本文選題：前庭誘發(fā)肌源性電位 + 眩暈��； 參考：《武漢大學(xué)》2013年博士論文

【摘要】：目的：前庭誘發(fā)肌源性電位(VEMP)是一種通過(guò)強(qiáng)音刺激,記錄骨骼肌對(duì)于前庭器官興奮發(fā)生反應(yīng)電位的客觀評(píng)估前庭功能的臨床檢測(cè)方法。在實(shí)際檢測(cè)過(guò)程中,VEMP反應(yīng)電位振幅受到刺激音強(qiáng)度和檢測(cè)部位肌肉收縮強(qiáng)度的影響,造成檢測(cè)結(jié)果變異較大,為臨床判斷和比較檢測(cè)結(jié)果帶來(lái)一定困難,使VEMP作為非創(chuàng)傷性前庭功能檢測(cè)方法的臨床應(yīng)用價(jià)值受到影響。本研究重點(diǎn)通過(guò)采用一種自行設(shè)計(jì)的在檢測(cè)時(shí)監(jiān)測(cè)和控制頸部肌肉收縮力度的方法,提高VEMP振幅檢測(cè)結(jié)果的穩(wěn)定性和可重復(fù)性,為臨床客觀評(píng)估前庭功能提供一種簡(jiǎn)單易操作的方法。 方法：受檢者為19名健康志愿者(12名男性,平均34.0±7.7歲)和16名耳部疾病患者(耳硬化癥9例,聽神經(jīng)瘤7例)。為了讓受檢者在檢測(cè)時(shí)可以有效控制頸部肌肉收縮力度,專門設(shè)計(jì)一個(gè)由氣囊和壓力表組成的壓力反饋裝置。檢測(cè)時(shí)受檢者取坐位,將下頜置于連接壓力計(jì)的氣囊上,以頸部肌肉牽引下頜壓迫氣囊,維持壓力在120mmHg。在受試耳同側(cè)胸鎖乳突肌記錄反應(yīng)電位的P13和N23潛伏期,以及P13-N23振幅。另外對(duì)9名健康志愿者進(jìn)行連續(xù)三周重復(fù)試驗(yàn)以檢驗(yàn)此檢測(cè)方法的可重復(fù)性。 結(jié)果：在健康志愿者,平均P13和N23潛伏期分別為13.97±1.33ms和24.03±1.79ms。平均P13-N23振幅為66.89±44.1μV。健康志愿者之間P13和N23潛伏期變異較小,而VEMP振幅變異較大,變化范圍從30.57μV到198.57μV。左右耳之間各項(xiàng)指標(biāo)均無(wú)顯著差異,平均AR%為15.8±13.34%。9名耳硬化癥患者有7例患耳VEMP消失,7例聽神經(jīng)瘤患者有3例患耳VEMP明顯減弱(AR%40%)。三周重復(fù)試驗(yàn)顯示檢測(cè)結(jié)果具有良好的可重復(fù)性,組間相關(guān)系數(shù)在P13和N23分別為0.8和0.93、P13-N23振幅為0.97。 結(jié)論： 1、采用我們?cè)O(shè)計(jì)的頸部肌肉收縮力反饋控制裝置,受檢者在檢測(cè)時(shí)可以通過(guò)觀察壓力表,反饋控制頸部肌肉收縮力度在120mmHg壓力左右。實(shí)驗(yàn)結(jié)果表明,此檢測(cè)方法簡(jiǎn)單實(shí)用,可以提高檢測(cè)結(jié)果的穩(wěn)定性和可重復(fù)性。 2、由于受檢者之間VEMP振幅變異范圍較大,從本次研究結(jié)果無(wú)法提出正常值范圍。但是采用本檢測(cè)方法,可以比較同一個(gè)體在不同時(shí)期VEMP振幅變化情況。 3、VEMP作為一種無(wú)創(chuàng)性前庭功能檢測(cè)方法,在診斷梅尼埃病和上半規(guī)管裂等疾病時(shí)有一定的臨床參考價(jià)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 鹵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 鹵1.33ms and 24.03 鹵1.79msrespectively. The average amplitude of P13-N23 was 66.89 鹵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 鹵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.
【學(xué)位授予單位】：武漢大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2013
【分類號(hào)】：R764

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相關(guān)期刊論文 前1條

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本文編號(hào)：2012730