单侧前庭周围性眩晕的平衡跟踪试验结果分析
发布时间：2018-08-11 16:06
【摘要】： 目的 视眼动系统检查是系列化前庭功能检查的基础,从视眼动系统的功能状态及其与前庭系统的相互作用中,既可以了解前庭系统功能状态,又能区别前庭功能异常是属于外周性还是中枢性的,对临床前庭功能评定有重要价值。扫视跟踪试验、平稳跟踪试验和视动性眼震检查是临床上最常用的检测视眼动系统功能状态的方法。本文通过对正常人视眼动系统检查中各参数的正常值范围进行总结,对单侧前庭周围性眩晕患者平稳跟踪试验结果进行定性、定量分析并探讨其影响因素,为临床上异常眼球运动的诊断、前庭系统的功能评估及眩晕的诊断等方面提供可靠有效的依据。方法 选取2007年3月-2009年4月天津市第一中心医院耳鼻咽喉科头颈外科眩晕中心收治的单侧前庭周围性眩晕患者,耳科及神经科学,影像学检查鉴别诊断除外前庭中枢性病变、外伤性耳聋、对侧耳听力或前庭功能异常、鼓膜穿孔及有慢性中耳炎病史,且末次眩晕发作距就诊时间一个月内的患者,共计185例纳入本研究实验组范围,其中男性98例,女性87例。包括突发聋伴眩晕167例,前庭神经炎4例,Hunt综合症14例；同时选取51例同期接受检查的我院医护人员及家属,无耳科疾病史,无眩晕史、无颅内及神经疾病史,眼科检查正常者纳入正常对照组。其中男性25例,女性26例。应用法国Synapsys视频眼震图仪对185例单侧前庭周围性眩晕(实验组)和51例正常人(正常对照组)行视眼动系统检查(扫视跟踪试验、平稳跟踪试验、视动性眼震)和自发性眼震(spontaneous nystagmus,SN)检测,确定正常人视眼动系统检查各参数的正常值范围,并以平稳跟踪试验(smooth pursuit test,SPT)水平眼跟踪波的增益值及SN为评定参数,对SPT眼动波形及增益进行定性、定量分析,并分析SPT眼动增益与SN强度之间的相关性。结果 1.正常对照组水平扫视运动波形呈基线平直、快速上升和下降的矩形方波,可有几个矫正性跳动,或有过冲或不足。一般不超过跟踪幅度的10%；左向运动潜伏期和速度为(223±29)ms、(325±49.7)°／s,右向为(226±34)ms(338±46.3)°／s；平稳跟踪运动波形呈正弦形,左、右向对称光滑。偶有扫视波叠加。潜伏期、速度、增益、两侧不对称比左向分别为(97±8.4)ms、(33±7.9)°／s、0.83±0.08、(4±3.4)%,右向分别为(99±6.9)ms、(32±9.3)°／s、0.82±0.07、(4±3.4)%；视动性眼震的波形呈锯齿状,每一个眼震可分为慢相和快相两部分,分别反映眼球追踪视靶而缓慢偏移和注视下一个目标快速复位的两个过程,如此反复形成节律性视动性眼震。当视靶光点速度加快时,视动性眼震频率也加快。且三种眼球运动形式的各参数正常值范围在性别和两眼左、右侧别等因素上没有显著性差异(均P0.05)。 2.实验组SPT呈现为Ⅰ、Ⅱ、Ⅲ型波,分别为105例(56.8%)、72例(38.9%)、8例(4.3%),存在SN者58例(31.4%),无Ⅳ型波。正常对照组仅呈现Ⅰ、Ⅱ型波,分别为38例(74.5%)、13例(25.5%),无Ⅲ、Ⅳ型波及SN。量化分析：正常对照组、实验组总体及定性划分后各型波的强、弱侧增益之间,两组的弱侧增益值之间均差异有统计学意义,组间的强侧增益值之间差异无统计学意义。实验组的Ⅰ、Ⅱ、Ⅲ型波强、弱侧增益值分别为：0.86±0.06、0.80±0.06；0.78±0.09、0.65±0.10；0.68±0.13、0.45±0.12。实验组的增益值与SN强度的相关性分析,两者同向时呈负相关(rs=-0.63,P0.05),两者异向时呈正相关(rs=0.43,P0.051。结论 本研究显示正常人眼球的扫视运动、平稳跟踪运动、视动性眼震运动的各参数正常值范围在性别和两眼左、右侧别等因素上没有差异。其平稳跟踪运动可出现Ⅰ、Ⅱ型波,无Ⅲ、Ⅳ型波。增益值约为0.8。单侧周围性眩晕患者的平稳跟踪运动可出现Ⅰ、Ⅱ、Ⅲ型波,其对应的增益值逐渐降低,其眼动增益受自发性眼震强度的影响。
[Abstract]:objective
Visual-oculomotor system examination is the basis of serialized vestibular function examination. From the functional state of visual-oculomotor system and its interaction with vestibular system, we can not only understand the functional state of vestibular system, but also distinguish whether vestibular dysfunction is peripheral or central. It is of great value for clinical vestibular function evaluation. Steady tracking test and optokinetic nystagmus test are the most commonly used methods to detect the functional state of the optokinetic system in clinic.This paper summarizes the normal range of the parameters in the examination of the optokinetic system in normal people and makes qualitative and quantitative analysis of the results of the steady tracking test in patients with unilateral peripheral vestibular vertigo. Influencing factors provide reliable and effective evidence for the diagnosis of abnormal eyeball movement, vestibular system function evaluation and vertigo diagnosis.
