【摘要】：背景：經(jīng)顱多普勒(Transcranial Doppler TCD)能夠動態(tài)觀測腦血流變化，其易操作、便攜、價廉等優(yōu)點(diǎn)越來越廣泛的應(yīng)用于臨床實(shí)踐中，得到更多的臨床工作者的重視。TCD監(jiān)測是TCD應(yīng)用價值的延伸，其目的性強(qiáng)、雙側(cè)對比、觀測時間長等優(yōu)點(diǎn)能更客觀的反映腦血流變化。位置性眩暈又稱為體位性眩暈，是由于頭部或者身體位置的改變引起的眩暈。有研究發(fā)現(xiàn)，眩暈患者在體位變化后存在著腦血流調(diào)節(jié)的異常。然而位置性眩暈患者體位變化時腦血流調(diào)節(jié)的異常及患者生活質(zhì)量（Quality of Life QOL）未引起臨床足夠重視。在本研究中，對位置性眩暈患者依次行常規(guī)TCD檢查，轉(zhuǎn)頸試驗及臥立位變化的TCD監(jiān)測，評估其腦血流調(diào)節(jié)功能。應(yīng)用漢化的英文版眩暈障礙量表（Dizziness handicapinventory DHI）評分及Berg評分（Berg balance scale BBS）評估位置性眩暈患者健康相關(guān)生活質(zhì)量。 目的：探討位置性眩暈患者體位變化時腦血流動力學(xué)的變化及眩暈障礙對位置性眩暈患者健康相關(guān)生活質(zhì)量的影響。 方法：主要收集我院2013年3月至2014年1月門診及住院確診的體位性眩暈患者。使用TCD檢測患者臥位、臥-立位、立位腦血流速度值，比較其體位改變前后的腦血流值變化。同時采用DHI評分及Berg平衡障礙量表評分評估患者健康相關(guān)生活質(zhì)量，進(jìn)行腦血流動力學(xué)與眩暈患者生活質(zhì)量的相關(guān)分析。 結(jié)果： 1.納入位置性眩暈患者59例，男20例（33.9%），女39例（66.1%），男女比例為1:1.95；年齡19-81歲，平均52.41±14.66歲，以46-60歲年齡段發(fā)病人數(shù)最多。納入健康對照組36例，男性14例，女性22例，年齡19-81歲，平均年齡50.81±14.74歲。 2.職業(yè)調(diào)查顯示患者中工程師、教師、管理工作者等腦力工作者多見，調(diào)查中發(fā)現(xiàn)工程師、教師、管理工作者常從事伏案工作，易導(dǎo)致頭、頸部疲勞。 3.位置性眩暈DHI評分，功能評分16.58±3.34分，軀體評分15.59±3.65分，情感評分17.19±4.07分，DHI總分49.36±9.63分。輕度眩暈障礙患者（DHI評分≤34分）4例，中度眩暈障礙患者（36≤DHI評分≤52分）31例，重度眩暈障礙患者（DHI評分≥54分）24例。位置性眩暈患者BBS評分47.00±3.48分，BBS評分≤45分19例（32.2%），BBS評分＞45分40例（67.8%）。位置性眩暈患者DHI評分與Berg評分比較結(jié)果顯示各年齡段位置性眩暈患者DHI評分與Berg評分呈負(fù)相關(guān)。 4.(1)平臥位時位置性眩暈患者與健康對照組各動脈腦血流值無明顯差異(58.18±7.20cm/s vs60.42±8.17cm/s)。(2)轉(zhuǎn)頸后椎動脈收縮期血流速度峰值位置性眩暈組與健康對照組有顯著性差異。隨轉(zhuǎn)頸角度的增大，位置性眩暈組椎動脈血流速明顯下降。位置性眩暈組出現(xiàn)單側(cè)椎動脈血流下降21/59例(36%)，其中左側(cè)12/59例(20%)，右側(cè)9/59例(15%)，雙側(cè)血流均有下降者7/59例(12%),而健康對照組2/36例(0.56%)均為左側(cè)。轉(zhuǎn)頸試驗結(jié)果陽性：健康對照組2／39例，占0.56%，位置性眩暈組28/59例，占47％。兩組對比有顯著性差異。(3)TCD監(jiān)測發(fā)現(xiàn)臥立位變化時存在腦血流調(diào)節(jié)的改變，血流頻譜呈“~”型波浪式起伏。位置性眩暈患者組與健康對照組腦血流臥位基線水平時無差異（58.18±7.20cm/s vs60.4±8.17cm/s，P0.05）；但是位置性眩暈患者由臥位轉(zhuǎn)為立位后腦血流下降明顯，臥立位腦血流差值較健康對照組變化顯著（5.89±5.45cm/svs2.44±2.62cm/s，P0.05）輕、中、重度位置性眩暈患者臥位腦血流比較無明顯差異（60.14±12.12cm/s vs57.26±14.68vs56.14±11.39，F(xiàn)=0.33，P=0.56）；輕、中、重度位置性眩暈患者臥-立位腦血流差值比較亦無明顯差異（5.68±7.14cm/s vs6.12±5.07cm/s vs6.23±4.95cm/s，F(xiàn)=1.47，，P=0.48）。 結(jié)論：1.眩暈患者人數(shù)在46-60歲是發(fā)病高峰。2.位置性眩暈患者普遍存在生活質(zhì)量損害，中度、重度損害多見。3.轉(zhuǎn)頸試驗加TCD對位置性眩暈患者椎動脈顱內(nèi)段血流動力學(xué)變化敏感，能夠提高位置性眩暈患者轉(zhuǎn)頸試驗陽性的發(fā)現(xiàn)率。4.位置性眩暈患者體位變動時存在腦血管自身調(diào)節(jié)功能受損。
[Abstract]:Background: Transcranial Doppler (TCD) can dynamically observe the changes of cerebral blood flow, which is easy to operate, portable and low in cost. TCD monitoring is the extension of the value of TCD application. It has the advantages of strong intention, double-sided contrast, long observation time and so on, and can reflect the changes of cerebral blood flow more objectively. Positional vertigo is also known as postural vertigo, due to a change in the position of the head or body. It was found that there was an abnormality of cerebral blood flow regulation after the position change of the patients with vertigo. However, the abnormality of cerebral blood flow regulation and the quality of life QOL in patients with positional vertigo did not cause clinical enough attention. In this study, the cerebral blood flow regulation function of the patients with positional vertigo was assessed by means of routine TCD, transvervical and horizontal position changes. The health-related quality of life of the patients with positional vertigo was assessed by using the Chinese-English Vertigo handle (DHI) score and the Berg balance scale BBS. Objective: To study the changes of cerebral hemodynamics in patients with positional vertigo and the quality of health-related life in patients with positional vertigo. In response to the method, the patients in our hospital from March 2013 to January 2014 were mainly collected. Patients with halo. TCD was used to detect the blood flow velocity in the supine, horizontal and vertical position of