位置性眩晕患者生活质量及体位改变时脑血流动力学观察

发布时间：2019-05-12 05:27

【摘要】：背景：经颅多普勒(Transcranial Doppler TCD)能够动态观测脑血流变化，其易操作、便携、价廉等优点越来越广泛的应用于临床实践中，得到更多的临床工作者的重视。TCD监测是TCD应用价值的延伸，其目的性强、双侧对比、观测时间长等优点能更客观的反映脑血流变化。位置性眩晕又称为体位性眩晕，是由于头部或者身体位置的改变引起的眩晕。有研究发现，眩晕患者在体位变化后存在着脑血流调节的异常。然而位置性眩晕患者体位变化时脑血流调节的异常及患者生活质量（Quality of Life QOL）未引起临床足够重视。在本研究中，对位置性眩晕患者依次行常规TCD检查，转颈试验及卧立位变化的TCD监测，评估其脑血流调节功能。应用汉化的英文版眩晕障碍量表（Dizziness handicapinventory DHI）评分及Berg评分（Berg balance scale BBS）评估位置性眩晕患者健康相关生活质量。目的：探讨位置性眩晕患者体位变化时脑血流动力学的变化及眩晕障碍对位置性眩晕患者健康相关生活质量的影响。方法：主要收集我院2013年3月至2014年1月门诊及住院确诊的体位性眩晕患者。使用TCD检测患者卧位、卧-立位、立位脑血流速度值，比较其体位改变前后的脑血流值变化。同时采用DHI评分及Berg平衡障碍量表评分评估患者健康相关生活质量，进行脑血流动力学与眩晕患者生活质量的相关分析。结果： 1.纳入位置性眩晕患者59例，男20例（33.9%），女39例（66.1%），男女比例为1:1.95；年龄19-81岁，平均52.41±14.66岁，以46-60岁年龄段发病人数最多。纳入健康对照组36例，男性14例，女性22例，年龄19-81岁，平均年龄50.81±14.74岁。 2.职业调查显示患者中工程师、教师、管理工作者等脑力工作者多见，调查中发现工程师、教师、管理工作者常从事伏案工作，易导致头、颈部疲劳。 3.位置性眩晕DHI评分，功能评分16.58±3.34分，躯体评分15.59±3.65分，情感评分17.19±4.07分，DHI总分49.36±9.63分。轻度眩晕障碍患者（DHI评分≤34分）4例，中度眩晕障碍患者（36≤DHI评分≤52分）31例，重度眩晕障碍患者（DHI评分≥54分）24例。位置性眩晕患者BBS评分47.00±3.48分，BBS评分≤45分19例（32.2%），BBS评分＞45分40例（67.8%）。位置性眩晕患者DHI评分与Berg评分比较结果显示各年龄段位置性眩晕患者DHI评分与Berg评分呈负相关。 4.(1)平卧位时位置性眩晕患者与健康对照组各动脉脑血流值无明显差异(58.18±7.20cm/s vs60.42±8.17cm/s)。(2)转颈后椎动脉收缩期血流速度峰值位置性眩晕组与健康对照组有显著性差异。随转颈角度的增大，位置性眩晕组椎动脉血流速明显下降。位置性眩晕组出现单侧椎动脉血流下降21/59例(36%)，其中左侧12/59例(20%)，右侧9/59例(15%)，双侧血流均有下降者7/59例(12%),而健康对照组2/36例(0.56%)均为左侧。转颈试验结果阳性：健康对照组2／39例，占0.56%，位置性眩晕组28/59例，占47％。两组对比有显著性差异。(3)TCD监测发现卧立位变化时存在脑血流调节的改变，血流频谱呈“~”型波浪式起伏。位置性眩晕患者组与健康对照组脑血流卧位基线水平时无差异（58.18±7.20cm/s vs60.4±8.17cm/s，P0.05）；但是位置性眩晕患者由卧位转为立位后脑血流下降明显，卧立位脑血流差值较健康对照组变化显著（5.89±5.45cm/svs2.44±2.62cm/s，P0.05）轻、中、重度位置性眩晕患者卧位脑血流比较无明显差异（60.14±12.12cm/s vs57.26±14.68vs56.14±11.39，F=0.33，P=0.56）；轻、中、重度位置性眩晕患者卧-立位脑血流差值比较亦无明显差异（5.68±7.14cm/s vs6.12±5.07cm/s vs6.23±4.95cm/s，F=1.47，，P=0.48）。结论：1.眩晕患者人数在46-60岁是发病高峰。2.位置性眩晕患者普遍存在生活质量损害，中度、重度损害多见。3.转颈试验加TCD对位置性眩晕患者椎动脉颅内段血流动力学变化敏感，能够提高位置性眩晕患者转颈试验阳性的发现率。4.位置性眩晕患者体位变动时存在脑血管自身调节功能受损。
[Abstract]:Background: Transcranial Doppler (TCD) can dynamically observe the changes of cerebral blood flow, which is easy to operate, portable and low in cost. TCD monitoring is the extension of the value of TCD application. It has the advantages of strong intention, double-sided contrast, long observation time and so on, and can reflect the changes of cerebral blood flow more objectively. Positional vertigo is also known as postural vertigo, due to a change in the position of the head or body. It was found that there was an abnormality of cerebral blood flow regulation after the position change of the patients with vertigo. However, the abnormality of cerebral blood flow regulation and the quality of life QOL in patients with positional vertigo did not cause clinical enough attention. In this study, the cerebral blood flow regulation function of the patients with positional vertigo was assessed by means of routine TCD, transvervical and horizontal position changes. The health-related quality of life of the patients with positional vertigo was assessed by using the Chinese-English Vertigo handle (DHI) score and the Berg balance scale BBS. Objective: To study the changes of cerebral hemodynamics in patients with positional vertigo and the quality of health-related life in patients with positional vertigo. In response to the method, the patients in our hospital from March 2013 to January 2014 were mainly collected. Patients with halo. TCD was used to detect the blood flow velocity in the supine, horizontal and vertical position of the patient, and to compare the cerebral blood flow before and after the change in the position of the patient. Changes of the value of the patient's health-related quality of life