Patients with unilateral peripheral vestibular vertigo admitted to the Vertigo Center of Head and Neck Surgery, Department of Otorhinolaryngology, Tianjin First Central Hospital from March 2007 to April 2009 were selected. Otological and neurological examinations were performed to differentiate and diagnose central vestibular lesions, traumatic deafness, contralateral hearing loss or vestibular dysfunction, tympanic membrane perforation and chronic middle ear. 185 patients with history of inflammation, including 98 males and 87 females, including 167 deaf patients with vertigo, 4 vestibular neuritis and 14 Hunt syndrome, were included in this study. There were 25 males and 26 females. 185 patients with unilateral peripheral vestibular vertigo (experimental group) and 51 normal subjects (normal control group) were examined with Synapsys video nystagmography. Motion nystagmus (MN) and spontaneous nystagmus (SN) were detected to determine the normal range of each parameter in normal people's visual eye movement system examination. The SPT eye movement waveform and gain were qualitatively and quantitatively analyzed by using the gain value and SN of horizontal eye tracking wave of smooth pursuit test (SPT) as evaluation parameters. Correlation between gain and SN strength.
1. In the normal control group, the horizontal sweep motion waveforms were straight baseline, rapidly rising and falling rectangular waveforms, with several corrective beats, or overshoots or insufficiencies. Generally, they did not exceed 10% of the tracking amplitude; the latency and velocity of left-directional motion were (223 + 29) ms, (325 + 49.7) [s], and the right-directional motion was (226 + 34) MS (338 + 46.3) [s]; the stable tracking motion. The waveforms were sinusoidal, symmetrical and smooth in the left and right directions, occasionally superimposed by scanning waves. The latency, velocity, gain, and asymmetrical ratio on both sides were (97 Rhythmic optokinetic nystagmus is formed repeatedly for slow phase and fast phase, reflecting the two processes of eye tracking and slow deviation and rapid reset of the next target, respectively. As the speed of the eye spot increases, the frequency of optokinetic nystagmus also increases. Normal values of the parameters of the three types of eye movement are in the range of sex and two. There was no significant difference in left eye and right side (P0.05).
2. SPT in the experimental group showed type I, II and III waves, 105 cases (56.8%), 72 cases (38.9%), 8 cases (4.3%) with SN, 58 cases (31.4%) with SN and no type IV wave. In the normal control group, only type I and type II waves were present, 38 cases (74.5%), 13 cases (25.5%) without type III and type IV waves and SN. Quantitative analysis: The strength of all types of waves in the normal control group, the experimental group after overall and qualitative classification. There was no significant difference in the strong side gain between the two groups. In the experimental group, the wave strengths of type I, II and III were 0.86 (+) 0.06, 0.80 (+) 0.06, 0.78 (+) 0.09, 0.65 (+) 0.10, 0.68 (+) 0.13, 0.45 (+) 0.12), respectively. Correlation analysis showed that they were negatively correlated in the same direction (rs = - 0.63, P 0.05), and positively correlated in the opposite direction (rs = 0.43, P 0.051).
