良性阵发性位置性眩晕两种位置试验的眼震特征

发布时间：2018-04-27 11:59

本文选题：眩晕 + 眼震　；参考：《天津医科大学》2017年硕士论文

【摘要】：目的良性阵发性位置性眩晕(benign positional paroxysmal vertigo,BPPV)即耳石症,是当前临床极为常见的眩晕类疾病,常累及后半规管及水平半规管。它是一种反复发作的、由头位相对重力方向变换所引发短暂性眩晕和眼球震颤的前庭外周疾病,其症状具有自行缓解的特点。目前,BPPV的诊断通常是依靠位置试验检查所引出的典型眼震来确定。本文应用视频眼震图(video nystagmo graph,VNG)技术,分析不同类型BPPV在Roll test和Dix-Hallpike test两种诊断性检查中引出眼震的参数特征,探讨BPPV诱发眼震机制及位置试验在其临床诊疗中的优选方案,为该症责任半规管的诊断提供客观参照依据。方法2015年10月至2017年1月就诊于天津市第一中心医院耳鼻咽喉头颈外科门诊的位置性眩晕患者共740例。包含BPPV患者735例,男237例,女498例,男女之比1:2.1。其中后半规管管石症(Posterior Semicircular Canal Canalithasis,PSC-Can)510例,水平半规管管石症(Horizontal Semicircular Canalithasis,HSC-Can)183例,水平半规管壶腹嵴顶结石症(horizontal semicircular canal cupulolithiasis,HSC-Cup)42例;另有轻嵴帽(Light Cupula,LC)患者5例。详细采集以上患者的眩晕病史(包括眩晕特点、发作时间、发作频率、伴随症状、既往史及发作诱因等),并完善耳科学检查及前庭功能检查、影像学检查,排除中枢性病变者、存在各类型自发眼震者及其他种类BPPV(包含PSC-Cup、前臂HSC-Can、前半规管BPPV)。使用VNG详细描记全体受检者Roll test和Dix-Hallpike test所刺激产生的眼震,对比各检查各头位引出眼震的参数特性。在SPSS 19.0统计软件的支持下进行数据处理。结果PSC-Can患者在Dix-Hallpike test悬头位都能够引出垂直向上为主的眼震,起身端坐后眼震方向相反,强度较悬头位减弱,悬头位和端坐位引出垂直眼震强度(均数±标准差)分别是(29.5±12.7)°/s和(13.1±7.2)°/s,差异有统计学意义(t=18.615,P0.05);悬头位和端坐位引出典型眼震的持续时间分别是(13.7±7.1)s和(13.5±6.9)s,无统计学差别(t=0.089,P0.05)。但PSC-Can患者在Roll test中未能引出典型连续性眼震。HSC-Can患者行Roll test检查呈现出水平相为主且与扭头同向的眼震,在患侧及健侧引出眼震的强度分别是(41.5±15.8)°/s及(20.2±7.7)°/s,眼震强度均值之比约为2.1:1,眼震持续时间分别是(22.1±6.1)s和(21.3±5.9)s,差异均有统计学意义(t值分别是10.637和3.724,P均0.05);并且169例HSC-Can患者行Dix-Hallpike test后表现出水平相为主的眼震。HSC-Cup患者在行Roll test检查后呈现出水平相为主与扭头反向的眼震,向健侧扭头所引出的眼震较患者强,向患侧及健侧扭头引出的眼震强度分别是(18.0±8.1)°/s及(40.27±16.6)°/s,强度之比约是1:2.2,差异有统计学意义(t=-15.803,P值0.05);并且全体HSC-Cup患者行Dix-Hallpike test检查后均能表现出水平相为主的眼震。5例轻嵴帽患者在Roll test中都能够诱发出水平相为主、方向与转头方向同向的眼震,眼震时间较长,均大于1分钟,强侧的水平眼震强度为(10.6~27.8)°/s,弱侧的水平眼震强度为(7.4~15.6)°/s。结论(1)Dix-Hallpike test是诊断PSC-Can的有效试验方法。在Dix-Hallpike test悬头位或端坐位其表现为垂直向上或向下的扭转性眼震,其中右PSC-Can仰卧悬头时眼球震颤呈逆时针方向旋转,左PSC-Can仰卧悬头时眼球震颤呈顺时针方向旋转,坐起后运动方向相反。并且,Dix-Hallpike test对HSC-BPPV也具有定位诊断意义,表现为HSC-Can向两侧仰卧悬头时可引出与扭头方向同向的水平眼震,HSC-Cup在仰卧悬头时可引出与扭头方向反向的水平眼震。而Roll test仅适用于水平半规管受累的定位诊断,并不能诱发后半规管内的耳石产生有效刺激。因此,临床检查中对于可疑BPPV的眩晕患者,位置试验检查时建议从Dix-Hallpike Test开始,依照Dix-Hallpike Test水平眼震的有无判断是否需要继续实行Roll Test,以减少对患者的不适刺激。(2)HSC-LC在Roll test和Dix-Hallpike test中均能引出连续的与转头方向同向的眼震,眼震时间大于1分钟,且以上患者在头偏向较强眼震侧与矢状面呈20°~30°处存在使眼震消失的零平面。
[Abstract]:Objective benign paroxysmal positional vertigo (benign positional paroxysmal vertigo, BPPV), otolith disease, is a very common clinical vertigo, often involving the posterior semicircular canal and horizontal semicircular canals. It is a recurrent, transient vestibular disease caused by transient dizziness and nystagmus caused by the head position relative gravity direction transformation. At present, the diagnosis of BPPV is usually determined by the typical nystagmus derived from the position test examination. In this paper, the video nystagmo graph (VNG) technique is used to analyze the parameter characteristics of the nystagmus of different types of BPPV in the two diagnostic tests of Roll test and Dix-Hallpike test, and discuss the BP The optimal scheme of PV induced nystagmus mechanism and position test in its clinical diagnosis provides an objective reference for the diagnosis of the responsible semicircular canal. Methods 740 cases of positional vertigo were diagnosed in the outpatient of the otolaryngology head and neck surgery department of Tianjin First Central Hospital from October 2015 to January 2017, including 735 cases, 237 men and 4 women. In 98 cases, the ratio of male and female to 1:2.1. was 510 cases (Posterior Semicircular Canal Canalithasis, PSC-Can), and 183 cases of horizontal semicircular canal stone syndrome (Horizontal Semicircular Canalithasis, HSC-Can), 42 cases of the horizontal semicircular canals of ampullary crest stone (horizontal semicircular). 