两种递质的温度试验在健康人中检测结果的比较及冷热气试验诊断标准初探  

Clinical comparative study of caloric test with water or air in healthy individuals and diagnosing study on air caloric test

作　　者：梁茵菲 张姝琪 曾祥丽[1] 岑锦添[1] 黎志成[1] 袁涛[1] 方必兴 顾晶[1] LIANG Yinfei;ZHANG Shuqi;ZENG Xiangli;CEN Jintian;LI Zhicheng;YUAN Tao;FANG Bixing;GU Jing(Department of Otolaryngology,Third Affiliated Hospital of Sun Yat-sen University,Guangzhou,501630,China)

机构地区：[1]中山大学附属第三医院耳鼻咽喉科,广州501630

出　　处：《临床耳鼻咽喉头颈外科杂志》2018年第15期1130-1133,共4页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

基　　金：广州市科技计划项目(No:201709010036)

摘　　要：目的:探讨2种递质的温度试验在健康人群中检测结果的等效性及受试者的顺从性,建立冷热气试验的诊断标准,为温度试验的临床选择提供科学依据。方法:应用随机临床交叉试验,将募集的60名健康人分成A、B两组,A组先进行冷热水实验,洗脱效应后再进行冷热气试验,B组顺序相反。以SPV值、CP值及SPV、CP值95%CI作为评定指标,分析健康人中冷热水试验和冷热气试验的等效性,及冷热气试验的临床正常参考值及稳定性、顺从性。结果:(1)60例冷热水试验及冷热气试验CP值进行卡方检验,提示2种递质在检查健康人前庭功能时CP值无统计学差异,二者的CP值在判断半规管轻瘫上的符合率为85%(51/60)。(2)冷热水刺激所得SPV值明显高于冷热气刺激所得SPV值,2种递质在各温度相对应的SPV值比较,差异显著。(3)冷热水刺激CP值95%CI为8%~12%,平均值10%;冷热气刺激CP值95%CI为10%~15%,平均值12%。(4)初步拟定了各对应温度的SPV 95%CI,作为医学参考值。(5)根据观察及问卷调查的结果,冷热气检测受试者不适感持续时间更短,程度更轻,且问卷调查结果98.33%(59/60)的受试者选择冷热气,提示冷热气的顺从性更好。结论:(1)冷热气试验能满足临床对于水平半规管功能评估的需求,且患者舒适度更佳。但由于眼震强度较弱,临床提示前庭功能低下时(即SPV值过低)需要冷热水试验进行验证。(2)本研究所得健康人冷热气CP值上限21.66%,与既往使用的冷热水的标准值25%的上限相差较大,因此各实验室应建立属于自己实验室冷热气试验的参考值,不应盲目借用冷热水试验的标准值作为一侧半规管轻瘫标准。本研究结果提示,冷热气试验可以代替冷热水试验,如患者偏向冷热气,则可以作为优先选择。Objective：To explore the equivalence of the test results of the water or air caloric tests and the compliance of the test in the healthy individuals.To provide scientific basis for clinical standardization of caloric test.Method：Randomized crossover clinical trial,60 healthy individuals were divided into group A and group B.Water caloric test was carried out first in group A,and air caloric test was carried out after elution effect（one day interval）.The treatment of group B was opposite to group A.SPV（Slow Phase Velocity）,CP（canal paralysis）and SPV and CP＇s 95%CI were used as evaluation indexes to analyze the equivalence of water and air caloric test in healthy people and the clinical normal reference value and stability and compliance of the water and air caloric test.Result：（1）60 cases of caloric test CP value of chi square test suggested that there was no statistical difference between two kinds of media in the examination of the vestibular function of healthy individuals,and the CP value of the two was 85%（51/60）.（2）the SPV value of the was obviously higher than that of the air caloric test.The SPV value at each temperature of the water caloric test stimulation is quite different from the air caloric test stimulation.（3）The range of water caloric test stimulation CP 95%CI was 8%-12%,and the average value was 10%.The interval of air caloric test stimulation CP 95%CI was 10%-15% and the average value was 12%.（4）This study provided the corresponding SPV 95%CIas the medical reference values.（5）The subjects of 98.33%（59/60）of the questionnaire survey selecting air caloric test and the results of the observation indicated that the duration of the air caloric test was shorter and more comfortable.Conclusion：（1）Air caloric test can satisfied the needs of clinical assessment of horizontal semicircular canal function,and can make patients feel more comfortable.However,due to the weak intensity of nystagmus,water caloric test has to be used when the the SPV value is

关 键 词：温度试验 冷热水试验 冷热气试验 前庭功能 眩晕 

分 类 号：R764.3[医药卫生—耳鼻咽喉科]