, amplitude and wave shape differentiation of each wave of BAEP. BAEP abnormal type was observed and abnormal rate of BAEP was calculated. MAIN OUTCOME MEASURES: ① Abnormal rate and abnormal type of BAEP. ② Latency of waves Ⅰ, Ⅲ　and Ⅴ, and wave duration of waves Ⅰ to Ⅲ, Ⅲ to Ⅴ, and Ⅰ to Ⅴ. RESULTS: Fifty-eight neonates with mild or moderate hyperbilirubinemia were involved in the final analysis. ①Abnormal type and abnormal rate of BAEP of neonates with hyperbilirubinemia: Among the 116 ears, unilateral or bilateral waves Ⅰ, Ⅲ, Ⅴ still existed. The latency of waves Ⅰ, Ⅲ and Ⅴ was +2.5 s longer than the normal level in 8, 4 and 15 ears, respectively. The wave duration of waves Ⅰ to Ⅲ and waves Ⅲ to Ⅴ was +2.5 s longer than the normal level in 6 and 14 ears, respectively. The wave duration of waves Ⅲ to Ⅴ was longer than that of ipsilateral waves Ⅰ to Ⅲ in 24 ears. The latency difference of wave Ⅴ between two ears was larger than 0.4 ms in 31 neonates with hyperbilirubinemia; The amplitude of wave Ⅴ to that of ipsilateral wave I was lower than 0.5 in 29 neonates. Totally 52 ears were abnormal, and the abnormal rate was 44.8%. One to two months later, 98% abnormal neonates with hyperbilirubinemia recovered. The abnormal rate in the low-, moderate-, and high-concentration bilirubin groups was 37.5%, 44.4% and 53.3%, respectively. ② Comparison of latency and wave duration of each wave of BAEP: Latency of waves Ⅰ, Ⅲ and Ⅴ, and wave duration of waves Ⅰ to Ⅲ and Ⅲ to Ⅴ were gradually prolonged in low-, moderate-, and high-concentration bilirubin groups, but significant difference did not exist between two groups (P > 0.05). ③ There were no significant differences in latency of waves Ⅰ, Ⅲ and Ⅴ, and wave duration of waves Ⅰ to Ⅲ, Ⅲ to Ⅴ and Ⅰ to Ⅴ between bilirubin rapid increase group and bilirubin slow increase group (P > 0.05). CONCLUSION: Auditory acuity and brainstem of neonates with mild or moderate hyperbilirubinemia are damaged to some extent. High-concentration bilirubin causes BAEP abnormality easily. Bilirubin increase and its concentration change are not consistent with nervous lesion degree.     

神经电生理监测桥小脑角手术的研究(附106例报告)

目的探讨桥小脑角(CPA)手术中行神经电生理监测的意义。方法对106例CPA肿瘤病人进行了术中神经电生理监测,主要包括面神经、三叉神经、后组颅神经以及健侧脑干听觉诱发电位(BAEP)监测,观察术后面神经功能及并发症。结果面神经解剖保留96例(91%),面神经功能Ⅰ、Ⅱ级57例(54%),Ⅲ、Ⅳ级42例(40%),Ⅴ、Ⅵ级7例(6%)。术中健侧BAEP变化最明显的是Ⅲ～Ⅴ、Ⅰ～Ⅴ峰间潜伏期。结论在CPA手术中,采用诱发电位、肌电图实时监测,可及时为术者提供脑干功能的情况;术中健侧BAEP的Ⅰ～Ⅴ、Ⅲ～Ⅴ峰间潜伏期是重要监测指标;术中肌电图监测可以提示颅神经的位置和走行,为手术时避免损伤神经提供依据。     

脑干听觉诱发电位在后循环脑梗死中的临床应用价值研究

目的 通过分析急性和慢性后循环脑梗死患者脑干听觉诱发电位变化特点,探讨脑干听觉诱发电 位（brainstem auditory evoked potential,BAEP）在后循环脑梗死早期识别和诊断方面的临床应用价值。 方法 选择2018年8月-2019年3月在上海第六人民医院神经内科就诊的后循环脑梗死患者为研究 对象,分为急性脑梗死组和慢性脑梗死组,同时设立健康对照组。比较3组BAEP的Ⅰ、Ⅲ、Ⅴ各波峰 潜伏期（peak latency,PL）,Ⅰ～Ⅲ波、Ⅲ～Ⅴ波和Ⅰ～Ⅴ波峰间潜伏期（interpeak latency,IPL）,Ⅲ～Ⅴ波 /Ⅰ～Ⅲ波I PL的比值等指标的特点。 结果 研究共入组急性脑梗死组患者36例,慢性脑梗死组32例,健康对照组32例。急性脑梗死组 Ⅲ波、Ⅴ波PL较慢性脑梗死组（P＜0.001、P =0.005）和对照组（均为P＜0.001）均延长;慢性脑梗死组 Ⅴ波PL较对照组延长（P＜0.001）。急性脑梗死组Ⅰ～Ⅲ波、Ⅰ～Ⅴ波I PL较慢性脑梗死组延长（P＜0.001、 P =0.029）;急性脑梗死组Ⅰ～Ⅲ波（P＜0.001）、Ⅲ～Ⅴ波（P =0.006）和Ⅰ～Ⅴ波（P＜0.001）IPL较对照 组延长;慢性脑梗死组Ⅲ～Ⅴ波I PL（P =0.003）较对照组延长。慢性脑梗死组Ⅲ～Ⅴ/Ⅰ～Ⅲ波IPL比值 异常者有9例（25.0%）,急性脑梗死组2例（6.3%）,两组差异有统计学意义（P =0.001）。 结论 ①BAEP检查能灵敏地检测出急性和慢性后循环脑梗死患者的听觉感觉通路的电生理异常。 ②急性脑梗死患者BAEP的Ⅲ波和Ⅴ波PL、Ⅰ～Ⅲ波和Ⅰ～Ⅴ波IPL均显著延长,以Ⅲ波PL、Ⅰ～Ⅲ波IPL延 长为主;慢性脑梗死患者BAEP以Ⅴ波PL、Ⅲ～Ⅴ波IPL的延长为主。     

