探讨仰卧正中位3眼震特征在HC-BPPV责任半规管判定及疗效预估中的价值  

Discussion and analysis the value of supine median3 nystagmus in the diagnosis and treatment of HC-BPPV

作　　者：邢娟丽[1] 杨盼 员艳宁 程子君 韩鹏 张婷[1] 李白芽[1] 常会敏[3] XING Juanli;YANG Pan;YUN Yanning;CHENG Zijun;HAN Peng;ZHANG Ting;LI Baiya;CHANG Huimin(Department of Otorhinolaryngology Head and Neck Surgery,First Affiliated Hospital of Xi'an Jiaotong University School of Medicine,Xi'an,710061,China;Department of Neurology,Jingyang County Hospital;Department of Otolaryngology Head and Neck Surgery,the First Affiliated Hospital of Xi'an Medical University)

机构地区：[1]西安交通大学第一附属医院耳鼻咽喉头颈外科,西安710061 [2]泾阳县医院神经内科 [3]西安医学院第一附属医院耳鼻咽喉头颈外科

出　　处：《临床耳鼻咽喉头颈外科杂志》2024年第5期432-435,441,共5页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

基　　金：国家重点研发计划资助(No:2023YFC2508002);陕西省重点研发计划一般项目(No:2024SF-YBXM-352)。

摘　　要：目的:探讨仰卧正中位3眼震特征在水平半规管良性阵发性位置性眩晕(horizontal canal benign paroxysmal positional vertigo,HC-BPPV)责任半规管准确判定及疗效预估中的临床价值。方法:选取2020年6月至2021年3月就诊于西安交通大学第一附属医院耳鼻咽喉头颈外科并确诊为HC-BPPV的患者187例,其中嵴顶结石症42例,管石症145例。采取快速轴位滚转试验(rapid axial roll test,RART)并详细记录患者在双耳下及仰卧正中位3引出的眼震参数,按照仰卧正中位3眼震方向分为3组:A组(眼震向弱侧)、B组(眼震向强侧)、C组(眼震阴性)。通过全自动前庭功能诊治系统(SRM-Ⅳ)进行复位治疗,比较3组HC-BPPV患者的复位治愈率,并进行多因素logistic回归分析HC-BPPV复位疗效的影响因素。结果:A组治愈率81.58%(62/76),B组治愈率16.13%(5/31),C组治愈率56.25%(45/80),3组治愈率比较,差异有统计学意义(χ^(2)=40.038,P<0.001),3组两两比较,患者治愈率差异均有统计学意义(χA-B2=40.294,P<0.001,χB-C2=14.528,P<0.001,χA-C2=11.606,P=0.001)。多因素logistic回归分析结果显示:仰卧正中位3眼震方向及BMI是HC-BPPV复位疗效的影响因素。结论:仰卧正中位3眼震的方向、强度及持续时间在判定HC-BPPV责任半规管中有重要意义。Objective To explore the clinical value of supine median3 nystagmus in the accurate diagnosis of horizontal semicircular canal benign paroxysmal positional vertigo(HC-BPPV).Methods A total of 187 patients with HC-BPPV admitted to the First Affiliated Hospital of Xi'an Jiaotong University from June 2020 to March 2021 were selected.Among them 42 cases of Cupulolithiasis and 145 cases of Canalithiasis.The nystagmus parameters of patients left and right supine position and supine median3 position were recorded in detail by RART.According to the direction of supine median3 nystagmus,patients were divided into three groups:group A(nystagmus to weak side),group B(nystagmus to strong side),group C(negative nystagmus).The canalith repositioning manoeuvres(CRM)was carried out by utility of an automatic vestibular function diagnosis and therapy system(SRM-Ⅳ).The cure rate of CRM in three groups of HC-BPPV patients was compared,Multivariate logistic regression analysis was performed to analyze the influencing factors of CRM for HC-BPPV.Results The cure rates of group A,group B and group C were 81.58%,16.13%and 56.25%,respectively.The difference among the three groups was statistically significant.Then a pairwise comparison of group A,B and C,the difference was statistically significant(χA-B2=40.294,P<0.001,χB-C2=14.528,P<0.001,χA-C2=11.606,P=0.001);the results of multivariate logistic regression analysis showed that the direction of supine median3 nystagmus and BMI were the influencing factors of CRM for HC-BPPV.Conclusion The direction,intensity and duration of supine median3 nystagmus play an important role in determining the responsibility semicircular canal of HC-BPPV.

关 键 词：仰卧正中位3眼震 水平半规管良性阵发性位置性眩晕 疗效预估 

分 类 号：R441.2[医药卫生—诊断学]