5 cases of Light Cupula, LC). The history of vertigo (including vertigo, seizure time, frequency, accompanying symptoms, previous history and seizure inducement, etc.), and the improvement of the ear science and vestibular function examination, the imaging examination, the exclusion of central lesions, the existence of various types of spontaneous nystagmus and other kinds of BPPV (including PS) C-Cup, forearm HSC-Can, anterior semicircular BPPV). Use VNG to describe the nystagmus stimulated by all subjects Roll test and Dix-Hallpike test in detail, compare the parameters of each head induced nystagmus. Data processing with the support of the SPSS 19 statistical software. Results PSC-Can patients can lead to the Dix-Hallpike test. The vertical upward nystagmus, with the opposite direction of eye shock after sitting, the intensity is weaker than the hanging head, and the vertical nystagmus intensity (29.5 + 12.7) /s and (13.1 + 7.2) /s, respectively, is statistically significant (t=18.615, P0.05), and the duration of the typical nystagmus leads to the suspension position and the end seat, respectively. (13.7 + 7.1) s and (13.5 + 6.9) s, there was no statistical difference (t=0.089, P0.05). But the patients with PSC-Can in Roll test failed to lead to the typical continuous nystagmus.HSC-Can in the Roll test examination, which presented a horizontal phase with the same direction as the twist. The intensity of the eye shock in the affected side and the healthy side was (41.5 + 15.8) degree /s and (20.2 + 7.7) degrees /s, nystagmus, respectively. The ratio of the mean intensity was about 2.1:1, and the duration of nystagmus was (22.1 + 6.1) s and (21.3 + 5.9) s respectively. The differences were statistically significant (T values were 10.637 and 3.724, P 0.05), and 169 cases of HSC-Can patients showed the horizontal phase after Dix-Hallpike test in the Roll test examination. The nystagmus led to the contralateral twist was stronger than that of the patients. The nystagmus intensity was (18 + 8.1) /s and (40.27 + 16.6) /s, respectively, and the intensity ratio was about 1:2.2, and the difference was statistically significant (t=-15.803, P 0.05), and all HSC-Cup patients were able to show the water after Dix-Hallpike test examination. .5 patients with nystagmus in Roll test were able to induce the horizontal phase in the same direction and the direction of the turning head in the same direction. The nystagmus time was longer than 1 minutes, the horizontal eye earthquake intensity of the strong side was (10.6~27.8) /s, the horizontal eye earthquake intensity of the weak side was (7.4~15.6) /s. conclusion (1) Dix-Hallpike test was the diagnostic PSC-Can. The effective test method. In the Dix-Hallpike test suspension head or the end sitting position, it shows a vertical upward or downward twist nystagmus, in which the right PSC-Can supine hanging head rotates in the reverse clockwise direction, while the left PSC-Can supine hanging head rotates clockwise in the direction of the hanging head, and the movement direction is opposite after sitting up. And, Dix-Hallpike test to HS C-BPPV also has the significance of positioning diagnosis, which shows that HSC-Can can lead to the same horizontal ocystagmus with the direction of torsion when the head is supine on both sides. HSC-Cup can lead to horizontal nystagmus opposite the direction of the twist in the supine hanging head. While Roll test is only suitable for the localization diagnosis of the horizontal semicircular canals, and can not induce the production of otolith in the posterior semicircular canals. Effective stimulation. Therefore, in the clinical examination for the vertigo in suspected BPPV, the position test is recommended from Dix-Hallpike Test, and whether Roll Test is required according to the judgment of Dix-Hallpike Test level nystagmus to reduce the discomfort to the patient. (2) HSC-LC in Roll test and Dix-Hallpike test The duration of nystagmus was more than 1 minutes, and the zero plane of nystagmus disappeared at the head bias and the sagittal face at 20 ~30 degrees.

【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R764

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