水平半规管良性阵发性位置性眩晕的临床特点

Clinical features of horizontal semicircular canal benign paroxysmal positional vertigo

目的探讨水平半规管良性阵发性位置性眩晕（benign paroxysmal positional vertigo,BPPV）的临床特点。方法回顾性分析2003年8月至2010年12月诊治的239例水平半规管BPPV患者的临床表现。结果水平半规管BPPV占同期全部BPPV患者的25．7％（239／931）。平卧侧头试验见水平向地性眼震者197例，眼震的平均潜伏期为（0．88±0．72）s，持续时间（26．36±19．71）S；水平离地性眼震者42例，平均潜伏期（2．69±1．83）S，持续时间（53．48±43．12）s；其中39例眼震表现为水平略带扭转向上而非纯水平，占16．3％（39／239）。离地组眼震潜伏期明显长于向地组（t=-6．33，P〈0．001），眼震持续时间亦明显长于向地组（t=-3．99，P〈0．001）。水平向地性眼震者予以Barbecue翻滚法治疗，192例经（1．6±0．8）个循环复位成功；水平离地性眼震者经左右侧头训练后，40例眼震转化为向地性，经（1．9±0．8）个循环后复位成功。结论水平半规管BPPV占同期BPPV的比例较预期高。水平向地性眼震患者可直接给予Barbecue翻滚法治疗，水平离地性眼震患者应先行左右侧头训练，再给予Barbecue翻滚法复位。

Objective To explore the clinical features of horizontal semicircular canal benign paroxysmal positional vertigo. Methods The clinical manifestations of 239 patients with horizontal semicircular canal benign paroxysmal positional vertigo from August 2003 to December 2010 were retrospectively analyzed. Results 25.7% （239/931） of all the benign paroxysmal positional vertigo patients were the horizontal semicircular canal benign paroxysmal positional vertigo was involved. One hundred and ninety-seven patients showed geotropic nystagmus in head rolling test with a mean latency period of （0. 88 ± 0. 72） s and a mean duration period of （26. 36 ± 19.71 ） s. Forty-two patients showed apogeotropic nystagmus in head rolling test with a mean latency period of （ 2. 69 ± 1. 83 ） s and a mean duration period of （53.48 ± 43.12 ）s. Among all the horizontal semicircular canal benign paroxysmal positional vertigo patients, 39 （16. 3% ） presented horizontal nystagmus with slight upbeating component. The nystagmus latency in apogeotropic nystagmus group was longer than that in geotropic nystagmus group （t = -6. 33,P 〈 0. 001 ）, and nystagmus duration period was also longer （t = -3.99, P 〈 0. 001 ）. Applied Barbecue maneuver to the patients with geotropic nystagmus, 192 patients were cured after （ 1.6 ± 0. 8 ） rotations; After applied head shaking maneuver to the patients with apogeotropic nystagmus, 40 patients changed to geotropic nystagmus and cured after （ 1.9 ± 0. 8 ） rotations. Conclusions Incidence rate of horizontal semicircular canal benign paroxysmal positional vertigo was higher than expectation. Barbecue maneuver was applied to patients with geotropic nystagmus. While to the patients with apogeotropic nystagmus, head shaking maneuver should be performed firstly and then followed by Barbecue maneuver.