当前位置:主页 > 医学论文 > 眼科论文 >

前庭诱发肌源性电位:临床检测方法的建立及临床应用研究

发布时间:2018-06-13 04:32

  本文选题:前庭诱发肌源性电位 + 眩晕 ; 参考:《武汉大学》2013年博士论文


【摘要】:目的:前庭诱发肌源性电位(VEMP)是一种通过强音刺激,记录骨骼肌对于前庭器官兴奋发生反应电位的客观评估前庭功能的临床检测方法。在实际检测过程中,VEMP反应电位振幅受到刺激音强度和检测部位肌肉收缩强度的影响,造成检测结果变异较大,为临床判断和比较检测结果带来一定困难,使VEMP作为非创伤性前庭功能检测方法的临床应用价值受到影响。本研究重点通过采用一种自行设计的在检测时监测和控制颈部肌肉收缩力度的方法,提高VEMP振幅检测结果的稳定性和可重复性,为临床客观评估前庭功能提供一种简单易操作的方法。 方法:受检者为19名健康志愿者(12名男性,平均34.0±7.7岁)和16名耳部疾病患者(耳硬化症9例,听神经瘤7例)。为了让受检者在检测时可以有效控制颈部肌肉收缩力度,专门设计一个由气囊和压力表组成的压力反馈装置。检测时受检者取坐位,将下颌置于连接压力计的气囊上,以颈部肌肉牵引下颌压迫气囊,维持压力在120mmHg。在受试耳同侧胸锁乳突肌记录反应电位的P13和N23潜伏期,以及P13-N23振幅。另外对9名健康志愿者进行连续三周重复试验以检验此检测方法的可重复性。 结果:在健康志愿者,平均P13和N23潜伏期分别为13.97±1.33ms和24.03±1.79ms。平均P13-N23振幅为66.89±44.1μV。健康志愿者之间P13和N23潜伏期变异较小,而VEMP振幅变异较大,变化范围从30.57μV到198.57μV。左右耳之间各项指标均无显著差异,平均AR%为15.8±13.34%。9名耳硬化症患者有7例患耳VEMP消失,7例听神经瘤患者有3例患耳VEMP明显减弱(AR%40%)。三周重复试验显示检测结果具有良好的可重复性,组间相关系数在P13和N23分别为0.8和0.93、P13-N23振幅为0.97。 结论: 1、采用我们设计的颈部肌肉收缩力反馈控制装置,受检者在检测时可以通过观察压力表,反馈控制颈部肌肉收缩力度在120mmHg压力左右。实验结果表明,此检测方法简单实用,可以提高检测结果的稳定性和可重复性。 2、由于受检者之间VEMP振幅变异范围较大,从本次研究结果无法提出正常值范围。但是采用本检测方法,可以比较同一个体在不同时期VEMP振幅变化情况。 3、VEMP作为一种无创性前庭功能检测方法,在诊断梅尼埃病和上半规管裂等疾病时有一定的临床参考价值。
[Abstract]:Objective: vestibular evoked myogenic potential (VEMPP) is a clinical method for the objective evaluation of vestibular function by recording the response potential of skeletal muscle to vestibular organ excitatory response through strong tone stimulation. The amplitude of VEMP response potential is affected by the intensity of stimulus sound and the muscle contraction intensity of the site, which results in great variation of the test results, which makes it difficult to judge and compare the test results. The clinical value of VEMP as a non-traumatic vestibular function test was affected. This study focuses on improving the stability and repeatability of VEMP amplitude detection results by using a self-designed method to monitor and control the muscle contraction strength in the neck. To provide a simple and easy method for clinical objective evaluation of vestibular function. Methods: 19 healthy volunteers (n = 12, mean 34.0 卤7.7 years) and 16 patients with ear disease (otorsclerosis, n = 9, acoustic neuroma, n = 7) were examined. A pressure feedback device consisting of airbags and pressure gauges is designed to effectively control muscle contraction in the neck. During the test, the subjects took the sitting position, placed the mandible on the air bag connected to the pressure gauge, and pulled the mandibular compression balloon with the neck muscle to maintain the pressure at 120mm Hg. The latency of P13 and N23 and the amplitude of P13-N23 were recorded in the ipsilateral sternocleidomastoid muscle. Nine healthy volunteers were repeated for three weeks to test the reproducibility of the method. Results: the average latency of P13 and N23 in healthy volunteers were 13.97 卤1.33ms and 24.03 卤1.79msrespectively. The average amplitude of P13-N23 was 66.89 卤44.1 渭 V. The latency of P13 and N23 in healthy volunteers varied slightly, while the amplitude of VEMP varied greatly, ranging from 30.57 渭 V to 198.57 渭 V. There was no significant difference between the left and right ears, the average AR% was 15.8 卤13.34.9 patients with ear sclerosis, 7 patients with ear VEMP disappeared and 7 patients with acoustic neuroma. The results of three-week repeated test showed good repeatability, and the correlation coefficients between groups were 0.8 and 0.93n23, respectively, and the amplitudes of P13-N23 were 0.97. Conclusion: 1. By using the cervical muscle contractile force feedback control device designed by us, the subjects can observe the pressure gauge and control the cervical muscle contraction force about 120mmHg. The experimental results show that the method is simple and practical, and can improve the stability and repeatability of the detection results. 2. Due to the large range of variation of VEMP amplitude among the subjects, the normal range can not be proposed from the results of this study. However, this method can be used to compare the changes of VEMP amplitude in the same body at different periods. The diagnosis of Meniere's disease and superior semicircular canal fissure has certain clinical reference value.
【学位授予单位】:武汉大学
【学位级别】:博士
【学位授予年份】:2013
【分类号】:R764

【参考文献】

相关期刊论文 前1条

1 吴子明;张素珍;周娜;冀飞;陈艾婷;谢塑江;杨伟炎;韩东一;;几项耳功能检查在梅尼埃病诊断中的意义[J];临床耳鼻咽喉科杂志;2006年10期



本文编号:2012730

资料下载
论文发表

本文链接:https://www.wllwen.com/yixuelunwen/yank/2012730.html


Copyright(c)文论论文网All Rights Reserved | 网站地图 |

版权申明:资料由用户95def***提供,本站仅收录摘要或目录,作者需要删除请E-mail邮箱bigeng88@qq.com