Discussion and analysis the value of supine median3 nystagmus in the diagnosis and treatment of HC-BPPV
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摘要: 目的 探讨仰卧正中位3眼震特征在水平半规管良性阵发性位置性眩晕(horizontal canal benign paroxysmal positional vertigo，HC-BPPV)责任半规管准确判定及疗效预估中的临床价值。方法 选取2020年6月至2021年3月就诊于西安交通大学第一附属医院耳鼻咽喉头颈外科并确诊为HC-BPPV的患者187例，其中嵴顶结石症42例，管石症145例。采取快速轴位滚转试验(rapid axial roll test，RART)并详细记录患者在双耳下及仰卧正中位3引出的眼震参数，按照仰卧正中位3眼震方向分为3组：A组(眼震向弱侧)、B组(眼震向强侧)、C组(眼震阴性)。通过全自动前庭功能诊治系统(SRM-Ⅳ)进行复位治疗，比较3组HC-BPPV患者的复位治愈率，并进行多因素logistic回归分析HC-BPPV复位疗效的影响因素。结果 A组治愈率81.58%(62/76)，B组治愈率16.13%(5/31)，C组治愈率56.25%(45/80)，3组治愈率比较，差异有统计学意义(χ2=40.038，P < 0.001)，3组两两比较，患者治愈率差异均有统计学意义(χA-B2=40.294，P < 0.001，χB-C2=14.528，P < 0.001，χA-C2=11.606，P=0.001)。多因素logistic回归分析结果显示：仰卧正中位3眼震方向及BMI是HC-BPPV复位疗效的影响因素。结论 仰卧正中位3眼震的方向、强度及持续时间在判定HC-BPPV责任半规管中有重要意义。
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关键词:
- 仰卧正中位3眼震 /
- 水平半规管良性阵发性位置性眩晕 /
- 疗效预估
Abstract: Objective To explore the clinical value of supine median3 nystagmus in the accurate diagnosis of horizontal semicircular canal benign paroxysmal positional vertigo(HC-BPPV).Methods A total of 187 patients with HC-BPPV admitted to the First Affiliated Hospital of Xi'an Jiaotong University from June 2020 to March 2021 were selected. Among them 42 cases of Cupulolithiasis and 145 cases of Canalithiasis. The nystagmus parameters of patients left and right supine position and supine median3 position were recorded in detail by RART. According to the direction of supine median3 nystagmus, patients were divided into three groups: group A(nystagmus to weak side), group B(nystagmus to strong side), group C(negative nystagmus). The canalith repositioning manoeuvres(CRM) was carried out by utility of an automatic vestibular function diagnosis and therapy system(SRM-Ⅳ). The cure rate of CRM in three groups of HC-BPPV patients was compared, Multivariate logistic regression analysis was performed to analyze the influencing factors of CRM for HC-BPPV.Results The cure rates of group A, group B and group C were 81.58%, 16.13% and 56.25%, respectively. The difference among the three groups was statistically significant. Then a pairwise comparison of group A, B and C, the difference was statistically significant(χA-B2=40.294, P < 0.001, χB-C2=14.528, P < 0.001, χA-C2=11.606, P=0.001); the results of multivariate logistic regression analysis showed that the direction of supine median3 nystagmus and BMI were the influencing factors of CRM for HC-BPPV.Conclusion The direction, intensity and duration of supine median3 nystagmus play an important role in determining the responsibility semicircular canal of HC-BPPV. -
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表 1 HC-BPPV复位疗效的多因素logistic回归分析
影响因素 β SE Wals Sig Exp(β) 95% CI 下限 上限 性别 0.360 0.374 0.929 0.335 1.434 0.689 2.982 BMI分组 1.423 0.391 13.275 < 0.001 4.151 1.930 8.925 年龄分组 0.497 0.513 0.937 0.333 1.643 0.601 4.494 仰卧正中位眼震 仰卧正中位眼震(1) 2.130 0.565 14.185 < 0.001 8.412 2.777 25.483 仰卧正中位眼震(2) -1.489 0.415 12.861 < 0.001 0.226 0.100 0.509 
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