單側(cè)前庭周圍性眩暈的平衡跟蹤試驗結(jié)果分析
發(fā)布時間：2018-08-11 16:06
【摘要】： 目的 視眼動系統(tǒng)檢查是系列化前庭功能檢查的基礎(chǔ),從視眼動系統(tǒng)的功能狀態(tài)及其與前庭系統(tǒng)的相互作用中,既可以了解前庭系統(tǒng)功能狀態(tài),又能區(qū)別前庭功能異常是屬于外周性還是中樞性的,對臨床前庭功能評定有重要價值。掃視跟蹤試驗、平穩(wěn)跟蹤試驗和視動性眼震檢查是臨床上最常用的檢測視眼動系統(tǒng)功能狀態(tài)的方法。本文通過對正常人視眼動系統(tǒng)檢查中各參數(shù)的正常值范圍進(jìn)行總結(jié),對單側(cè)前庭周圍性眩暈患者平穩(wěn)跟蹤試驗結(jié)果進(jìn)行定性、定量分析并探討其影響因素,為臨床上異常眼球運動的診斷、前庭系統(tǒng)的功能評估及眩暈的診斷等方面提供可靠有效的依據(jù)。方法 選取2007年3月-2009年4月天津市第一中心醫(yī)院耳鼻咽喉科頭頸外科眩暈中心收治的單側(cè)前庭周圍性眩暈患者,耳科及神經(jīng)科學(xué),影像學(xué)檢查鑒別診斷除外前庭中樞性病變、外傷性耳聾、對側(cè)耳聽力或前庭功能異常、鼓膜穿孔及有慢性中耳炎病史,且末次眩暈發(fā)作距就診時間一個月內(nèi)的患者,共計185例納入本研究實驗組范圍,其中男性98例,女性87例。包括突發(fā)聾伴眩暈167例,前庭神經(jīng)炎4例,Hunt綜合癥14例；同時選取51例同期接受檢查的我院醫(yī)護(hù)人員及家屬,無耳科疾病史,無眩暈史、無顱內(nèi)及神經(jīng)疾病史,眼科檢查正常者納入正常對照組。其中男性25例,女性26例。應(yīng)用法國Synapsys視頻眼震圖儀對185例單側(cè)前庭周圍性眩暈(實驗組)和51例正常人(正常對照組)行視眼動系統(tǒng)檢查(掃視跟蹤試驗、平穩(wěn)跟蹤試驗、視動性眼震)和自發(fā)性眼震(spontaneous nystagmus,SN)檢測,確定正常人視眼動系統(tǒng)檢查各參數(shù)的正常值范圍,并以平穩(wěn)跟蹤試驗(smooth pursuit test,SPT)水平眼跟蹤波的增益值及SN為評定參數(shù),對SPT眼動波形及增益進(jìn)行定性、定量分析,并分析SPT眼動增益與SN強度之間的相關(guān)性。結(jié)果 1.正常對照組水平掃視運動波形呈基線平直、快速上升和下降的矩形方波,可有幾個矯正性跳動,或有過沖或不足。一般不超過跟蹤幅度的10%；左向運動潛伏期和速度為(223±29)ms、(325±49.7)°／s,右向為(226±34)ms(338±46.3)°／s；平穩(wěn)跟蹤運動波形呈正弦形,左、右向?qū)ΨQ光滑。偶有掃視波疊加。潛伏期、速度、增益、兩側(cè)不對稱比左向分別為(97±8.4)ms、(33±7.9)°／s、0.83±0.08、(4±3.4)%,右向分別為(99±6.9)ms、(32±9.3)°／s、0.82±0.07、(4±3.4)%；視動性眼震的波形呈鋸齒狀,每一個眼震可分為慢相和快相兩部分,分別反映眼球追蹤視靶而緩慢偏移和注視下一個目標(biāo)快速復(fù)位的兩個過程,如此反復(fù)形成節(jié)律性視動性眼震。當(dāng)視靶光點速度加快時,視動性眼震頻率也加快。且三種眼球運動形式的各參數(shù)正常值范圍在性別和兩眼左、右側(cè)別等因素上沒有顯著性差異(均P0.05)。 2.實驗組SPT呈現(xiàn)為Ⅰ、Ⅱ、Ⅲ型波,分別為105例(56.8%)、72例(38.9%)、8例(4.3%),存在SN者58例(31.4%),無Ⅳ型波。正常對照組僅呈現(xiàn)Ⅰ、Ⅱ型波,分別為38例(74.5%)、13例(25.5%),無Ⅲ、Ⅳ型波及SN。量化分析：正常對照組、實驗組總體及定性劃分后各型波的強、弱側(cè)增益之間,兩組的弱側(cè)增益值之間均差異有統(tǒng)計學(xué)意義,組間的強側(cè)增益值之間差異無統(tǒng)計學(xué)意義。實驗組的Ⅰ、Ⅱ、Ⅲ型波強、弱側(cè)增益值分別為：0.86±0.06、0.80±0.06；0.78±0.09、0.65±0.10；0.68±0.13、0.45±0.12。實驗組的增益值與SN強度的相關(guān)性分析,兩者同向時呈負(fù)相關(guān)(rs=-0.63,P0.05),兩者異向時呈正相關(guān)(rs=0.43,P0.051。結(jié)論 本研究顯示正常人眼球的掃視運動、平穩(wěn)跟蹤運動、視動性眼震運動的各參數(shù)正常值范圍在性別和兩眼左、右側(cè)別等因素上沒有差異。其平穩(wěn)跟蹤運動可出現(xiàn)Ⅰ、Ⅱ型波,無Ⅲ、Ⅳ型波。增益值約為0.8。單側(cè)周圍性眩暈患者的平穩(wěn)跟蹤運動可出現(xiàn)Ⅰ、Ⅱ、Ⅲ型波,其對應(yīng)的增益值逐漸降低,其眼動增益受自發(fā)性眼震強度的影響。
[Abstract]:objective
Visual-oculomotor system examination is the basis of serialized vestibular function examination. From the functional state of visual-oculomotor system and its interaction with vestibular system, we can not only understand the functional state of vestibular system, but also distinguish whether vestibular dysfunction is peripheral or central. It is of great value for clinical vestibular function evaluation. Steady tracking test and optokinetic nystagmus test are the most commonly used methods to detect the functional state of the optokinetic system in clinic.This paper summarizes the normal range of the parameters in the examination of the optokinetic system in normal people and makes qualitative and quantitative analysis of the results of the steady tracking test in patients with unilateral peripheral vestibular vertigo. Influencing factors provide reliable and effective evidence for the diagnosis of abnormal eyeball movement, vestibular system function evaluation and vertigo diagnosis.
