后循环缺血性眩晕患者的前庭功能变化  

Changes of vestibular function in patients with posterior circulation ischemia vertigo

作　　者：林细康[1] 季晓林[1] 罗高青[2] 叶华[1] 严金柱[1] 

机构地区：[1]福建省级机关医院,福建卫生职业技术学院附属医院神经内科,福建福州350003 [2]福建省级机关医院,福建卫生职业技术学院附属医院耳鼻咽喉科,福建福州350003

出　　处：《中国耳鼻咽喉头颈外科》2016年第12期686-690,共5页Chinese Archives of Otolaryngology-Head and Neck Surgery

摘　　要：目的通过检测后循环缺血性眩晕（posterior circulation ischemic vertig,PCIV）患者前庭神经电生理和眼动功能的变化以探讨PCIV的前庭功能变化。方法对已经由临床和磁共振动脉成像或CT血管造影证实为PCIV的患者分别进行颈性前庭诱发肌源电位（cervical vestibular evoked myogenic potential,cVEMP）、眼性前庭诱发肌源电位（ocular vestibular evoked myogenic potential,oVEMP）、视频眼震电图（videonystagmography,VNG）及前庭双温交替试验（alternate bithermal caloric test,BT）等检查,并将各项检测数据与对照组的相应数据进行统计学分析。结果病例组cVEMP,o VEMP的潜伏期及左侧峰间振幅与对照组比较差异有统计学意义。病例组和对照组cVEMP左右侧潜伏期差异分别为（t=11.4、9.55、7.17和7.71,P〈0.00）。左侧峰间振幅差异（t=3.07,P〈0.00）。oVEMP左右侧潜伏期差异分别为（t=7.88、5.35、7.58和6.39,P〈0.00）。左侧峰间振幅差异为（t=2.33,P〈0.00）;右侧峰间振幅及双侧振幅差比值比较差异无统计学意义（P〉0.05）;VNG检查病例组扫视试验、平稳跟踪试验及视动试验的异常率明显增高,与对照组比较差异有显著性意义（扫视试验：χ~2=7.35,P〈0.01;平稳跟踪试验及视动试验：χ~2=8.08,P〈0.005）。病例组半规管轻瘫指数阳性率43%,对照组18%,两组半规管轻瘫指数对比差异有统计学意义（χ~2=4.40,P〈0.05）。结论 VEMP主要检测前庭神经的电生理变化,VNG和BT注重于视眼动和视前庭功能检测,能够在神经体征和影像学变化出现前敏感检测出PCIV的前庭功能异常变化,对PCIV的诊断、治疗和预后判断具有较大的价值,值得临床推广应用。OBJECTIVE To investigate the changes of vestibular function in patients with Posterior Circulation Ischemia Vertigo（PCIV） by testing vestibular nerve electrophysiology and eye movement function.METHODS PCIV patients confirmed by clinical and MRA or CTA were performed cervical vestibular evoked myogenic potentials（cVEMP）,ocular vestibular evoked myogenic potentials（oVEMP）,Videonystagmography（VNG） and vestibular double temperature alternating test（BT） examination,The test data of case group and the corresponding data of the control group were statistically analyzed.RESULTS There were significant differences in the latency and the amplitude of the left peak of cVEMP,oVEMP between the two groups.The differences of left and right side latency of cVEMP were11.4,9.55,7.17 and 7.71,respectively,P〈0.00.The left peak amplitude difference was 3.07,P〈0.00.The differences of left and right side latency of oVEMP were 7.88,5.35,7.58 and 6.39,respectively,P〈0.00 The left peak amplitude difference was 2.33,P〈0.00,the difference of the right amplitude and the amplitude difference of cVEMP,oVEMP were not statistically significant between the two groups（P〉0.05）.In VNG examinations,the abnormal rate of scanning test、smooth tracking test and visual test of case group was significantly higher,compared with the control group,there was significant difference（In saccade test：χ~2=7.35,P〈0.01;and in smooth tracking test and optokinetic tests：χ~2=8.08,P〈0.005）.The positive rate of CP in case group was 43%,the control group was 18%,there were significant difference of CP value between the two groups（χ~2=4.40,P〈0.05）.CONCLUSION VEMPs mainly detecte the vestibular nerve electrophysiological changes,and VNG and BT focus on eye movement and visual vestibular function test.They can sensitively detect abnormal changes in the vestibular function of PCIV before neurological signs and imaging changes,and have great values for diagnosis,treatment and prognosis of PCIV.They are worth being popular

关 键 词：眩晕 前庭功能试验 眼震电图描记术 后循环缺血 

分 类 号：R741[医药卫生—神经病学与精神病学]