良性阵发性位置性眩晕患者眼震参数客观特征

发布时间：2018-06-24 06:11

本文选题：眩晕 + 半规管　；参考：《天津医科大学》2014年硕士论文

【摘要】：目的良性阵发性位置性眩晕(BPPV)是头部运动到某一特定位置时诱发的短暂眩晕,是一种具有自限性的前庭周围性疾病。近年来,视频眼震图(video nystagmo graph)的应用普及使眼震方向、强度及时间等参数的判断更加精确、客观和方便,为BPPV眼震分析提供了技术支撑。本研究采用视频眼震图记录、分析各类型BPPV患者位置试验时诱发眼震的方向、强度及时间等参数特征并深入探讨其机制,为进一步制定BPPV的客观诊断方案提供依据。方法 BPPV患者715例,其中水平半规管管石症(Horizontal Semicircular Canalithasis, HSC-Can)208例、水平半规管壶腹嵴顶结石症(horizontal semicircular canal cupulolithiasis, HSC-Cup)68例、后半规管管石症(Posterior Semicircular Canal Canalithasis, PSC-Can)439例。应用视频眼震图仪分别记录位置试验诱发眼震,比较各个试验头位的眼震方向、强度、时间等参数特点。采用SPSS17.0统计软件进行数据处理。结果水平半规管BPPV患者滚转试验在左侧、右侧转头位均可诱发出水平性眼震,后半管BPPV患者在Dix-Hallpike试验中悬头位、坐位均可诱发出垂直方向的眼震。HSC-Can与PSC-Can诱发眼震方向均与转头方向相同。HSC-Can向患侧和健侧转头位诱发眼震的潜伏期(均数±标准差)为(1.916±1.493)s和(1.452±0.811)s,持续时间为(24.924±10.105)s和(22.003±10.824)s,强度为(55.413±31.054)。/s和(26.128±13.889)。/s,向患侧转头诱发眼震的潜伏期、持续时间及强度均大于健侧转头位,差异均具有统计学意义(t值分别为3.697、15.051和3.897,P值均0.01),其中眼震强度之比约为2：1。HSC-Cup患者滚转试验诱发的眼震方向与转头方向相反,向健侧转头诱发眼震的强度明显大于向患侧转头,其强度之比约为2：1,差异具有统计学意义(t=-8.012,P0.01)；而向健侧和向患侧转头诱发眼震的潜伏期差异则无统计学意义(t=1.586,P0.05)。HSC-Can滚转试验中向患侧转头诱发眼震的潜伏期、强度均大于HSC-Cup向健侧转头,但差异无统计学意义(P值均0.05)。PSC-Can悬头位及坐位诱发垂直方向眼震的潜伏期(latency, L)、持续时间(duration,D)及强度(peak of slow phase velocity, P)分别为L(2.670±1.810；1.366±1.204)、D(15.040±8.777；14.090±8.111)、P(27.438±19.269；14.126±9.437)。在悬头位诱发垂直方向眼震的潜伏期、强度明显大于坐位,其中两者强度之比近似2：1(t=14.477,P0.05),差异均具有统计学意义；两者的眼震持续时间的差异无统计学意义(t=0.916,P0.05)。管石症患者的滚转试验向患侧转头位或Dix-Hallpike试验患侧悬头位诱发的眼震存在两种形式：有反转相眼震和无反转相眼震。647例管石症患者中,379例(58.6%)有反转相眼震。HSC-Can第一相眼震的强度较反转相强,而潜伏期和持续时间较反转相眼震短,两相眼震参数比较,差异均具有统计学意义(P0.01)。无反转相眼震与有反转相眼震HSC-Can患者的第一相眼震比较,其中眼震潜伏期、持续时间两个参数间的差异均无统计学意义,但眼震强度的差异有统计学意义,有反转相眼震患者的第一相眼震较强。PSC-Can第一相眼震与反转相眼震比较,反转相眼震的潜伏期和持续时间较长,强度较弱。差异均具有统计学意义(P0.01)。管石症患者有反转相眼震的第-相眼震与反转相眼震相比较,其中潜伏期、持续时间、强度均大于反转相眼震,差异具有统计学意义。有反转相眼震的第一相眼震较强,与无反转相眼震患者的第一相眼震强度比较,差异均有统计学意义(P0.01)。PSC-Can和HSC-Can患者的其他试验头位均未发现反转相眼震。结论 (1)BPPV位置试验诱发眼震特征遵循Ewald定律,BPPV既是临床疾病,也可以作为研究人体半规管-眼震效应的模型；(2)BPPV位置试验眼震图的眼震方向、强度与持续时间可以作为BPPV耳石定位的客观指标；(3)反转相眼震在BPPV管石症中很常见,是管石症的临床特征之一,其产生机制类似于前庭后象眼震,是前庭后象反应在BPPV患者的另一种表现形式。
[Abstract]:objective
Benign paroxysmal positional vertigo (BPPV) is a transient vertigo induced by head movement to a certain position. It is a self limiting vestibular disease. In recent years, the application of video nystagmo graph has made the judgment of nystagmus direction, intensity and time more accurate, objective and convenient, as BPPV nystagmus The analysis provides technical support. This study uses video nystagmus record to analyze the direction, intensity and time of the induced nystagmus in the BPPV patients' position test and explore its mechanism, which provides the basis for further formulating the objective diagnosis scheme of BPPV.
Method
715 patients with BPPV, 208 cases of horizontal semicircular canal stone syndrome (Horizontal Semicircular Canalithasis, HSC-Can), 68 cases of the horizontal semicircular canals of ampullary crest stone (horizontal semicircular canal cupulolithiasis, HSC-Cup), and 439 cases of posterior semicircular canal stone disease (Posterior Semicircular). The graph instrument records the nystagmus induced by the position test, and compares the nystagmus direction, intensity and time of each test head, and uses the SPSS17.0 statistical software to process the data.
Result
BPPV patients with horizontal semicircular canals can induce horizontal nystagmus on the left side, the right turn head can induce a horizontal nystagmus. The posterior semicircular BPPV patients suspend the head position in the Dix-Hallpike test. The sitting position can induce the vertical direction of the nystagmus.HSC-Can and PSC-Can induced nystagmus, which are the same as.HSC-Can to the affected side and the healthy side. The incubation period (1.916 + 1.493) s and (1.452 + 0.811) s, duration (24.924 + 10.105) s and (22.003 + 10.824) s, intensity (55.413 + 31.054)./s and (26.128 + 13.889)./s, induced