Patients with unilateral peripheral vestibular vertigo admitted to the Vertigo Center of Head and Neck Surgery, Department of Otorhinolaryngology, Tianjin First Central Hospital from March 2007 to April 2009 were selected. Otological and neurological examinations were performed to differentiate and diagnose central vestibular lesions, traumatic deafness, contralateral hearing loss or vestibular dysfunction, tympanic membrane perforation and chronic middle ear. 185 patients with history of inflammation, including 98 males and 87 females, including 167 deaf patients with vertigo, 4 vestibular neuritis and 14 Hunt syndrome, were included in this study. There were 25 males and 26 females. 185 patients with unilateral peripheral vestibular vertigo (experimental group) and 51 normal subjects (normal control group) were examined with Synapsys video nystagmography. Motion nystagmus (MN) and spontaneous nystagmus (SN) were detected to determine the normal range of each parameter in normal people's visual eye movement system examination. The SPT eye movement waveform and gain were qualitatively and quantitatively analyzed by using the gain value and SN of horizontal eye tracking wave of smooth pursuit test (SPT) as evaluation parameters. Correlation between gain and SN strength.
1. In the normal control group, the horizontal sweep motion waveforms were straight baseline, rapidly rising and falling rectangular waveforms, with several corrective beats, or overshoots or insufficiencies. Generally, they did not exceed 10% of the tracking amplitude; the latency and velocity of left-directional motion were (223 + 29) ms, (325 + 49.7) [s], and the right-directional motion was (226 + 34) MS (338 + 46.3) [s]; the stable tracking motion. The waveforms were sinusoidal, symmetrical and smooth in the left and right directions, occasionally superimposed by scanning waves. The latency, velocity, gain, and asymmetrical ratio on both sides were (97 Rhythmic optokinetic nystagmus is formed repeatedly for slow phase and fast phase, reflecting the two processes of eye tracking and slow deviation and rapid reset of the next target, respectively. As the speed of the eye spot increases, the frequency of optokinetic nystagmus also increases. Normal values of the parameters of the three types of eye movement are in the range of sex and two. There was no significant difference in left eye and right side (P0.05).
2. SPT in the experimental group showed type I, II and III waves, 105 cases (56.8%), 72 cases (38.9%), 8 cases (4.3%) with SN, 58 cases (31.4%) with SN and no type IV wave. In the normal control group, only type I and type II waves were present, 38 cases (74.5%), 13 cases (25.5%) without type III and type IV waves and SN. Quantitative analysis: The strength of all types of waves in the normal control group, the experimental group after overall and qualitative classification. There was no significant difference in the strong side gain between the two groups. In the experimental group, the wave strengths of type I, II and III were 0.86 (+) 0.06, 0.80 (+) 0.06, 0.78 (+) 0.09, 0.65 (+) 0.10, 0.68 (+) 0.13, 0.45 (+) 0.12), respectively. Correlation analysis showed that they were negatively correlated in the same direction (rs = - 0.63, P 0.05), and positively correlated in the opposite direction (rs = 0.43, P 0.051).