the patient, and to compare the cerebral blood flow before and after the change in the position of the patient. Changes of the value of the patient's health-related quality of life were assessed by using the DHI score and the Berg balance disorder scale score, and the phase of the life quality of the patients with cerebral hemodynamics and vertigo was performed. cross-correlation analysis Results:1.59 patients with positional vertigo were included,20 (33.9%),39 (66.1%),1: 1.95,19-81 years old, 52.41-14.66 years old, and 46-60 years of age. The highest incidence of the segment was included in 36 healthy controls,14 males and 22 females. The age was 19 to 81 years. The average age was 50.81. In that survey, the engineer, the teacher, the management worker and other mental workers were found to be more common, and in the investigation, the engineer, the teacher and the management worker were often involved in the work of the case. The head and neck fatigue can be easily caused.3. The position-based vertigo DHI score, the functional score of 16.58-3.34, the body score of 15.59-3.65, the emotional score of 17.19-4.07, and the total score of DHI 49.36 to 9.63 points.4 patients with mild vertigo (34 scores of DHI score),31 patients with moderate vertigo (36% DHI score,52 points), and patients with severe vertigo (DH The scores of BBS in the patients with positional vertigo were 47.00, 3.48, and the BBS score was 45:19 (32.2%), and the BBS score was more than 45. 40 patients (67.8%). The results of the DHI score and the Berg score in the patients with positional vertigo showed a DHI score for patients with positional vertigo at all ages and B 4. (1) There was no significant difference (58.18) 7.20 cm/ s vs60 between the patients with position vertigo and the control group. .42 (8.17 cm/ s). (2) The peak position of the peak systolic blood flow velocity of the vertebral artery after subcervical vertigo There was a significant difference between the group and the healthy control group. The blood flow rate of the vertebral artery of the vertigo group was significantly decreased. The blood flow rate of the one-sided vertebral artery in the position vertigo group decreased by 21/59 (36%), of which 12/59 (20%) left,9/59 (15%) on the right,7/59 (12%) of the bilateral blood flow, and 2/3 of the healthy control group. 6 (0.56%) were left. The results of the test were positive:2/39 of the healthy control group, 0.56% in the healthy control group, and the position of the control group. Sickness group 28/59 cases,4% There was a significant difference between the two groups. (3) There was a change in the blood flow regulation of the cerebral blood flow in the case of the change of the horizontal standing position, and the blood flow spectrum was . There was no difference (58.18-7.20 cm/ s vs60.4-8.17 cm/ s, P0.05) in the patients with positional vertigo and the level of baseline in the healthy control group. 2.44 (2.62 cm/ s, P0.05). There was no significant difference in the blood flow of the patients with moderate and severe positional vertigo (60.14, 12.12 cm/ s vs57.26, 14.68 vs56.14, 11.39, F = 0.33, P = 0.56), and there was no significant difference (5.68 to 7.14 cm/ s vs6.12) 5.07 cm/ s vs6.23 and 4.95 cm/ s, F = 1.47 (P = 0.48). Conclusion:1. Patients with vertigo The number between 46 and 60 years is the peak of the disease.2. There is a common life in the patients with positional vertigo. 3. The rotational-neck test and TCD were sensitive to the hemodynamic changes of the vertebral artery of the vertebral artery of the patients with positional vertigo. The rate of finding positive in the neck test of patients with halo.4. The position of the patients with positional vertigo.
【學(xué)位授予單位】：南昌大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R741

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