the latent period of nystagmus to the affected side, and the duration and intensity were greater than those of the healthy side, the difference was statistically significant (t value, respectively) The 3.697,15.051 and 3.897, P values were 0.01). The ratio of nystagmus intensity was about the opposite of the direction of the 2:1.HSC-Cup patient rolling test. The intensity of the nystagmus induced by the turn to the healthy side was significantly greater than that of the affected side. The intensity ratio was about 2:1, and the difference was statistically significant (t=-8.012, P0.01), but to the healthy side and to the affected side. The incubation period induced nystagmus difference was not statistically significant (t=1.586, P0.05).HSC-Can rolling test to induce the latent period of nystagmus, the intensity was greater than that of HSC-Cup to the healthy side, but the difference was not statistically significant (P value was 0.05).PSC-Can suspension head and sitting position induced the incubation period of vertical direction nystagmus (latency, L), duration of duration (latency, L). The duration (duration, D) and the intensity (peak of slow phase velocity, P) are L (2.670 + 1.810; 1.366 + 1.204), D (15.040 + 8.777; 14.090 + 8.111), P (27.438 + 19.269; 14.126 + 9.437). The incubation period of vertical direction induced by the suspension head is greater than the sitting position, and the intensity ratio is similar to 2:1 There was no statistically significant difference in the duration of nystagmus (t=0.916, P0.05). There were two forms of nystagmus induced by the roll test of the patients with tube stones to the lateral head or the side of the Dix-Hallpike test. 379 cases (58.6%) had reverse phase nystagmus and non reversal phase nystagmus patients (58.6%). The intensity of the first phase nystagmus of the phase nystagmus.HSC-Can is stronger than that of the reverse phase, while the latency and duration are shorter than those of the reverse phase, and the difference of the two phase nystagmus parameters is statistically significant (P0.01). The first phase nystagmus ratio of the non reversal phase nystagmus and the reverse phase nystagmus HSC-Can patients is between the nystagmus incubation period and the duration of the two parameters. There is no statistical significance, but the difference in nystagmus intensity is statistically significant. The first phase nystagmus of reverse phase nystagmus is stronger.PSC-Can first phase nystagmus and reverse phase iystagmus, the latent period and duration of reversal phase nystagmus are longer and the intensity is weaker. The difference is statistically significant (P0.01). The nystagmus of nystagmus was compared with reverse phase nystagmus, in which the latency, duration and intensity were greater than the reverse phase nystagmus, and the difference was statistically significant. The first phase nystagmus with reverse phase nystagmus was stronger, and the difference was statistically significant (P0.01).PSC-Can and HSC-Can patients compared with the first phase nystagmus intensity of patients without inversion phase nystagmus The reverse phase nystagmus was not found in the other test positions.
conclusion
(1) the BPPV position test induced the nystagmus to follow Ewald's law, BPPV is both a clinical disease and a model for the study of the human semicircular cannolal effect. (2) the eye earthquake direction of the BPPV position test, the intensity and duration can be the objective index of BPPV otolith location; (3) reverse phase iystagmus is very common in the case of BPPV tube stone disease. It is one of the clinical features of urolithiasis. Its mechanism is similar to that of posterior vestibular nystagmus. It is another manifestation of vestibular posterior reaction in BPPV patients.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R764.3

【参考文献】