This study shows that there is no difference in the normal range of the parameters of the normal eye movement, the stable tracking motion and the normal range of the parameters of the optokinetic nystagmus movement between the sexes and the left and right side of the eyes. Type I, II and III waves may occur, and the corresponding gain decreases gradually. The oculomotor gain is affected by the intensity of spontaneous nystagmus.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R764.04
本文编号：2177490
[Abstract]:objective
Visual-oculomotor system examination is the basis of serialized vestibular function examination. From the functional state of visual-oculomotor system and its interaction with vestibular system, we can not only understand the functional state of vestibular system, but also distinguish whether vestibular dysfunction is peripheral or central. It is of great value for clinical vestibular function evaluation. Steady tracking test and optokinetic nystagmus test are the most commonly used methods to detect the functional state of the optokinetic system in clinic.This paper summarizes the normal range of the parameters in the examination of the optokinetic system in normal people and makes qualitative and quantitative analysis of the results of the steady tracking test in patients with unilateral peripheral vestibular vertigo. Influencing factors provide reliable and effective evidence for the diagnosis of abnormal eyeball movement, vestibular system function evaluation and vertigo diagnosis.
Patients with unilateral peripheral vestibular vertigo admitted to the Vertigo Center of Head and Neck Surgery, Department of Otorhinolaryngology, Tianjin First Central Hospital from March 2007 to April 2009 were selected. Otological and neurological examinations were performed to differentiate and diagnose central vestibular lesions, traumatic deafness, contralateral hearing loss or vestibular dysfunction, tympanic membrane perforation and chronic middle ear. 185 patients with history of inflammation, including 98 males and 87 females, including 167 deaf patients with vertigo, 4 vestibular neuritis and 14 Hunt syndrome, were included in this study. There were 25 males and 26 females. 185 patients with unilateral peripheral vestibular vertigo (experimental group) and 51 normal subjects (normal control group) were examined with Synapsys video nystagmography. Motion nystagmus (MN) and spontaneous nystagmus (SN) were detected to determine the normal range of each parameter in normal people's visual eye movement system examination. The SPT eye movement waveform and gain were qualitatively and quantitatively analyzed by using the gain value and SN of horizontal eye tracking wave of smooth pursuit test (SPT) as evaluation parameters. Correlation between gain and SN strength.
1. In the normal control group, the horizontal sweep motion waveforms were straight baseline, rapidly rising and falling rectangular waveforms, with several corrective beats, or overshoots or insufficiencies. Generally, they did not exceed 10% of the tracking amplitude; the latency and velocity of left-directional motion were (223 + 29) ms, (325 + 49.7) [s], and the right-directional motion was (226 + 34) MS (338 + 46.3) [s]; the stable tracking motion. The waveforms were sinusoidal, symmetrical and smooth in the left and right directions, occasionally superimposed by scanning waves. The latency, velocity, gain, and asymmetrical ratio on both sides were (97 Rhythmic optokinetic nystagmus is formed repeatedly for slow phase and fast phase, reflecting the two processes of eye tracking and slow deviation and rapid reset of the next target, respectively. As the speed of the eye spot increases, the frequency of optokinetic nystagmus also increases. Normal values of the parameters of the three types of eye movement are in the range of sex and two. There was no significant difference in left eye and right side (P0.05).
2. SPT in the experimental group showed type I, II and III waves, 105 cases (56.8%), 72 cases (38.9%), 8 cases (4.3%) with SN, 58 cases (31.4%) with SN and no type IV wave. In the normal control group, only type I and type II waves were present, 38 cases (74.5%), 13 cases (25.5%) without type III and type IV waves and SN. Quantitative analysis: The strength of all types of waves in the normal control group, the experimental group after overall and qualitative classification. There was no significant difference in the strong side gain between the two groups. In the experimental group, the wave strengths of type I, II and III were 0.86 (+) 0.06, 0.80 (+) 0.06, 0.78 (+) 0.09, 0.65 (+) 0.10, 0.68 (+) 0.13, 0.45 (+) 0.12), respectively. Correlation analysis showed that they were negatively correlated in the same direction (rs = - 0.63, P 0.05), and positively correlated in the opposite direction (rs = 0.43, P 0.051).
This study shows that there is no difference in the normal range of the parameters of the normal eye movement, the stable tracking motion and the normal range of the parameters of the optokinetic nystagmus movement between the sexes and the left and right side of the eyes. Type I, II and III waves may occur, and the corresponding gain decreases gradually. The oculomotor gain is affected by the intensity of spontaneous nystagmus.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R764.04
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