前庭自旋转试验对前庭神经炎患者康复疗效的评价

Application of vestibular autorotation test in the rehabilitation of patients with vestibular neuritis

目的分析前庭神经炎患者前庭自旋转试验的特征表现及临床意义,以及在前庭康复治疗中的价值。方法选择2016年9月至2017年12月共42例前庭神经炎患者,分别以增益、相移、非对称性偏向作为前庭自旋转试验的评价参考指标。结果本组42例患者增益降低占73.81%(31/42)、相移延迟占61.90%(26/42)、非对称性偏向占19.05%(8/42),与对照组相比,增益降低(χ~2=17.890,P=0.000)和相移延迟(χ~2=12.446,P=0.001)组间差异具有统计学意义,而非对称性偏向组间差异无统计学意义(χ~2=0.010,P=0.920)。康复治疗3个月后,前庭自旋转试验显示联合治疗组患者增益降低与相移延迟基本恢复至正常值范围,增益降低(χ~2=8.005,P=0.005)和相移延迟(χ~2=8.400,P=0.004)发生率较单纯药物治疗组降低且差异具有统计学意义。结论前庭自旋转试验可用于分析前庭神经炎患者的高频区间半规管功能状态,有助于前庭康复训练效果的评价;于前庭神经炎早期施行前庭康复训练可有效改善患者预后。

Objective To analyze the characteristics and clinical significance of vestibular autorotation test (VAT)in patients with vestibular neuritis (VN)and the role of VAT in vestibular rehabilitation.Methods A total of 42 patients with VN (VN group)from September 2016 to December 2017 and 37 healthy employees (control group)in our hospital were enrolled in this study.Patients were treated with drug treatment (N =21,drug group)and drug treatment combined with vestibular rehabilitation (N =21,combined group).VAT was performed in 42 patients and 30 healthy controls.The parameters including gain,phase and eye asymmetry were evaluated.The positive result of test could be defined if any of the parameters was abnormal,which indicated abnormal functional status of semicircular canal at high- frequency range (2-6 Hz).Results In VN group,the proportion of decreased gain was 73.81%(31/42), the proportion of prolonged phase was 61.90%(26/42)and the proportion of eye asymmetry was 19.05%(8/ 42).Compared with control group,there was significant difference on decreased gain (x^2 =17.890,P = 0.000)and prolonged phase (x^2 =12.446,P =0.001),but no significant difference on eye asymmetry (x^2 = 0.010,P =0.920).Three months after vestibular rehabilitation treatment,VAT showed the decreased gain and prolonged phase in combined group recovered to normal range,and the occurrence rate of decreased gain (x^2 =8.005,P =0.005)and prolonged phase (x^2=8.400,P =0.004)was significantly lower than that in drug group.Conclusions VAT can analyze the high-frequency semicircular canal function of patients with VN and evaluate the effect of vestibular rehabilitation.Early vestibular rehabilitation can improve the prognosis of VN patients.