眼震-头脉冲-步态检查法在急性眩晕鉴别诊断中的应用  

The application of STANDING bedside algorithm in differential diagnosis of acute vertigo

作　　者：李山峰[1] 管锐瑞 沈磊[1] 韩永生[1] 范西真[1] LI Shan-feng;GUAN Rui-rui;SHEN Lei(Department of Emergency,Anhui Provincial Hospital,Hefei,Anhui 230000,Chin)

机构地区：[1]安徽省立医院急诊内科,安徽合肥230000 [2]安徽省立医院耳鼻喉科

出　　处：《中华全科医学》2018年第10期1612-1614,1768,共4页Chinese Journal of General Practice

基　　金：2016年安徽省卫生计生委科研计划项目(2016QK011)

摘　　要：目的评价眼震-头脉冲-步态检查法(spontaneous nystagmus,direction,head impulse test,standing,STANDING)鉴别中枢性眩晕的诊断价值。方法选取到急诊就诊的急性眩晕患者,收集临床资料,完成STANDING检查法,计算STANDING检查法诊断中枢性眩晕的敏感度和特异度。结果 2016年10月—2017年5月因眩晕就诊于安徽省立医院急诊内科的患者,符合入组标准的患者85例;其中,中枢性眩晕16例,周围性眩晕60例,9例患者不能确定病变部位。STANDING检查法对鉴别中枢性眩晕的灵敏度为100%,特异度为87.0%。在纳入研究的患者中,脑卒中组患者9例(10.6%),其余76例(89.4%)患者为非卒中组,比较发现卒中组年龄(67.3±5.7)岁,显著高于非卒中组(56.2±16.2)岁(t=2.028,P=0.046);脑卒中组患者均有一个以上血管性危险因素,非脑卒中组24例(31.6%)有1个以上危险因素,2组比较差异有统计学意义(χ2=7.413,P=0.006)。结论 STANDING检查法能有效筛查急性眩晕中的中枢性眩晕患者,如患者合并多个血管性危险因素,需高度警惕脑卒中可能。Objective To assess the diagnostic performance of STANDING（ spontaneous nystagmus,direction,head impulse test,standing） bedside algorithm to differentiate central form non-central acute vertigo（ AV）. Methods The clinical data of adult patients presenting to the emergency department with vertigo were collected and evaluated with STANDING. The sensibility and specificity of STANDING in diagnosis of central vertigo were calculated. Results A total of 85 patients who were treated in Anhui Provincial Hospital from October,2016 to May,2017 and met the criteria were included. And 16 cases had a diagnosis of central AV,60 cases had a diagnosis of peripheral AV,and 9 cases were unclear. The sensitivity of STANDING in diagnosis of central vertigo is 100%,and its specificity is 87%. All the patients were divided into stroke group（ 9 cases,10. 6%） and non-stroke group（ 76 cases,89. 4%）. The average ages of stroke group and non-stroke group are respectively（ 67. 3 ± 5. 7） years of age and（ 56. 2 ± 16. 2） years of age（ t =2. 028,P = 0. 046）. All stroke group patients have more than one stroke risk factor,but only 24（ 31. 6%） cases of nonstroke group patients do the same,which showed statistical significance between the two groups（ χ2= 7. 413,P =0. 006）. Conclusion STANDING bedside algorithm can preliminarily screen central AV with a very high sensitivity in Emergency room,and central AV with many stroke risk factors have a higher possibility of stroke.

关 键 词：眩晕 定位诊断 眼震-头脉冲-步态检查法 

分 类 号：R441.2[医药卫生—诊断学] R443[医药卫生—临床医学]