本文選題：眩暈 + 半規(guī)管　； 參考：《天津醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的 良性陣發(fā)性位置性眩暈(BPPV)是頭部運(yùn)動到某一特定位置時(shí)誘發(fā)的短暫眩暈,是一種具有自限性的前庭周圍性疾病。近年來,視頻眼震圖(video nystagmo graph)的應(yīng)用普及使眼震方向、強(qiáng)度及時(shí)間等參數(shù)的判斷更加精確、客觀和方便,為BPPV眼震分析提供了技術(shù)支撐。本研究采用視頻眼震圖記錄、分析各類型BPPV患者位置試驗(yàn)時(shí)誘發(fā)眼震的方向、強(qiáng)度及時(shí)間等參數(shù)特征并深入探討其機(jī)制,為進(jìn)一步制定BPPV的客觀診斷方案提供依據(jù)。 方法 BPPV患者715例,其中水平半規(guī)管管石癥(Horizontal Semicircular Canalithasis, HSC-Can)208例、水平半規(guī)管壺腹嵴頂結(jié)石癥(horizontal semicircular canal cupulolithiasis, HSC-Cup)68例、后半規(guī)管管石癥(Posterior Semicircular Canal Canalithasis, PSC-Can)439例。應(yīng)用視頻眼震圖儀分別記錄位置試驗(yàn)誘發(fā)眼震,比較各個(gè)試驗(yàn)頭位的眼震方向、強(qiáng)度、時(shí)間等參數(shù)特點(diǎn)。采用SPSS17.0統(tǒng)計(jì)軟件進(jìn)行數(shù)據(jù)處理。 結(jié)果 水平半規(guī)管BPPV患者滾轉(zhuǎn)試驗(yàn)在左側(cè)、右側(cè)轉(zhuǎn)頭位均可誘發(fā)出水平性眼震,后半管BPPV患者在Dix-Hallpike試驗(yàn)中懸頭位、坐位均可誘發(fā)出垂直方向的眼震。HSC-Can與PSC-Can誘發(fā)眼震方向均與轉(zhuǎn)頭方向相同。HSC-Can向患側(cè)和健側(cè)轉(zhuǎn)頭位誘發(fā)眼震的潛伏期(均數(shù)±標(biāo)準(zhǔn)差)為(1.916±1.493)s和(1.452±0.811)s,持續(xù)時(shí)間為(24.924±10.105)s和(22.003±10.824)s,強(qiáng)度為(55.413±31.054)。/s和(26.128±13.889)。/s,向患側(cè)轉(zhuǎn)頭誘發(fā)眼震的潛伏期、持續(xù)時(shí)間及強(qiáng)度均大于健側(cè)轉(zhuǎn)頭位,差異均具有統(tǒng)計(jì)學(xué)意義(t值分別為3.697、15.051和3.897,P值均0.01),其中眼震強(qiáng)度之比約為2：1。HSC-Cup患者滾轉(zhuǎn)試驗(yàn)誘發(fā)的眼震方向與轉(zhuǎn)頭方向相反,向健側(cè)轉(zhuǎn)頭誘發(fā)眼震的強(qiáng)度明顯大于向患側(cè)轉(zhuǎn)頭,其強(qiáng)度之比約為2：1,差異具有統(tǒng)計(jì)學(xué)意義(t=-8.012,P0.01)；而向健側(cè)和向患側(cè)轉(zhuǎn)頭誘發(fā)眼震的潛伏期差異則無統(tǒng)計(jì)學(xué)意義(t=1.586,P0.05)。HSC-Can滾轉(zhuǎn)試驗(yàn)中向患側(cè)轉(zhuǎn)頭誘發(fā)眼震的潛伏期、強(qiáng)度均大于HSC-Cup向健側(cè)轉(zhuǎn)頭,但差異無統(tǒng)計(jì)學(xué)意義(P值均0.05)。PSC-Can懸頭位及坐位誘發(fā)垂直方向眼震的潛伏期(latency, L)、持續(xù)時(shí)間(duration,D)及強(qiáng)度(peak of slow phase velocity, P)分別為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)。在懸頭位誘發(fā)垂直方向眼震的潛伏期、強(qiáng)度明顯大于坐位,其中兩者強(qiáng)度之比近似2：1(t=14.477,P0.05),差異均具有統(tǒng)計(jì)學(xué)意義；兩者的眼震持續(xù)時(shí)間的差異無統(tǒng)計(jì)學(xué)意義(t=0.916,P0.05)。管石癥患者的滾轉(zhuǎn)試驗(yàn)向患側(cè)轉(zhuǎn)頭位或Dix-Hallpike試驗(yàn)患側(cè)懸頭位誘發(fā)的眼震存在兩種形式：有反轉(zhuǎn)相眼震和無反轉(zhuǎn)相眼震。647例管石癥患者中,379例(58.6%)有反轉(zhuǎn)相眼震。HSC-Can第一相眼震的強(qiáng)度較反轉(zhuǎn)相強(qiáng),而潛伏期和持續(xù)時(shí)間較反轉(zhuǎn)相眼震短,兩相眼震參數(shù)比較,差異均具有統(tǒng)計(jì)學(xué)意義(P0.01)。無反轉(zhuǎn)相眼震與有反轉(zhuǎn)相眼震HSC-Can患者的第一相眼震比較,其中眼震潛伏期、持續(xù)時(shí)間兩個(gè)參數(shù)間的差異均無統(tǒng)計(jì)學(xué)意義,但眼震強(qiáng)度的差異有統(tǒng)計(jì)學(xué)意義,有反轉(zhuǎn)相眼震患者的第一相眼震較強(qiáng)。PSC-Can第一相眼震與反轉(zhuǎn)相眼震比較,反轉(zhuǎn)相眼震的潛伏期和持續(xù)時(shí)間較長,強(qiáng)度較弱。差異均具有統(tǒng)計(jì)學(xué)意義(P0.01)。管石癥患者有反轉(zhuǎn)相眼震的第-相眼震與反轉(zhuǎn)相眼震相比較,其中潛伏期、持續(xù)時(shí)間、強(qiáng)度均大于反轉(zhuǎn)相眼震,差異具有統(tǒng)計(jì)學(xué)意義。有反轉(zhuǎn)相眼震的第一相眼震較強(qiáng),與無反轉(zhuǎn)相眼震患者的第一相眼震強(qiáng)度比較,差異均有統(tǒng)計(jì)學(xué)意義(P0.01)。PSC-Can和HSC-Can患者的其他試驗(yàn)頭位均未發(fā)現(xiàn)反轉(zhuǎn)相眼震。 結(jié)論 (1)BPPV位置試驗(yàn)誘發(fā)眼震特征遵循Ewald定律,BPPV既是臨床疾病,也可以作為研究人體半規(guī)管-眼震效應(yīng)的模型；(2)BPPV位置試驗(yàn)眼震圖的眼震方向、強(qiáng)度與持續(xù)時(shí)間可以作為BPPV耳石定位的客觀指標(biāo)；(3)反轉(zhuǎn)相眼震在BPPV管石癥中很常見,是管石癥的臨床特征之一,其產(chǎn)生機(jī)制類似于前庭后象眼震,是前庭后象反應(yīng)在BPPV患者的另一種表現(xiàn)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.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R764.3

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