前庭自旋转试验在耳源性眩晕中的应用

发布时间：2019-04-26 00:11

【摘要】：目的： 1.本文通过前庭自旋转试验在耳源性眩晕疾病患者中应用的结果分析,评估患者的高频前庭功能检查情况,探讨前庭自旋转试验在耳源性眩晕相关疾病中检查的临床应用价值。 2.通过对患者行前庭自旋转试验(vestibular autorotation test, VAT)及冷热试验(caloric test,CT)检查结果的对比分析,探讨高频前庭自旋转试验与传统低频的冷热试验联合应用对耳源性眩晕患者检查及诊断中的临床应用价值。方法：收集2014年2月～2014年8月在山东省立医院集团眼耳鼻喉医院眩晕疾病科就诊耳源性眩晕的患者,确诊病例共86人,其中男36人,女50人；年龄21岁-69岁,平均45.1岁；其中梅尼埃病患者36例,良性阵发性位置性眩晕(BPPV)38例,前庭神经炎12例。所有患者都行前庭自旋转试验(ves tibular autorotation test, VAT)及冷热试验(caloric test,CT)检查。在VAT中有五项检查指标,分别是水平增益及相移、垂直增益及相移,水平非对称性；VAT检查的指标如果非对称性、垂直增益与相移,水平增益与相移中出现1项或1项以上异常指标即可评定为该测试结果异常。冷热试验(caloric test,CT)中一侧水平半规管功能低下的判定标准是一侧功能减低(unilateral weakness, UW)值大于或等于20%。结果： VAT检查中,结果异常者为59例(68.6%)。异常结果中,其中相位异常48例(81.4%),增益异常42例(71.2%),非对称性异常10例(16.9%)；增益和相位病理数据分布具有的频率一致性。增益异常42例,包括水平增益异常34例,其中增益降低32例,增益升高2例；垂直增益异常8例,均为增益降低；其中水平及垂直增益均异常的为6例；相位异常48例,均表现为相位延迟,其中水平相位异常44例,垂直相位异常为4例；非对称性异常10例,均与前庭损伤侧别相符。检查的结果频率异常主要集中出现在某一波段,而不是全频异常。冷热试验(caloric test,CT)检查中半规管减弱和优势偏向结果为单项或双项异常的37例(43.0%)。两项对比试验中,单独结果异常VAT为31例(36%),冷热试验(caloric test,CT)为9例(10%)；两者均异常为28例(32.6%),两者总异常为68例(79.1%)。结论： 1、VAT作为高频、宽带的前庭检查技术,既能提供前庭高频区的功能信息,即反应传统前庭功能检测不能显示的高频水平VOR异常,又可检测垂直半规管功能,弥补了冷热试验(caloric test,CT)检查中的不足,提高了临床病情的诊断正确率。 2、VAT与冷热试验(caloric test,CT)联合应用,可相互补充,有助于更全面的了解半规管功能。 3、VAT为耳源性眩晕疾病的诊断提供了一种敏感的筛查方法,也是定位诊断的一种客观检测手段。使前庭功能检查更加完善,对疾病的明确诊断提供依据。
[Abstract]:Purpose: 1. In this paper, the results of the application of vestibular rotation test in patients with otogenic vertigo were analyzed, and the high frequency vestibular function test was evaluated, and the clinical application value of vestibular autorotation test in otogenic vertigo-related diseases was discussed. 2. The results of vestibular self-rotation test (vestibular autorotation test, VAT) and cold-heat test (caloric test,CT) were compared and analyzed. To explore the clinical value of high frequency vestibular rotation test combined with traditional low frequency cold-heat test in the examination and diagnosis of patients with otogenic vertigo. Methods: from February 2014 to August 2014, 86 patients (36 males and 50 females) with otogenic vertigo were admitted to the Department of vertigo, Otolaryngology Hospital of Shandong Provincial Hospital Group. Among them, 36 patients with Meniere's disease, 38 patients with benign paroxysmal positional vertigo (BPPV) and 12 patients with vestibular neuritis. All patients underwent vestibular autorotation test (ves tibular autorotation test, VAT) and cold-heat test (caloric test,CT). There are five indexes in VAT, namely horizontal gain and phase shift, vertical gain and phase shift, horizontal asymmetry; If asymmetry, vertical gain and phase shift, and one or more abnormal indexes appear in the horizontal gain and phase shift, the results of VAT can be evaluated as abnormal. The criterion of low horizontal semicircular canal function in cold-heat test (caloric test,CT) is that the (unilateral weakness, UW) value of one side function decrease is greater than or equal to 20%. Results: 59 cases (68.6%) were abnormal in VAT examination. Among the abnormal results, 48 cases (81.4%) had abnormal phase, 42 cases (71.2%) had abnormal gain and 10 cases (16.9%) had asymmetrical anomaly, and the distribution of gain and phase pathological data had the same frequency. There were 42 cases of gain abnormality, including 34 cases of horizontal gain abnormality, 32 cases of gain decrease and 2 cases of gain increase, 8 cases of vertical gain anomaly, 6 cases of horizontal and vertical gain abnormality, 6 cases of vertical gain abnormality, and 3 cases of vertical gain anomaly, including 6 cases of horizontal gain anomaly and 2 cases of vertical gain anomaly. All of the 48 cases showed phase delay, including 44 cases of horizontal phase anomaly and 4 cases of vertical phase anomaly, and 10 cases of asymmetrical anomaly, all of which were consistent with the vestibular injury side. The frequency anomalies of the check results mainly occur in a certain band, rather than all-frequency anomalies. In the cold-heat test (caloric test,CT), the semicircular canal weakening and dominant bias were found in 37 cases (43.0%) with one or two items abnormal. Among the two contrast tests, 31 cases (36%) had abnormal VAT and 9 cases (10%) had cold-hot test (caloric test,CT), 28 cases (32.6%) had abnormal results and 68 cases (79.1%) had abnormal results. Conclusion: 1. As a high-frequency and wide-band vestibular examination technique, VAT can not only provide the functional information of the high-frequency area of the vestibular, that is, reflect the high-frequency horizontal VOR abnormality which can not be displayed by the traditional vestibular function test, but also can detect the vertical semicircular canal function. It makes up for the deficiency of cold-heat test (caloric test,CT) and improves the diagnostic accuracy of clinical condition. 2. VAT combined with cold-heat test (caloric test,CT) can complement each other and contribute to a more comprehensive understanding of semicircular canal function. (3) VAT provides a sensitive screening method for the diagnosis of otogenic vertigo, and it is also an objective detection method for localizing diagnosis. To make the vestibular function examination more perfect, to provide the basis for the definite diagnosis of the disease.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R764

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