后半规管管石症和嵴顶结石症复位眼震分析

龚清平; 张扬; 李远军; 徐先荣; 罗金叶

doi:10.13201/j.issn.1001-1781.2018.04.005

后半规管管石症和嵴顶结石症复位眼震分析

- 空军总医院航空航天眩晕诊疗研究中心(北京, 100142)
基金项目:
全军后勤标准项目（No：BKJ15B013）；全军后勤面上项目（No：CKJ14J013）；空军后勤部资助项目（No：BKJ10J054）

详细信息

通讯作者: 徐先荣,E-mail:xuxianrongkz@sina.com

中图分类号: R764.3

收稿日期: 2017-11-13

Analysis of repositioning nystagmus in patients with posterior canal benign paroxysmal positional vertigo

- Chinese PLA Center of Clinical Aviation Medicine, Vertigo Clinical Research Center of Aerospace, Air Force General Hospital of PLA, Beijing, 100142, China

More Information

Corresponding author: XU Xianrong, E-mail: xuxianrongkz@sina.com

Received Date: 13 November 2017

摘要

摘要: 目的：总结后半规管耳石在Epley复位第5位置（从仰卧位到坐起时）出现的四种眼震形式，总结其意义。方法：行Dix-hallpike试验明确诊断后半规管耳石，应用SRM-Ⅳ治疗仪描记在Epley复位治疗过程中产生的眼震，并观察复位第5步骤出现的眼震。符合PC-BPPV的入组患者共223例。将复位第5步骤出现不同的眼震分为四类，并讨论其临床意义。结果：①出现与诱发眼震方向一致的眼震，提示复位成功，共128例（57.4%）。②出现同侧前管兴奋性眼震，垂直成分相反、但旋转成分一致的眼震，也提示复位成功，共35例（15.7%）。③出现对侧前管兴奋性眼震，垂直和旋转成分均相反的眼震，提示复位不成功，共36例（16.1%），考虑后半规管顶石症或复位时耳石朝壶腹嵴方向流动所致，此时再次行2~3次Epley复位或Semont快速复位，可获成功。④如果旋转垂直性眼震消失后，患者仍诉眩晕，再行Roll-test试验时出现单纯水平性眼震，共24例（10.8%），提示耳石异位，再次行Barbecue复位，水平眼震可消失。后半规管管石症Epley 1次复位成功率（83.2%）高于嵴顶耳石症（23.1%），差异有统计学意义（χ²=46.198，P<0.01）。后半规管管石Epley复位成功平均次数（1.06±0.233）少于嵴顶耳石（2.08±0.744），差异有统计学意义（t=10.048，P<0.01）。结论：后半规管耳石复位时，根据不同眼震形式，可评价临床疗效。后半规管管石症行Epley 1次复位成功率高于嵴顶耳石症。
- 眩晕 /
- 后半规管 /
- 眼震 /
- 预后
Abstract: Objective: To conclude the four types of nystagmus in the final position during canalith repositioning procedure (CRP) for posterior canal benign paroxysmal positional vertigo (PC-BPPV), and predict the outcome of CRP therapy.Method: Nystagmus were recorded by an infrared charge-coupled devicecamera when underwent CRP therapy, which observed in the final position and concluded into four types.Result: Two hundred and twenty-three patients were included in our research and the results as follow. ①The nystagmus replicates the initial nystagmus during the Hallpike maneuver, which suggests therapeutic outcome,128 cases in total (57.4%). ②The direction of vertical component is composite while the rotary component is the same, also deeming a successful trial, 35 cases (15.7%). ③The direction of both vertical component and rotary component isreverse to the initial, which indicates a poor response, 36 cases (16.1%). ④Twenty-four cases (10.8%) showed no certain nystagmus but exhibit horizontal nystagmus in roll-test, denoting that the otolith moves to the lateral semicircular. At this appointment, the horizontal nystagmus can resolute after several times of barbecue maneuver. There is a significant difference of the one-time success rate (χ²=46.198, P<0.01) and the mean treatment times (t=10.048, P<0.01) between cupulolithiasis and canalolithiasis PC-BPPV.Conclusion: Different nystagmus in the final position of CRP maneuver is important in predicting the repositioning outcome. The one-time success rate of canalolithiasis is better than cupulolithiasis.
- vertigo /
- posterior canal /
- nystagmus /
- prognosis

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