以离地性眼震为表现的水平半规管良性阵发性位置性眩晕的诊治体会  

Management of horizontal semicircular canal benign paroxysmal positional vertigo with apogeotropic nystagmus

作　　者：靳哲 赵菲[1,2] 庄建华 陈瑛[1,2] 李艳成 赵忠新[1,2] 

机构地区：[1]第二军医大学第二附属医院神经内科 [2]第二军医大学眩晕诊治中心,上海200003

出　　处：《中国眼耳鼻喉科杂志》2014年第3期142-145,共4页Chinese Journal of Ophthalmology and Otorhinolaryngology

摘　　要：目的探讨以离地性眼震为表现的水平半规管良性阵发性位置性眩晕（HC—BPPV）的诊治。方法回顾分析2012年1～12月我科眩晕专病门诊诊治的经平卧侧头试验诱发出水平离地性眼震的HC—BPPV患者的临床资料。结果41例患者在行平卧侧头试验时诱发出水平离地性眼震，占同期HC—BPPV患者的27．7％（41／148），其眼震平均潜伏期为（2．53±1．24）s，眼震持续时间〉1min者33例、〈1min者8例。复位分2步进行，第1步给予Gufoni方法、平躺左右摇头训练及患侧侧卧位；第2步给予Barbecue翻滚法复位。第1步完成后，34例患者眼震转变成水平向地性，提示耳石黏附在壶腹嵴的半规管侧；5例眩晕与眼震迅速缓解，判断耳石黏附在椭圆囊侧；2例自发缓解。34例患者眼震转变为水平向地性后，其眼震平均潜伏期为（0．87±0．65）s，与复位前差异显著（t=7．040，P〈0．001）。其中眼震持续时间〈1min者26例，〉1min者8例。给予第2步Barbecue翻滚法复位后眩晕症状消失。结论眼震类型较眼震持续时间能更可靠地判断HC．BPPV类型。出现离地性眼震的HC—BPPV病因主要是壶腹嵴帽耳石症，其耳石更多黏附于壶腹嵴的半规管侧，予以分步复位治疗疗效确切。Objective To explore the diagnosis and treatment of horizontal semicircular canal benign paroxysmal positional vertigo （HC-BPPV） with apogeotropic nystagmus. Methods The clinical data of HC-BPPV with apogeotropie nystagmus from January to December 2012 were analyzed retrospectively. Results Forty-one patients showed apogeotropic nystagmus in head rolling test which accounted for 27.7% of all HC-BPPV patients during that period. The mean nystagmus latency was （2.53 ± 1.24） s, and 33 patients＇ nystagmus were longer than 1 min, while 8 patients＇ nystagmus duration periods were shorter than 1 min. Treatment maneuver included two steps. Firstly, Gufoni maneuver, head shaking maneuver and the affected side lying were applied. Secondly, Barbecue maneuver was applied. After the first step, 34 patients showed a changed nystagmus type which indicated that the otolith attached to the semicircular side, 5 patients showed a quick remission which indicated that the otolith attached to the utriele side, the other two relieved spontaneously. The mean nystagmus latency of 34 patients which turned to geotropic nystagmus were （0.87± 0.65 ） s. There was a significant difference between the latencies before and after nystagmus type change （t = 7. 040 ,P 〈 0.001 ）. Among them, 26 patients＇ nystagmus were shorter than 1 rain, while 8 patients＇ nystagmus were longer than 1 rain. After applying the Barbecue maneuver, the symptom disappeared. Conclusions The nystagmus type was more reliable than duration period in judging the type of HC-BPPV. Cupulolithiasis is the main etiology of HC-BPPV with apogeotropic nystagmus, and most of the otolith might attach to the semicircular side. The step-by-step maneuver is effective.

关 键 词：眩晕 水平半规管 离地性眼震 复位治疗 

分 类 号：R764[医药卫生—耳鼻咽喉科]