基底动脉发育不全患者脑干血流动力的变化及临床意义  

The clinical significance of brainstem hemodynamic alterations associated with basilar artery hypoplasia

作　　者：尹所 张道培[2] 禹萌[2] 任雅芳[2] 张淑玲[2] 张洪涛[2] 付胜奇[2] 

机构地区：[1]郑州人民医院影像科,河南郑州450003 [2]郑州人民医院神经内科,河南郑州450003

出　　处：《中国实用神经疾病杂志》2017年第19期18-23,共6页Chinese Journal of Practical Nervous Diseases

基　　金：国家自然科学基金资助项目(81471203);河南省医学科技攻关项目(201303224)

摘　　要：目的探讨基底动脉发育不全(basilar artery hypoplasia,BAH)对脑干血流动力学变化的影响。方法 2011-01-2014-12对952例头晕或眩晕患者进行头颅CT、MRI和MRA检查筛查出符合研究条件BAH患者67例,符合标准的非BAH患者108例作为对照组。对2组患者记录血管危险因素,完成动态磁敏感增强灌注成像(PWI)检查、脑干听觉诱发电位(BAEP)、瞬目反射(BR)、经颅多普勒超声(TCD)。结果BAH组TCD基底动脉异常42例(62.7%),非BAH组异常14例(12.9%),差异有统计学意义(P<0.001);主要为低血流速度和低搏动指数。BAH组脑桥出现低灌注26例(38.8%),非BAH组脑桥出现低灌注10例(9.3%),差异有统计学意义(P<0.001),以平均通过时间(MTT)延长最多见。BAH组合并后循环梗死19例(28.4%),非BAH组后循环梗死6例(5.6%),差异有统计学意义(P=0.023)。BAH组BAEP异常48例(71.6%),非BAH组BAEP异常15例(13.8%),差异有统计学意义(P<0.001);以Ⅲ~Ⅴ/Ⅰ~Ⅲ>1最常见。BAH组BR异常51例(76.1%);非BAH组BR异常19例(17.6%),差异有统计学意义(P<0.001);以R2波异常率最高(69.5%)。结论 BAH患者易出现脑桥部位的血流动力学改变,局部低灌注可能是BAH促发缺血性眩晕的原因之一。Objective The aim of this study was to observe brainstem hemodynamic alterations associated with basilar artery hypoplasia(BAH).Methods Nine hundred and fifty-two consecutive patients received emergency multimodal computed tomography,magnetic resonance imaging and magnetic resonance angiogram during January 2011 to December 2014 were included.The vascular risk factors,brainstem auditory evoked potential,blink reflex,transcranial Doppler and dynamic susceptibility contrast-enhanced perfusion weighted imaging were completed.Results In BAH group to non-BAH group,the difference of basilar artery anomalies on TCD,BAEP,BR and low perfusion of pons was statistically significant(P<0.001).Conclusion BAH is closely associated with hemodynamic alterations within the pons,which might contribute to vascular vertigo due to regional hypoperfusion.

关 键 词：基底动脉发育不全 脑干听觉诱发电位 瞬目反射 灌注成像 眩晕 

分 类 号：R743[医药卫生—神经病学与精神病学]