摘要
目的：通过对椎基底动脉系统短暂性脑缺血发作（TIA）
患者治疗前后的脑干听觉诱发电位(BAEP)及脑电地形图(BE
AM)检查，探讨其早期诊断价值，明确受损部位，判断病情
严重程度，观察疗效，以指导临床，选择最佳治疗。
方法：选择我院收治的符合1995 年全国第四次脑血管
病学术会议诊断标准的椎基底动脉系统TIA 患者60 例（患
者组），男32 例，女28 例，年龄35～65 岁之间，平均 4
7.18±8.14 岁，有类发作史50 例，病程1 月～16 年。35
例年龄、性别比例与患者组相近的健康人35 名（对照组），
男19 例，女16 例，年龄30～65 岁，平均46.46±9.70 岁，
均无耳疾。在25℃的隔音室内安静状态下行BAEP 检查，受
检者坐位，全身肌肉放松，闭目，Cz 作参考点，A1、A2 分
别作记录点，Fz 接地，电极与皮肤间阻抗低于5kΩ，听觉
刺激为变换极性的“喀嗒”声，先测主观听阈，大于60dB
者不纳入本研究范围。双耳分别给予主观听阈加60dB clic
k 刺激，平均叠加1500 次，每侧最少重复两次，选重复性
好的波形，滤波后标出BAEP 各波。游标测量Ⅰ、Ⅲ、Ⅴ各
波峰潜伏期（PL）和峰间潜伏期（IPL），采用t 检验对两
组检查结果进行比较。对椎基底动脉系统TIA 组行BEAM 检
查，应用随机所带的电极帽，按国际10/20 系统安放21 个
电极，双耳垂为参考电极，Fpz 为接地电极，描记安静闭目
2
脑电图3 分钟，取30 秒无干扰脑电进行快速傅立叶转换（F
FT）显示频带功率分布图，得出α、β、θ、δ频带功率分
布地形图进行分析，并与BAEP 检查结果相比较，结合患者
临床表现，分析其病情与BAEP、BEAM 异常程度之间的关系。
BAEP 与BEAM 检查均在患者入院后即刻完成，异常者治疗一
周后复查BAEP、BEAM。对椎基底动脉系统TIA 组治疗前后
及对照组两两比较，计量资料均以x ±s 表示，采用t 检验，
比较其差异。检验水准取a=0.05。
结果：（1）60 例椎基底动脉系统TIA 患者BAEP 异常
45 例占75%，其中脑干型异常28 例占62.2%，内耳型7 例
占15.6%，混合型10 例占22.2%。（2）椎基底动脉系统TIA
组Ⅰ、Ⅴ波PL、Ⅲ-ⅤIPL、及Ⅲ-Ⅴ/Ⅰ-Ⅲ比值均较对照组
增大，经t 检验，P <0.01，差异均有非常显著性，Ⅲ波PL、
Ⅰ-ⅤIPL 与对照组比较P <0.05 差异均有显著性，Ⅰ-ⅢIPL
与对照组比较P >.05 差异无统计学意义。（3）椎基底动
脉系统TIA 组BAEP 各指标的异常率中以Ⅲ-Ⅴ/Ⅰ-Ⅲ>1 最
常见，占48.3%，其次是Ⅲ-Ⅴ和Ⅰ-ⅤIPL 的延长，分别占
35%和30%。Ⅰ、Ⅲ、Ⅴ波波形分化不良较相应PL 延长和波
幅下降多见。（4）60 例椎基底动脉系统TIA 患者BEAM 异
常48 例占80%，表现为α频带功率分布地形图上枕颞区功
率值降低，和/或在θ、δ频带相应部位功率值增高。（5）
在同一患者中，BAEP、BEAM 均异常者38 例占63.3%，仅BEAM
异常而BAEP 正常者占10 例占16.7%，仅BAEP 异常而BEAM
正常者7 例占11.7%，二者均正常者5 例占8.3%。（6）椎
基底动脉系统TIA 患者治疗后第７天BAEP 的异常率为10%。
45 例异常BAEP 患者治疗前后BAEP 均有不同程度改善，Ⅰ、
Ⅲ、Ⅴ波PL 经t 检验，P <0.01，差异均有非常显著性。与
正常对照组比较，经t 检验，P >.05，差异无统计学上意
义。（7）异常BEAM 复查均有不同程度改善，表现为原病变
侧α频带相应部位功率值增高或慢波功率不同程度下降。
（8）椎基底动脉系统TIA 患者发作症状越重越频繁，BAEP
表现波形分化、潜伏期、波间期异常越明显，BEAMα频带功
率分布地形图上枕颞区功率值越低。
结论：（1）BAEP 能从电生理角度早期反映内耳迷路及
脑干听觉传导通路上的异常，对椎基底动脉系统TIA 早期诊
断具有重要价值，并有助于缺血早期定位。（2）BAEP 中Ⅰ、
Ⅲ、Ⅴ是最稳定可靠的3 个主要反应波，Ⅲ-Ⅴ/Ⅰ-Ⅲ>1 是
反映脑干缺血的敏感指标，Ⅴ波波形分化不良可作为脑干功
能损害的早期指标之一。（3）BEAM 可作为椎基底动脉系统
TIA 早期诊断较灵敏的检查方法，主要反映枕颞部供血不
足。（4）BAEP 与BEAM 联合检测可明显提高椎基底动脉系
统TIA 的诊断率（91.7％），并有助于缺血定位。（5）两
项检查结果异常程度能准确反映椎基底动脉系统TIA 患者
病情严重程度，可用于临床指导治疗。（6）两项检查对椎
基底动脉系统TIA 病情的动态评估、疗效观察具有重要价
值。
Objective: To explore the early diagnostic value of
brainstem auditory evoked potential(BAEP) and brain
electrical activity mapping(BEAM) in patients with
vertebrobasilar systemic transient ischemic
attack(TIA). To identify the damaged position and
judge the severity of patient’s condition. We tried
to investigate the curative effect and to instruct
clinical treatment and select the best therapy.