听神经瘤术中面部肌肉肌电图及BAEP的监测与面听神经功能保留：400例临床研究

目的总结听神经瘤术中监测面部肌肉自发与诱发肌电图和脑干听觉诱发电位（BAEP）的经验,分析术中面、听神经解剖功能保留的方法及影响因素。方法使用美国Nicolet公司生产的Viking—Ⅳ型和Axon公司的Epoch XP型多导术中监测仪,对收治的400例听神经瘤患者进行了术中监测面部肌肉自发与诱发肌电图和BAEP。手术切除肿瘤,术后对患者进行面、听神经功能评估。结果肿瘤全切388例（97．70％）,次全切9例,死亡3例。本组病人面神经解剖保留率为95．97％,功能保留率为91．94％。术后主要并发症包括完全性永久性面瘫11例,面部麻木23例,角膜溃疡18例,耳呜29例,后经颅神经瘫痪28例,轻偏瘫3例,听力完全丧失139例。结论通过面部肌肉肌电图及BAEP的监测,可以准确判断颅神经的位置,最大程度避免颅神经的损伤。术中面部肌肉自发与诱发肌电图和BAEP监测,对听神经瘤外科手术的安全性提供了一定的保障,减少了手术的风险,使用得当可降低手术的致残率,应该成为听神经瘤手术的常规工作。     

面肌痉挛显微血管减压术中脑干听觉诱发电位监测的应用

目的 研究脑干听觉诱发电位(BAEP)监测在显微血管减压术(MVD)治疗面肌痉挛手术中的应用.方法 回顾性分析90例面肌痉挛患者在MVD术中进行BAEP监测的临床资料.结果 MVD手术操作过程均可引起BAEP改变,包括:BAEP的Ⅰ、Ⅲ、Ⅴ波绝对潜伏期明显延长(P＜0.01),Ⅰ～Ⅲ、Ⅲ～Ⅴ、Ⅰ～Ⅴ波间期明显延长(P＜0.01),Ⅲ波、Ⅴ波波幅明显降低(P＜0.01);有16例术中Ⅴ波绝对潜伏期延长超过1ms,Ⅰ波波幅也有明显降低(P＜0.01),但术后无听力障碍;手术结束时Ⅲ～Ⅴ波间期及16例的Ⅰ、Ⅴ波波幅恢复较快.2例术后患侧听力丧失的患者中,1例术中Ⅴ波波幅逐渐降低至消失,另1例术中未监测到Ⅴ波波形.结论 MVD手术操作过程均可引起BAEP改变;Ⅴ波绝对潜伏期延迟超过1ms者相对多见,但无听力受损;Ⅴ波波幅下降程度可为术中神经功能受损提供客观指标,以采取相应措施减少听力并发症的发生.     

孤独症谱系障碍患儿婴儿期体格、神经心理发育及脑干听觉诱发电位特征

目的:探讨孤独症谱系障碍(ASD)患儿婴儿期体格、神经心理发育及脑干听觉诱发电位(BAEP)特征。方法:收集21例2～6岁ASD患儿(ASD组)在其1、3、6及12月龄时体格发育资料(体质量、身长和头围)、神经心理发育评估资料[包括智力发展指数(MDI)和精神运动发展指数(PDI)]及BAEP检测结果(包括Ⅰ、Ⅲ、Ⅴ波潜伏期及I-Ⅲ、Ⅲ-Ⅴ、Ⅰ-Ⅴ峰间期),并与63名同龄正常儿童(对照组)比较。结果:两组婴儿期各月龄体格发育水平比较差异无统计学意义(P>0.05)。神经心理发育评估显示,12月龄时ASD组MDI和PDI明显低于对照组(P均<0.01)。BAEP检测结果显示,1及3月龄时ASD组BAEPⅠ波、Ⅲ波、Ⅴ波潜伏期、Ⅰ-Ⅲ峰间期、Ⅲ-Ⅴ峰间期及Ⅰ-Ⅴ峰间期明显长于对照组(P<0.05或P<0.01)。ASD组异常频率最多的是V波潜伏期延长(47.2%)。结论:婴儿期早期(1～3月龄)持续V波潜伏期延长、12月龄时神经心理发育迟缓可能为ASD患儿早期特征性改变,可作为ASD早期预警指标之一。