【摘要】：目的： 1.本文通過(guò)前庭自旋轉(zhuǎn)試驗(yàn)在耳源性眩暈疾病患者中應(yīng)用的結(jié)果分析,評(píng)估患者的高頻前庭功能檢查情況,探討前庭自旋轉(zhuǎn)試驗(yàn)在耳源性眩暈相關(guān)疾病中檢查的臨床應(yīng)用價(jià)值。 2.通過(guò)對(duì)患者行前庭自旋轉(zhuǎn)試驗(yàn)(vestibular autorotation test, VAT)及冷熱試驗(yàn)(caloric test,CT)檢查結(jié)果的對(duì)比分析,探討高頻前庭自旋轉(zhuǎn)試驗(yàn)與傳統(tǒng)低頻的冷熱試驗(yàn)聯(lián)合應(yīng)用對(duì)耳源性眩暈患者檢查及診斷中的臨床應(yīng)用價(jià)值。 方法： 收集2014年2月～2014年8月在山東省立醫(yī)院集團(tuán)眼耳鼻喉醫(yī)院眩暈疾病科就診耳源性眩暈的患者,確診病例共86人,其中男36人,女50人；年齡21歲-69歲,平均45.1歲；其中梅尼埃病患者36例,良性陣發(fā)性位置性眩暈(BPPV)38例,前庭神經(jīng)炎12例。所有患者都行前庭自旋轉(zhuǎn)試驗(yàn)(ves tibular autorotation test, VAT)及冷熱試驗(yàn)(caloric test,CT)檢查。在VAT中有五項(xiàng)檢查指標(biāo),分別是水平增益及相移、垂直增益及相移,水平非對(duì)稱(chēng)性；VAT檢查的指標(biāo)如果非對(duì)稱(chēng)性、垂直增益與相移,水平增益與相移中出現(xiàn)1項(xiàng)或1項(xiàng)以上異常指標(biāo)即可評(píng)定為該測(cè)試結(jié)果異常。冷熱試驗(yàn)(caloric test,CT)中一側(cè)水平半規(guī)管功能低下的判定標(biāo)準(zhǔn)是一側(cè)功能減低(unilateral weakness, UW)值大于或等于20%。結(jié)果： VAT檢查中,結(jié)果異常者為59例(68.6%)。異常結(jié)果中,其中相位異常48例(81.4%),增益異常42例(71.2%),非對(duì)稱(chēng)性異常10例(16.9%)；增益和相位病理數(shù)據(jù)分布具有的頻率一致性。增益異常42例,包括水平增益異常34例,其中增益降低32例,增益升高2例；垂直增益異常8例,均為增益降低；其中水平及垂直增益均異常的為6例；相位異常48例,均表現(xiàn)為相位延遲,其中水平相位異常44例,垂直相位異常為4例；非對(duì)稱(chēng)性異常10例,均與前庭損傷側(cè)別相符。檢查的結(jié)果頻率異常主要集中出現(xiàn)在某一波段,而不是全頻異常。冷熱試驗(yàn)(caloric test,CT)檢查中半規(guī)管減弱和優(yōu)勢(shì)偏向結(jié)果為單項(xiàng)或雙項(xiàng)異常的37例(43.0%)。兩項(xiàng)對(duì)比試驗(yàn)中,單獨(dú)結(jié)果異常VAT為31例(36%),冷熱試驗(yàn)(caloric test,CT)為9例(10%)；兩者均異常為28例(32.6%),兩者總異常為68例(79.1%)。 結(jié)論： 1、VAT作為高頻、寬帶的前庭檢查技術(shù),既能提供前庭高頻區(qū)的功能信息,即反應(yīng)傳統(tǒng)前庭功能檢測(cè)不能顯示的高頻水平VOR異常,又可檢測(cè)垂直半規(guī)管功能,彌補(bǔ)了冷熱試驗(yàn)(caloric test,CT)檢查中的不足,提高了臨床病情的診斷正確率。 2、VAT與冷熱試驗(yàn)(caloric test,CT)聯(lián)合應(yīng)用,可相互補(bǔ)充,有助于更全面的了解半規(guī)管功能。 3、VAT為耳源性眩暈疾病的診斷提供了一種敏感的篩查方法,也是定位診斷的一種客觀檢測(cè)手段。使前庭功能檢查更加完善,對(duì)疾病的明確診斷提供依據(jù)。
[Abstract]:Purpose: 1. In this paper, the results of the application of vestibular rotation test in patients with otogenic vertigo were analyzed, and the high frequency vestibular function test was evaluated, and the clinical application value of vestibular autorotation test in otogenic vertigo-related diseases was discussed. 2. The results of vestibular self-rotation test (vestibular autorotation test, VAT) and cold-heat test (caloric test,CT) were compared and analyzed. To explore the clinical value of high frequency vestibular rotation test combined with traditional low frequency cold-heat test in the examination and diagnosis of patients with otogenic vertigo. Methods: from February 2014 to August 2014, 86 patients (36 males and 50 females) with otogenic vertigo were admitted to the Department of vertigo, Otolaryngology Hospital of Shandong Provincial Hospital Group. Among them, 36 patients with Meniere's disease, 38 patients with benign paroxysmal positional vertigo (BPPV) and 12 patients with vestibular neuritis. All patients underwent vestibular autorotation test (ves tibular autorotation test, VAT) and cold-heat test (caloric test,CT). There