良性阵发性位置性眩晕体位检查方法及临床价值的探讨  

An introduction of different positioning tests of benign paroxysmal positional vertigo and their clinical values

作　　者：梅晓峰[1] 纪树芳[1] 吕雪冰[1] 邝丽文[1] 

机构地区：[1]佛山市中医院耳鼻咽喉-头颈外科,广东佛山528000

出　　处：《临床耳鼻咽喉头颈外科杂志》2010年第19期872-875,879,共5页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

摘　　要：目的:探讨不同类型良性阵发性位置性眩晕(BPPV)各体位检查方法的临床应用价值。方法:本研究中后半规管BPPV(PC-BPPV)体位检查方法采用Dix-Hallpike test和Side-lying test;水平半规管(HC-BPPV)体位检查方法采用Roll test和WRW test;上半规管BPPV(SC-BPPV)体位检查方法采用Dix-Hallpike test、Side-lying test和Rahko T manoeuvre。将研究对象共613例随机分为2组,均按照PC-BPPV、HC-BPPV、SC-BPPV的体位检查顺序,先左侧后右侧进行检查,每进行下一项检查前静坐10min以上,两组之间PC-BPPV和HC-BPPV的体位检查方法的检查次序相反。观察并记录每个患者每种体位检查方法下有无眼震及特点。结果:Dix-Hallpike test和Side-lying test对PC-BPPV检出率的差异无统计学意义(P>0.05);Roll test和WRW test对HC-BPPV检出率的差异无统计学意义(P>0.05);Rahko T manoeuvre对SC-BPPV的检出率高于其余2种方法,差异均有统计学意义(均P<0.05)。PC-BPPV和HC-BPPV各体位检查方法两组之间的检出率差异均无统计学意义(均P>0.05),即采用不同的体位检查次序均不影响各方法的敏感性。结论:Dix-Hallpiketest对后半规管可以产生最有效刺激,仍然是PC-BPPV首选的体位检查方法;Side-lying test的敏感性与前者无明显差异且具有良好的操作可控性,可用于怀疑PC-BPPV且不易配合Dix-Hallpike test的患者;Roll test与WRW test对HC-BPPV的检出率无差异且均达到90%以上,但前者操作更安全简便,且检查结果有助于复位手法的选择,故Roll test应作为HC-BPPV的首选体位检查方法,WRW test可作为其补充;Rahko T manoeuvre对SC-BPPV的敏感性明显高于Dix-Hallpike test和Side-lying test,可用于验证2种方法初筛阳性的SC-BPPV患者,或筛查2种方法漏诊的SC-BPPV患者。受累半规管的判断不仅通过体位检查方法,更需注意诱发的眼震特点,以免误诊和漏诊。Objective：To explore the clinical value of different positioning tests for different benign paroxysmal positional vertigo（BPPV）.Method：This research applies Dix-Hallpike test and Side-lying test for PC-BPPV,Roll test and WRW test for HC-BPPV,Dix-Hallpike test,Side-lying test and Rahko T maneuvers for SC-BPPV.Six hundred and thirteen cases,who were tested with different positioning tests in the sequence of firstly PC-BPPV then HC-BPPV and finally SC-BPPV,were randomly divided into 2groups.Theorder of positioning tests for PCBPPV and HC-BPPV in the two groups was reversed.Result：There＇s no significant difference between the detection rate of Dix-Hallpike test and Side-lying test for PC-BPPV（P0.05）.Similarly,there＇s no difference in statistics between the detection rate of Roll test and WRW test for HC-BPPV（P0.05）.However,the detection rate of Rahko T maneuver was higher than the other two tests for SC-BPPV and the differences were statistically significant（P0.05）.The detection rates of different positioning tests for PC-BPPV and HC-BPPV between the two groups were not different in statistics（P0.05）,which implies that the different order had no effect on the sensitivity of each positioning test.Conclusion：Dix-Hallpike test is recommended as the first choice for PC-BPPV for its more efficient stimulus to the posterior semicircular canal,and Side-lying test is recommended as a prior choice to the patients with suspected PC-BPPV but unable to receive Dix-Hallpike test because of its similar sensitivity and more convenient manipulation.The detection rate of Both Roll test and WRW test were higher than 90%and there＇s no significant difference between the two tests.In addition,Roll test is easier to perform and helpful for the therapy,so it＇s considered as the preferred test for HC-BPPV with WRW test as the supplement test.Nevertheless,for SC-BPPV the sensitivity of Rahko T maneuver was higher than that of the other two tests,so it can be used to confirm the suspected SC-BPPV patients d

关 键 词：眩晕 体位检查 

分 类 号：R441.2[医药卫生—诊断学]