This study shows that there is no difference in the normal range of the parameters of the normal eye movement, the stable tracking motion and the normal range of the parameters of the optokinetic nystagmus movement between the sexes and the left and right side of the eyes. Type I, II and III waves may occur, and the corresponding gain decreases gradually. The oculomotor gain is affected by the intensity of spontaneous nystagmus.
【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】：2010
【分類號】：R764.04
本文編號：2177490
[Abstract]:objective
Visual-oculomotor system examination is the basis of serialized vestibular function examination. From the functional state of visual-oculomotor system and its interaction with vestibular system, we can not only understand the functional state of vestibular system, but also distinguish whether vestibular dysfunction is peripheral or central. It is of great value for clinical vestibular function evaluation. Steady tracking test and optokinetic nystagmus test are the most commonly used methods to detect the functional state of the optokinetic system in clinic.This paper summarizes the normal range of the parameters in the examination of the optokinetic system in normal people and makes qualitative and quantitative analysis of the results of the steady tracking test in patients with unilateral peripheral vestibular vertigo. Influencing factors provide reliable and effective evidence for the diagnosis of abnormal eyeball movement, vestibular system function evaluation and vertigo diagnosis.
Patients with unilateral peripheral vestibular vertigo admitted to the Vertigo Center of Head and Neck Surgery, Department of Otorhinolaryngology, Tianjin First Central Hospital from March 2007 to April 2009 were selected. Otological and neurological examinations were performed to differentiate and diagnose central vestibular lesions, traumatic deafness, contralateral hearing loss or vestibular dysfunction, tympanic membrane perforation and chronic middle ear. 185 patients with history of inflammation, including 98 males and 87 females, including 167 deaf patients with vertigo, 4 vestibular neuritis and 14 Hunt syndrome, were included in this study. There were 25 males and 26 females. 185 patients with unilateral peripheral vestibular vertigo (experimental group) and 51 normal subjects (normal control group) were examined with Synapsys video nystagmography. Motion nystagmus (MN) and spontaneous nystagmus (SN) were detected to determine the normal range of each parameter in normal people's visual eye movement system examination. The SPT eye movement waveform and gain were qualitatively and quantitatively analyzed by using the gain value and SN of horizontal eye tracking wave of smooth pursuit test (SPT) as evaluation parameters. Correlation between gain and SN strength.
1. In the normal control group, the horizontal sweep motion waveforms were straight baseline, rapidly rising and falling rectangular waveforms, with several corrective beats, or overshoots or insufficiencies. Generally, they did not exceed 10% of the tracking amplitude; the latency and velocity of left-directional motion were (223 + 29) ms, (325 + 49.7) [s], and the right-directional motion was (226 + 34) MS (338 + 46.3) [s]; the stable tracking motion. The waveforms were sinusoidal, symmetrical and smooth in the left and right directions, occasionally superimposed by scanning waves. The latency, velocity, gain, and asymmetrical ratio on both sides were (97 Rhythmic optokinetic nystagmus is formed repeatedly for slow phase and fast phase, reflecting the two processes of eye tracking and slow deviation and rapid reset of the next target, respectively. As the speed of the eye spot increases, the frequency of optokinetic nystagmus also increases. Normal values of the parameters of the three types of eye movement are in the range of sex and two. There was no significant difference in left eye and right side (P0.05).
2. SPT in the experimental group showed type I, II and III waves, 105 cases (56.8%), 72 cases (38.9%), 8 cases (4.3%) with SN, 58 cases (31.4%) with SN and no type IV wave. In the normal control group, only type I and type II waves were present, 38 cases (74.5%), 13 cases (25.5%) without type III and type IV waves and SN. Quantitative analysis: The strength of all types of waves in the normal control group, the experimental group after overall and qualitative classification. There was no significant difference in the strong side gain between the two groups. In the experimental group, the wave strengths of type I, II and III were 0.86 (+) 0.06, 0.80 (+) 0.06, 0.78 (+) 0.09, 0.65 (+) 0.10, 0.68 (+) 0.13, 0.45 (+) 0.12), respectively. Correlation analysis showed that they were negatively correlated in the same direction (rs = - 0.63, P 0.05), and positively correlated in the opposite direction (rs = 0.43, P 0.051).
This study shows that there is no difference in the normal range of the parameters of the normal eye movement, the stable tracking motion and the normal range of the parameters of the optokinetic nystagmus movement between the sexes and the left and right side of the eyes. Type I, II and III waves may occur, and the corresponding gain decreases gradually. The oculomotor gain is affected by the intensity of spontaneous nystagmus.
【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】：2010
【分類號】：R764.04
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