are five indexes in VAT, namely horizontal gain and phase shift, vertical gain and phase shift, horizontal asymmetry; If asymmetry, vertical gain and phase shift, and one or more abnormal indexes appear in the horizontal gain and phase shift, the results of VAT can be evaluated as abnormal. The criterion of low horizontal semicircular canal function in cold-heat test (caloric test,CT) is that the (unilateral weakness, UW) value of one side function decrease is greater than or equal to 20%. Results: 59 cases (68.6%) were abnormal in VAT examination. Among the abnormal results, 48 cases (81.4%) had abnormal phase, 42 cases (71.2%) had abnormal gain and 10 cases (16.9%) had asymmetrical anomaly, and the distribution of gain and phase pathological data had the same frequency. There were 42 cases of gain abnormality, including 34 cases of horizontal gain abnormality, 32 cases of gain decrease and 2 cases of gain increase, 8 cases of vertical gain anomaly, 6 cases of horizontal and vertical gain abnormality, 6 cases of vertical gain abnormality, and 3 cases of vertical gain anomaly, including 6 cases of horizontal gain anomaly and 2 cases of vertical gain anomaly. All of the 48 cases showed phase delay, including 44 cases of horizontal phase anomaly and 4 cases of vertical phase anomaly, and 10 cases of asymmetrical anomaly, all of which were consistent with the vestibular injury side. The frequency anomalies of the check results mainly occur in a certain band, rather than all-frequency anomalies. In the cold-heat test (caloric test,CT), the semicircular canal weakening and dominant bias were found in 37 cases (43.0%) with one or two items abnormal. Among the two contrast tests, 31 cases (36%) had abnormal VAT and 9 cases (10%) had cold-hot test (caloric test,CT), 28 cases (32.6%) had abnormal results and 68 cases (79.1%) had abnormal results. Conclusion: 1. As a high-frequency and wide-band vestibular examination technique, VAT can not only provide the functional information of the high-frequency area of the vestibular, that is, reflect the high-frequency horizontal VOR abnormality which can not be displayed by the traditional vestibular function test, but also can detect the vertical semicircular canal function. It makes up for the deficiency of cold-heat test (caloric test,CT) and improves the diagnostic accuracy of clinical condition. 2. VAT combined with cold-heat test (caloric test,CT) can complement each other and contribute to a more comprehensive understanding of semicircular canal function. (3) VAT provides a sensitive screening method for the diagnosis of otogenic vertigo, and it is also an objective detection method for localizing diagnosis. To make the vestibular function examination more perfect, to provide the basis for the definite diagnosis of the disease.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類(lèi)號(hào)】：R764

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