【摘要】：目的 前庭功能是人體重要的感覺功能,前庭感受器包括耳石器和半規(guī)管,半規(guī)管主要感受角加速度的變化,耳石器主要感受線加速度和頭部位置的變化。前庭功能評定是前庭系統(tǒng)疾病診治的重要環(huán)節(jié),既往只側(cè)重于半規(guī)管功能的檢查,由于耳石器特殊的解剖、生理特性和技術(shù)的限制,耳石器功能檢查在臨床難以有效開展。近年的研究發(fā)現(xiàn)主觀視覺垂直線(subjective visual vertical, SVV)在判斷耳石器功能、特別是雙側(cè)耳石器功能不對稱性方面有十分重要的意義。主觀視覺水平線(subjective visual horizontal,SVH)是否具有同樣的評定功能鮮有報道。本文通過對正常人主觀視覺水平線、主觀視覺垂直線的正常值范圍進行總結(jié),對單側(cè)外周前庭功能減退患者的主觀視覺水平線、主觀視覺垂直線進行定性、定量分析并探討其影響因素,為臨床上前庭系統(tǒng)的功能評估及眩暈的診斷、前庭康復等方面提供可靠有效的依據(jù)。 方法 設(shè)立正常人為對照組和單側(cè)外周前庭功能減退患者為試驗組,進行對照試驗研究。正常對照組為我院醫(yī)護人員及家屬共39例,女21例,男18例,要求視力正常,既往無眩暈、平衡障礙、聽力障礙、中耳炎等耳科疾患病史,無神經(jīng)科及肌肉骨骼系統(tǒng)疾病史。試驗組病例于2009年3月至2010年5月來自天津市第一中心醫(yī)院耳鼻咽喉頭頸外科眩暈中心,共計85例,男性38例,女性47例；其中突發(fā)性聾50例、前庭神經(jīng)炎18例、Hunt綜合征4例、單側(cè)慢性中耳炎4例、梅尼埃病9例；耳科及神經(jīng)科學、影像學檢查鑒別診斷除外前庭中樞性病變、外傷性耳聾等,且末次眩暈發(fā)作距就診時間一個月內(nèi)的患者。應(yīng)用法國Synapsys視頻眼震電圖儀及其主觀視覺垂直線、主觀視覺水平線插件、德國ATMOS冷熱氣刺激儀,按常規(guī)要求行冷熱試驗(Caloric test, CT)和主觀視覺垂直線、主觀視覺水平線檢測。對照組單獨進行主觀視覺垂直線、主觀視覺水平線檢查,試驗組先行主觀視覺垂直線、主觀視覺水平線檢查,然后完成冷熱試驗。觀測正常人主觀視覺垂直線、主觀視覺水平線的正常值范圍,以主觀視覺垂直線、主觀視覺水平線的偏斜角度、冷熱試驗優(yōu)勢偏向(directional preponderance, DP)、單側(cè)半規(guī)管輕癱(unilateral weakness, UW)值為評定參數(shù),對主觀視覺水平線及主觀視覺垂直線的偏斜角度、冷熱試驗優(yōu)勢偏向、單側(cè)半規(guī)管輕癱值進行定性、定量分析,分析主觀視覺水平線與主觀視覺垂直線之間的相關(guān)性,且各自與優(yōu)勢偏向、單側(cè)半規(guī)管輕癱值之間的相關(guān)性。 結(jié)果 1.正常對照組主觀視覺水平線、主觀視覺垂直線向左和向右的偏斜角度呈正態(tài)分布,以x±s表示,右向偏斜分別為0.80±0.58°、0.93±0.54°,左向偏斜分別為1.13±0.44°、0.94±0.53°,健康對照組主觀視覺水平線、主觀視覺垂直線右向偏斜角度的95%可信區(qū)間分別為0°-1.94°、0°-1.99°；左向偏斜95%可信區(qū)間分別為0.27°-1.99°、0°-1.98°,故本研究以主觀視覺水平線、主觀視覺垂直線在—2.00°-2.000為正常參考范圍。85例試驗組的主觀視覺水平線、主觀視覺垂直線偏斜角度范圍分別為—22.20°-20.33°、—18.90°-20.40°,右向偏斜分別為4.26±4.56°、4.40±4.67°,左向偏斜分別為4.10±4.69°、4.32±4.80°,健康對照組與試驗組主觀視覺水平線、主觀視覺垂直線右向及左向偏斜角度分別進行兩組獨立樣本資料的t檢驗,差異均有統(tǒng)計學意義(t值分別為-4.31、—4.83、3.98、3.32,P值均0.05)。 2.試驗組主觀視覺水平線與主觀視覺垂直線之間行Pearson積差相關(guān)分析顯示,二者之間呈正相關(guān)(r=0.939,P值0.01)。試驗組DP值、UW值均呈正態(tài)分布,Pearson積差相關(guān)分析顯示,主觀視覺水平線、主觀視覺垂直線偏斜角度分別與DP值呈正相關(guān)(r分別為0.648、0.658,P值均0.01),而與UW值無相關(guān)性(r值分別為0.048、0.085,P值均0.05)。 3.根據(jù)主觀視覺水平線或主觀視覺垂直線、DP、UW 3個參數(shù)的陽性或陰性組合,可分別構(gòu)成三種主要結(jié)果形式：主觀視覺水平線(+),主觀視覺垂直線(+),DP(+)UW(+)；主觀視覺水平線(一),主觀視覺垂直線(一),DP(+),UW(+)；主觀視覺水平線(一),主觀視覺垂直線(一),DP(一),UW(+),其病程中位數(shù)分別為5、10、15 d,5、9.5、14.5 d,分別行多樣本秩和檢驗,差異均有統(tǒng)計學意義(χ2水平線=8.80,P=0.012；χ2垂直線=6.26,P=0.040)。 結(jié)論 主觀視覺水平線可以評估耳石器(橢圓囊)功能；單側(cè)外周前庭功能減退患者的主觀視覺水平線、主觀視覺垂直線偏斜角度隨病程和前庭代償進程呈動態(tài)變化,可用于前庭靜態(tài)代償評定。
[Abstract]:objective
Vestibular function is an important sensory function of the human body. The vestibular receptors include the otolith and the semicircular canal, the semicircular canals mainly feel the change of angular acceleration. The otolith organs mainly feel the change of the line acceleration and the position of the head. Vestibule function evaluation is an important link in the diagnosis and treatment of vestibular system diseases, with a previous emphasis on the examination of the function of the semicircular canal, because The special anatomical, physiological and technical limitations of the otolith are difficult to carry out in clinical practice. In recent years, it is found that the subjective visual vertical line (subjective visual vertical, SVV) is of great significance in judging the function of the otolith, especially the function of the bilateral otolith. It is rarely reported whether (subjective visual horizontal, SVH) has the same evaluation function. By summarizing the normal visual horizontal line of the normal person and the subjective visual vertical line, the subjective visual horizontal line and the subjective visual vertical line of the patients with unilateral peripheral vestibule dysfunction are qualitatively, quantitatively analyzed and discussed. The influencing factors can provide reliable and effective evidence for clinical evaluation of vestibular system function, diagnosis of vertigo and vestibular rehabilitation.
Method
The normal control group was established as the control group and the unilateral peripheral vestibule hypofunction in the experimental group. The normal control group was 39 cases, 21 women and 18 men in our hospital, with normal visual acuity, no previous vertigo, balance disorder, hearing impairment, otitis media and other ear disorders, no neurology and musculoskeletal system. From March 2009 to May 2010, the experimental group came from the vertigo center of the otolaryngology head and neck surgery in Tianjin First Central Hospital, including 85 cases, 38 males and 47 females, including 50 cases of sudden deafness, 18 cases of vestibular neuritis, 4 cases of Hunt syndrome, 4 cases of unilateral chronic otitis, 9 cases of Meniere's disease, and the ear and neuroscience, and the