were assessed by using the DHI score and the Berg balance disorder scale score, and the phase of the life quality of the patients with cerebral hemodynamics and vertigo was performed. cross-correlation analysis Results:1.59 patients with positional vertigo were included,20 (33.9%),39 (66.1%),1: 1.95,19-81 years old, 52.41-14.66 years old, and 46-60 years of age. The highest incidence of the segment was included in 36 healthy controls,14 males and 22 females. The age was 19 to 81 years. The average age was 50.81. In that survey, the engineer, the teacher, the management worker and other mental workers were found to be more common, and in the investigation, the engineer, the teacher and the management worker were often involved in the work of the case. The head and neck fatigue can be easily caused.3. The position-based vertigo DHI score, the functional score of 16.58-3.34, the body score of 15.59-3.65, the emotional score of 17.19-4.07, and the total score of DHI 49.36 to 9.63 points.4 patients with mild vertigo (34 scores of DHI score),31 patients with moderate vertigo (36% DHI score,52 points), and patients with severe vertigo (DH The scores of BBS in the patients with positional vertigo were 47.00, 3.48, and the BBS score was 45:19 (32.2%), and the BBS score was more than 45. 40 patients (67.8%). The results of the DHI score and the Berg score in the patients with positional vertigo showed a DHI score for patients with positional vertigo at all ages and B 4. (1) There was no significant difference (58.18) 7.20 cm/ s vs60 between the patients with position vertigo and the control group. .42 (8.17 cm/ s). (2) The peak position of the peak systolic blood flow velocity of the vertebral artery after subcervical vertigo There was a significant difference between the group and the healthy control group. The blood flow rate of the vertebral artery of the vertigo group was significantly decreased. The blood flow rate of the one-sided vertebral artery in the position vertigo group decreased by 21/59 (36%), of which 12/59 (20%) left,9/59 (15%) on the right,7/59 (12%) of the bilateral blood flow, and 2/3 of the healthy control group. 6 (0.56%) were left. The results of the test were positive:2/39 of the healthy control group, 0.56% in the healthy control group, and the position of the control group. Sickness group 28/59 cases,4% There was a significant difference between the two groups. (3) There was a change in the blood flow regulation of the cerebral blood flow in the case of the change of the horizontal standing position, and the blood flow spectrum was . There was no difference (58.18-7.20 cm/ s vs60.4-8.17 cm/ s, P0.05) in the patients with positional vertigo and the level of baseline in the healthy control group. 2.44 (2.62 cm/ s, P0.05). There was no significant difference in the blood flow of the patients with moderate and severe positional vertigo (60.14, 12.12 cm/ s vs57.26, 14.68 vs56.14, 11.39, F = 0.33, P = 0.56), and there was no significant difference (5.68 to 7.14 cm/ s vs6.12) 5.07 cm/ s vs6.23 and 4.95 cm/ s, F = 1.47 (P = 0.48). Conclusion:1. Patients with vertigo The number between 46 and 60 years is the peak of the disease.2. There is a common life in the patients with positional vertigo. 3. The rotational-neck test and TCD were sensitive to the hemodynamic changes of the vertebral artery of the vertebral artery of the patients with positional vertigo. The rate of finding positive in the neck test of patients with halo.4. The position of the patients with positional vertigo.
【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R741

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