多管受累的良性阵发性位置性眩晕的临床特点  

Clinical features of multiple canal involvement in benign paroxysmal positional vertigo

作　　者：高波[1] 黄魏宁[1] 宋海涛[1] 王利一[1] 周金梅[1] 

机构地区：[1]卫生部北京医院耳鼻咽喉科,100730

出　　处：《中华耳鼻咽喉头颈外科杂志》2009年第8期627-630,共4页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

摘　　要：目的探讨多管受累的良性阵发性位置性眩晕（benign paroxysmal positional vertigo，BPPV）的眼震特点和管石复位法治疗效果。方法根据患者典型的临床病史、红外视频眼震仪记录变位试验的眼震结果，确诊为多管受累的BPPV患者95例，所有患者均采用管石复位治疗。结果Dix—Hallpike试验和（或）滚转试验中，两个或两个以上头位可诱发出相同或不同眼震。双侧半规管同时受累的BPPV患者14例（14．7％），其中6例患者双侧后半规管同时受累，6例患者双侧外半规管同时受累，2例患者双侧前半规管同时受累。53例（55．8％）患者出现垂直向上扭转和垂直向下扭转的眼震，考虑为后半规管合并前半规管BPPV；20例（21．1％）患者出现垂直向卜扭转和水平方向的眼震，考虑为后半规管合并外半规管BPPV；5例患者出现垂直向下扭转和水平方向的眼震，考虑为前半规管合并外半规管BPPV；3例患者两种试验中出现三种不同眼震，考虑为多个半规管同时受累。采用管石复位治疗，以症状重的受累半规管为主，治愈62例（65．3％），有效27例（28．4％），无效6例（6．3％），总有效率93．7％（89／95）。结论多管受累的BPPV临床中并不少见，尤其以后半规管合并前半规管多见。通过管石复位治疗，多数患者有效。Objective To describe a series of patients with multiple canal involvement in benign paroxysmal positional vertigo （BPPV）, with respect to diagnosis and management. Methods Ninety-five individuals with symptoms of BPPV and positional nystagmus were included in this study. The diagnosis was based on a history of brief episodes of vertigo and the presence of multiple positional nystagmus as confirmed by video-oculographic examination. Patients were treated by means of different particle repositioning manoeuvres according to the affected canal. Results Ninety-five patients showed multiple positional nystagmus during the examination corresponding to simultaneous multi-canal BPPV. Fourteen patients （14. 7% ） had bilateral canal BPPV. Six patients had bilateral posterior canal. Six patients had bilateral horizontal canal, and two patients had bilateral anterior canal. Fifty-three patients（55.8% ） had torsional,up-beating nystagmus with down-beating nystagmus, which suggested possible affected both of posterior and anterior canals. Twenty patients （21.1%） had torsional up-beating nystagmus and horizontal direction nystagmus, which suggested possible affected both of posterior and horizontal canals. Five patients had down-beating nystagmus with horizontal nystagmus, which suggested affected both of anterior and horizontal canals.Three patients had torsional up-beating with down-beating and horzontal nystagmus, which suggested possible affected multiple canals. Treatment given to the patients varied according to the canal affected, started with the canal that elicited a strong positional nystagmus and vertigo, and 93.7% （ 89/95 ） of patients were symptom free or improved. Conclusions It has been found that multi-canal BPPV is not a rate observation in clinic, and most of them affected posterior and anterior canals. Treatment of multi-canal BPPV can be effective using repositioning maneuver.

关 键 词：半规管 眩晕 耳石膜 

分 类 号：R686[医药卫生—骨科学]