shadow of neuroscience. Patients with vestibule central lesions, traumatic deafness, and the duration of the final vertigo interval for one month were excluded. The French Synapsys video lngg and the subjective visual vertical line, the subjective vision horizontal line plug-in, the German ATMOS cold heat irritation instrument, and the cold and heat test (Caloric test) were performed according to the routine requirements. CT) and subjective visual vertical line, subjective vision horizontal line detection. The control group performed subjective visual vertical line, subjective vision horizontal line examination, subjective visual vertical line, subjective vision horizontal line examination before the test group, and then completed the cold and heat test. Subjective visual vertical line, skew angle of subjective vision horizontal line, directional preponderance, DP, and unilateral semicircular canal hemiplegia (unilateral weakness, UW) value as evaluation parameters, skew angle of subjective visual horizontal line and subjective visual vertical line, advantage bias of cold and heat test, unilateral semicircular canal hemiplegia value Qualitative and quantitative analysis, analysis of the correlation between the subjective visual horizontal line and the subjective visual vertical line, and the correlation with the dominant bias and the unilateral semicircular hemiplegia.
Result
1. the subjective visual horizontal line of the normal control group, the subjective visual vertical line has a normal distribution to the left and right oblique angles, with x + s, the right deviation is 0.80 + 0.58, 0.93 + 0.54 degrees respectively, the left oblique deviation is 1.13 + 0.44, 0.94 + 0.53 degrees respectively, and the subjective vision horizontal line of the healthy control group and the 95% of the subjective visual vertical line right deviation angle are 95% The interval of the letter is 0 -1.94 and 0 -1.99, and the 95% confidence interval of the left oblique deviation is 0.27 -1.99 and 0 -1.98, respectively. Therefore, the subjective visual horizontal line and the subjective visual vertical line from 2 to -2.000 are the subjective visual horizontal lines of the normal reference range, and the angle range of the visual vertical line deviation is 22.20 degrees respectively. 20.33 degrees, 18.90 degrees -20.40 degrees, the right deviation was 4.26 + 4.56, 4.40 + 4.67 degrees, the left deviation was 4.10 + 4.69 degrees, 4.32 + 4.80 degrees respectively. The subjective visual horizontal line of the healthy control group and the experimental group, the t test of the subjective visual vertical line right direction and left oblique angle respectively, the difference was statistically significant (t value). They are -4.31, - 4.83,3.98,3.32, and P values are 0.05).
2. the correlation analysis of Pearson product difference between the subjective visual horizontal line and the subjective visual vertical line showed that there was a positive correlation between the two groups (r=0.939, P value 0.01). The DP value of the experimental group, UW values were all positive distribution, and the Pearson product difference correlation analysis showed that the subjective visual horizontal line and the subjective visual vertical line deviation angle were positively correlated with the DP value (r score). The values were 0.648, 0.658, P 0.01, respectively, but no correlation with UW values (r values were 0.048, 0.085, P values were 0.05).
3. the positive or negative combinations of the 3 parameters of the subjective visual horizontal line or the subjective visual vertical line, DP, UW can form three main forms: subjective vision horizontal line (+), subjective visual vertical line (+), DP (+) UW (+); subjective vision horizontal line (1), subjective visual vertical line (1), DP (+), UW (+); subjective vision horizontal line (1), master Visual vertical line (1), DP (I), UW (+), the median of the course of disease were 5,10,15 D and 5,9.5,14.5 D respectively, and the different rank and test were performed respectively. The difference was statistically significant (=8.80, P=0.012, =6.26, P=0.040) of the x 2 horizontal line.
conclusion
The subjective visual horizontal line can evaluate the function of the otolith (oval SAC); the subjective visual horizontal line of the unilateral peripheral vestibule dysfunction patients, the subjective visual vertical line deflection angle with the course of disease and the vestibular compensatory process, can be used for the vestibular static compensatory assessment.
【學位授予單位】：天津醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2011
【分類號】：R764.04