Methods: We selected 60 inpatients(patients
group)with vertebrobasilar systemic TIA diagnosed by
clinical standards referred to the fourth national
cerebrovascular diseases meeting in 1995 in our
hospital, including male 32 cases, female 28 cases,
ages were from 35 to 65 years old, average was 47.18
±8.14 years old. 50 cases had the same similar
symptoms in the past. The course of disease was from
one month to 16 years old. 35 health controls whose
ages and gender were similar to the patients group,
including male 19 cases, female 16 cases, ages were
5
from 30 to 65 years old, average was 46.46±9.70 years
old. BAEP were performed on both groups in quiet state
in 25℃ room with sound insulation. Subjects sat in
soft chair, loosen, closed eyes. Cz was reference
point, A1A2 was record point respectively. Fz was
ground electrode. The resistance of electrodes on skin
was less than 5 kΩ. Auditory stimulation was
alternative click sound. Subjective threshold was
examined first. Those went beyond 60dB were excluded
from this study. Two ears was given 60dB click over
subjective threshold respectively. We overlapped 1500
repeatedly. Two times every side at least. The two
better overlapping waves were selected and were
filtered, then we marked every wave and measured peak
latency(PL) and interpeak latency(IPL) of Ⅰ Ⅲ Ⅴ
with cursor. The data of two group were compared by
t test. BEAM was performed in vertebrobasilar systemic
TIA patients. BEAM examination used electrode cap with
the machine. It had 21 electrodes laying according to
international 10/20 systerm. We traced EEG 3 minutes
with the earlobes as reference electrodes, and 30
seconds EEG without confusion was input computer to
FTT exchange to obtain power ofαβθδ distribution
images.The results were compared with BAEP, and we
combined the patient’s manifestation to analyzed the
relationship between the condition and the abnormal
6
degree of BEAM and BAEP. BEAM and BAEP were performed
instantly after admission. The patients with abnormal
results were checked again after a week’s treatment.
We compared the results among control group,
pre-treatment and post-treatment vertebrobasilar
systemic TIA group. Measurement data were expressed
with x ±s and dealt with t test. The size of test took
a=0.05.
Results: (1) 45 cases were abnormal in 60
vertebrobasilar systemic TIA patients. The abnormal
rate of BAEP was 75﹪, including 62.2% brainstem
type(28 cases), 15.6% (7 cases) internal ear type and
22.2%(10 cases) mixed type. (2) Ⅰ Ⅴ PL,Ⅲ-ⅤIPL and
Ⅲ-Ⅴ/Ⅰ-Ⅲ were increased very significantly in
vertebrobasilar systemic TIA group as compared with
control group(P<0.01). Ⅲ PL,Ⅰ-Ⅴ IPL were
increased significantly(P<0.05).Ⅰ-ⅢIPL was no
significance statisticly(P>.05). (3) In the BAEP
indexes, the abnormal rate of Ⅲ-Ⅴ/Ⅰ-Ⅲ>1 was
the highest(48.3%), then was the prolongation of Ⅲ
-Ⅴand Ⅰ-Ⅴ IPL. The abnormal rate was 35%,30%
respectively. The bad form of Ⅰ Ⅲ Ⅴ wave was more
than PL prolongation and Amp drop. (4) The abnormal
rate of BEAM was 80% in vertebrobasilar systemic TIA
group. BEAM showed power decreased in occipital or/and
temporal area of the α distribution images or/and
7
power increased in the same area of the θδ
distribution images. (5) The abnormal rate in both
BAEP and BEAM was 63.3% (38 cases) in a same patient.
Abnormal BEAM accounted for 16.7% (10 cases). Only
abnormal BAEP accounted for 11.7%(7 cases). Normal
BAEP and BEAM accounted for 8.3%(5 cases). (6) The
abnormal rate after seven days therapy in patients
with vertebrobasilar systemic TIA
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