“椎基动脉供血不足”758例的再评价及其新认识  

Re-evaluating and rethinking "vertebrobasilar insufficiency":an analysis of 758 cases.

作　　者：王彦莉[1,2] 盛文利[1] 黄如训[1] 苏镇培[1] 

机构地区：[1]中山大学附属第一医院神经科 [2]广州市第一人民医院神经科,广州510000

出　　处：《中国神经精神疾病杂志》2009年第9期551-553,共3页Chinese Journal of Nervous and Mental Diseases

基　　金：国家自然科学基金资助项目(编号:39700048,30271378);广东省自然科学基金资助项目(编号:06021225,021866,980066,974151);广东省科技攻关基金项目(编号:2002C30603,2005B31201013,2005B50301009);广东省卫生厅医学基金资助项目(编号:A2002168);教育部高校博士点启动基金(编号:20070558234)

摘　　要：目的对住院诊断为"椎基动脉供血不足"(vertebrobasilar insufficiency,VBI)的病例重新评价,分析误诊的可能原因,为减少临床滥用提供依据。方法根据1988年国内VBI诊断标准和2000年美国Caplan的后循环缺血(posterior circulation ischemia,PCI)诊断标准的核心内容(椎基动脉供血区缺血导致的脑干和小脑的症状和体征),设计了"VBI"病例再评价调查表进行分析我院1989年至2003年临床诊断的"椎基动脉供血不足"。结果符合VBI及PCI诊断标准的患者75例(75/758,占9.89%);不符合诊断的患者683例(683/758,占90.11%),其中眩晕病因明确的338例(338/683,占49.49%),未能确定病因的345例(345/683,占50.51%)。结论将绝大多数眩晕症患者"误诊"为VBI的主要原因是未严格掌握VBI和PCI的诊断标准。需注意超过TIA时限的急性椎基动脉缺血发作。Objective To re-evaluate in-patient cases diagnosed as ＂vertebrobasilar insufficiency, VBI＂, to analyze the reasons for the misdiagnosis and to provide the evidenced data to reduce the abuse of the concept of VBI. Methods According to the national VBI and Caplan＇s PCI（ Posterior circulation ischemia） diagnostic criteria published in 1988 and 2000 （ that is, the symptoms and signs of the brainstem and cerebella are solely caused by the vcrtebrobasilar artery system ischemia） , the re-evaluation questionnaires of ＂VBI＂ cases were designed and conduced in-patient cases with the clinical diagnosis of ＂vertebrobasilar insufficiency＂ during 1989 to 2003 were re-evaluated. Results Seventy-five cases met the criteria of VBI and PCI（75/763,9.89% ）. All had symptoms and signs of VBI and PCI. Six hundard and eighty-three cases failed to meet the criteria of VBI. Among them, ,338 cases had identified causes of vertigo whereas the rest did not had identified causes of vertigo. Conclusions The main reason for the misdiagnosis is that the diagnosis was not made strictly according to VBI and PCI standards. Special attention should be given to the cases with new-termed ＂acute vertebrobasilar ischemic attack ＂ in which ischemia time beyond the criterion of TIA.

关 键 词：眩晕 椎基动脉供血不足 后循环缺血 病因 误诊 

分 类 号：R743.3[医药卫生—神经病学与精神病学]