摘要
目的：分析良性阵发性位置性眩晕（ BPPV）患者变位试验中反转相眼震的参数特征，探讨其临床意义和产生机制。方法 BPPV患者183例，其中后半规管管石症（ posterior semicircular canalithasis， PSC-Can）108例（59.0％），水平半规管管石症（horizontal semicircular canalithasis， HSC-Can）55例（30.1％），水平和后半规管的壶腹嵴顶结石症（semicircular canal cupulolithiasis， SC-Cup）15例（8.2％），上半规管管石症（anterior semicircular canalithasis ，ASC-Can）5例（2.7％）。应用视频眼震图仪记录变位试验诱发的眼震，分析比较Dix-Hallpike试验各头位的垂直眼震以及滚转试验各头位水平眼震的方向、强度、时间等参数特点。结果15例SC-Cup和5例ASC-Can患者均未见反转相眼震；108例PSC-Can患者在Dix-Hallpike试验患侧悬头位诱发向上的垂直眼震（第一相眼震）消失之后，其中54例（50.0％）出现向下的垂直眼震（反转相眼震），其第一相眼震与反转相眼震的潜伏期、持续时间、眼震强度分别为[（2.00＆#177;1.10） s，（3.54＆#177;1.42） s]、[（16.27＆#177;4.95） s，（61.65＆#177;33.69） s]、[（51.80＆#177;25.25）＆#176;/s，（10.65＆#177;6.29）＆#176;/s]；55例HSC-Can患者在滚转试验患侧转头位诱发与转头方向相同的水平眼震（第一相眼震）消失之后，其中43例（78.2％）出现与转头方向相反的水平眼震（反转相眼震），其第一相眼震与反转相眼震的潜伏期、持续时间、眼震强度分别为[（1.67＆#177;1.07）s，（3.57＆#177;1.89） s]、[（25.19＆#177;9.74） s，（70.48＆#177;40.26） s]、[（68.47＆#177;30.18）＆#176;/s，（11.22＆#177;8.78）＆#176;/s]。通过配对t检验分别比较PSC-Can及HSC-Can患者第一相眼震与反转相眼震的潜伏期、眼震强度及持续时间，其差异均具有统计学意义（ P值均＜0.05）。通过独立样本t检验比较这两组管石症患者中有反转相眼震者与无反转相眼震者第一相眼震的参数，其中眼震强度的差异有统计学意义（P值均＜0.05）；而眼震潜伏期、持续时间的差异则均无统计学意义（P值均＞0.05）。结论反转相眼震在PSC-Can及HSC-Can患者中很常见，是其临床特征之一，分别出现在Dix-Hallpike试验患侧悬头位及滚转试验向患侧转头位；第一相眼震越强，越容易诱发反转相眼震；第一相眼震的潜伏期和持续时间较反转相眼震短，但眼震强度较反转相眼震强。正确认识反转相眼震有助于避免其对临床上耳石定位及复位产生干扰，其产生机制可能类似于前庭后象眼震，是前庭后象反应在BPPV患者的另一种表现形式。
Objective To investigate the clinical significances and formation mechanism by analyzing the characteristics of the reverse phase nystagmus parameters from benign paroxysmal positional vertigo （ BPPV ） positioning test.Methods There were 183 cases with BPPV , including 108 cases （59.0%） of posterior semicircular canal canalthasis , 55 cases （ 30.1%） of horizontal semicircular canal canalthasis, and 15 cases（8.2%） of horizontal and posterior semicircular canal cupulolithiasis and 5 cases （2.7%） of anterior semicircular canalithasis .The video-nystagmograph was utilized in positioning tests to induce nystagmus.The direction , intensity , time parameters characteristic of vertical nystagmus in＆amp;nbsp;Dix-Hallpike test and horizontal nystagmus in roll test were analyzed and compared.Results There were no reversal phase nystagmus in 15 cases of semicircular canal cupulolithiasis and 5 cases of anterior semicircular canalithasis .After the disappearance of vertical nystagmus which induced by hanging position （ the first phase nystagmus ） in 108 cases of posterior semicircular canalithasis of Dix-Hallpike test , there was 54 cases （ 50.0%） of posterior semicircular canal canalthasis displayed downward vertical nystagmus （reverse phase nystagmus ） .The latency, duration time and intensity of the first phase nystagmus and reverse phase nystagmus were [（2.00 ＆#177;1.10）s, （3.54 ＆#177;1.42）s], [（16.27 ＆#177;4.95）s, （61.65 ＆#177;33.69） s] and [ （ 51.80 ＆#177;25.25 ） ＆#176;/s, （ 10.65 ＆#177;6.29 ） ＆#176;/s ] respectively; 43 cases （ 78.2%） of horizontal semicircular canal canalithasis displayed the opposite to turning head （ reverse phase nystagmus ） after the horizontal nystagmus , similar with turning head disappeared in Roll test.The latency, duration time and intensity of the first phase of nystagmus and reverse phase nystagmus were [（1.67 ＆#177;1.07） s, （3.57 ＆#177; 1.89）s], [（25.19 ＆#177;9.74） s, （70.48 ＆#177;40.26） s] and [（68.47 ＆#177;30.18）＆#176;/s, （11.22 ＆#177;8.78）＆#176;/s] respectively.Comparing with the latency , duration time , intensity of first phase nystagmus and reverse phase nystagmus of posterior and horizontal semicircular canal canalithasis , the differences had statistical significances （P＆lt;0.05）.Comparing with the first phase nystagmus of reverse phase and no reverse phase nystagmus canalithasis , the difference of nystagmus intensity had statistical significances （ P＆lt;0.05）; but the differences of latency and duration of nystagmus had no significant difference （ P＆gt;0.05）.Conclusions It is common in PSC-Can and HSC-Can patients that reverse phase nystagmus is one of the clinical features of canalithasis.It appears in side head position of Rolling test or the hanging of Dix-Hallpike test.More power of the first phase nystagmus has , reverse phase nystagmus will be induced much easier.In comparison of the reverse phase nystagmus , the first phase nystagmus has the shorter incubation and duration , but it has more power .It is helpful to avoid interruptions of clinical statolith positioning and reset since we recognize the reverse phase nystagmus.The mechanism might be similar to the vestibular mirror image nystagmus.It is another form of the vestibular mirror image nystagmus in BPPV patients.
出处
《中华耳鼻咽喉头颈外科杂志》
CAS
CSCD
北大核心
2014年第5期384-389,共6页
Chinese Journal of Otorhinolaryngology Head and Neck Surgery
基金
天津市卫生局攻关课题（10KG219）
关键词
眩晕
前庭功能试验
眼震
病理性
Vertigo
Vestibular function tests
Nystagmus,pathologic
