良性阵发性位置性眩晕临床特点  

Clinical features of benign paroxysmal positional vertigo

作　　者：张祎[1] 刘博[1,2] 左丽静[1,2] 陈秀伍[1,2] 赵小燕[1,2] 段金萍[1] 

机构地区：[1]首都医科大学附属北京同仁医院耳鼻咽喉头颈外科耳鼻咽喉头颈科学教育部重点实验室(首都医科大学),北京100730 [2]北京市耳鼻咽喉科研究所,北京100005

出　　处：《中国耳鼻咽喉头颈外科》2010年第12期646-649,共4页Chinese Archives of Otolaryngology-Head and Neck Surgery

基　　金："十一五"国家科技支撑计划资助项目(2007BAI18B13)

摘　　要：目的分析良性阵发性位置性眩晕(benign paroxysmal positional vertigo,BPPV)患者临床特点。方法 2009年9月～2010年6月明确诊断BPPV的患者90例,详细记录病史、伴随症状、既往史,进行耳科常规检查、纯音听力测试和前庭功能检查,使用视频眼震图观察记录视动功能试验、冷热试验、水平滚转试验、变位试验等,计算半规管轻瘫(canal paresis,CP)值。结果①患者平均年龄(52.48±15.43)岁,男女比例为1∶2.1;耳鼻咽喉科首诊36例(40.0%)、神经内科首诊31例(34.4%)。②后半规管BPPV 51例(56.7%),水平半规管BPPV 18例(20.0%),上半规管BPPV 20例(22.2%),混合型BPPV 1例(1.1%)。③行前庭功能检查78例患者中有52例(66.7%)出现CP,当病史≤2周、2周<病史≤1个月、1个月<病史≤6个月、6个月<病史≤5年、病史>5年,CP所占比例分别为42.9%、61.5%、75.0%、84.2%、62.5%,P>0.05,不具有统计学意义。77例单侧BPPV患者中,患侧CP25例(32.5%),健侧CP11例(14.3%),双侧CP15例(19.5%)。④行纯音听力测试,67例BPPV患者(68耳)中有21例(21耳,30.9%)伴有感音神经性听力损失。结论 BPPV是常见的前庭系统疾病,病因尚不明确。可伴有前庭功能异常和感音神经性聋,临床上应重视对BPPV患者前庭功能和听功能评价,以明确相关的防治策略。OBJECTIVE To analyze the clinical features of benign paroxysmal positional vertigo（BPPV）.METHODS Ninety patients with BPPV were detailed with medical histories.The results of the routine examination,pure tone test,vestibular function test,vedio nystagmograph（VNG）,caloric test,Roll test and Dix-Hallpike test were recorded.RESULTS ①The mean age was（52.48±15.43）years,and male to female ratio was 1∶2.1,up to 34.4% and 40.0% of patients consulted the neurologists and the otolaryngologists first.②Fifty one cases（56.7%）presented posterior canal BPPV（PC-BPPV）,18（20.0%）horizontal canal BPPV（HC-BPPV）,20（22.2%）anterior canal BPPV（AC-BPPV）,and 1（1.1%）multipule canal BPPV.③Vestibular functional test showed that 52 of 78（66.7%）patients were diagnosed as canal paresis（CP）.When dizziness history≤2 weeks,≤1 month,≤6 months,≤5 years and5 years,the incidence of CP is 42.9%,61.5%,75.0%,84.2% and 62.5% respectively.There was no significant difference on the incidence of CP（P0.05）.Of 77 patients with unilateral BPPV,25（32.5%）patients showed ipsilateral CP,meanwhile 11（14.3%）and 15（19.5%）patients showed contralateral and bilateral CP.④Pure tone test showed that 21 of 67 cases（21 of 68 ears,30.9%）with sensorial-neural hearing loss.CONCLUSION Patients with BPPV may have vestibular dysfunction and hearing loss.Clinicians should pay close attention to this result.

关 键 词：眩晕 冷热试验 半规管 临床方案 

分 类 号：R764[医药卫生—耳鼻咽喉科]