【參考文獻】

相關(guān)期刊論文 前10條

1 張道宮;樊兆民;韓月臣;于剛;王海波;;前庭下神經(jīng)炎的臨床分析[J];中國耳鼻咽喉頭頸外科;2010年06期

2 薛彬;楊軍;;聽神經(jīng)瘤患者前庭誘發(fā)肌源性電位的特征[J];臨床耳鼻咽喉頭頸外科雜志;2008年01期

3 吳軍;王錦玲;謝娟;韓麗萍;高磊;;大前庭水管綜合征患者的聽力學及前庭誘發(fā)肌源性電位檢測的特點[J];臨床耳鼻咽喉頭頸外科雜志;2010年01期

4 趙曉燕;王建明;黃安;;前庭誘發(fā)肌源性電位在梅尼埃病診斷中的意義[J];實用醫(yī)技雜志;2008年01期

5 吳子明,張素珍,周娜,趙承君,陳艾亭,楊偉炎,韓東一;伴眩暈的突發(fā)性聾患者橢圓囊-球囊功能分析[J];聽力學及言語疾病雜志;2005年06期

6 馬匯川;隱斜視淺析[J];中國眼鏡科技雜志;2005年11期

7 謝溯江;鄭穎鵑;賈宏博;;前庭誘發(fā)的肌源性電位新進展[J];中國眼耳鼻喉科雜志;2009年04期

8 陳�；�;陳曉霞;;眩暈病278例的病因分析[J];中國社區(qū)醫(yī)師(醫(yī)學專業(yè));2010年34期

9 吳子明,張素珍,趙承君,楊偉炎,韓東一;耳石功能檢查儀的設(shè)計與臨床初步應(yīng)用[J];中華耳鼻咽喉科雜志;2004年09期

10 ;梅尼埃病的診斷依據(jù)和療效評估(2006年,貴陽)[J];中華耳鼻咽喉頭頸外科雜志;2007年03期

，

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