水平半规管良性阵发性位置性眩晕患者摇头试验分析

Head-shaking Test in the 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(HC-BPPV)患者摇头试验的结果。方法选取2015年1—11月于嘉兴学院附属第二医院眩晕门诊就诊或住院的HC-BPPV患者56例,其中向地性眼震型35例,离地性眼震型21例。向地性眼震型翻滚试验时眼震相对较强烈一侧为患侧,离地性眼震型翻滚试验时眼震相对较弱一侧为患侧。患者端坐位行摇头试验,频率3 Hz,水平方向摇头30次,左、右范围均为30°。裸眼观察1 min并记录患者是否出现眼震及眼震方向。结果 56例患者摇头试验阳性19例,离地性眼震型患者摇头试验阳性率为71.4%(15/21),高于向地性眼震型患者的11.4%(4/35)(P<0.05)。离地性眼震型患者摇头试验阳性15例,其中14例朝向健侧,1例朝向患侧;向地性眼震型患者摇头试验阳性4例,其中2例朝向患侧,2例朝向健侧。结论离地性眼震型HC-BPPV患者摇头试验诱发的眼震常见且多朝向健侧,向地性眼震型HC-BPPV患者摇头试验诱发的眼震少见且可以朝向健侧或患侧。

Objective To investigate the result of head-shaking test in horizontal semicircular canal benign paroxysmal positional vertigo（ HC-BPPV）. Methods Fifty-six patients with HC-BPPV including 35 geotropic types and 21 apogeotropic types,visited the Vertigo Clinic of the Second Affiliated Hospital of Jiaxing University or hospitalized in the hospital from January to November in 2015 were enrolled in this study. The side with relatively strong nystagmus in roll test was judged as affected side in geotropic type HC-BPPV of patients,and the side with relatively weak nystagmus was judged as affected side in apogeotropic type. All of the patients performed head-shaking test. The method of head-shaking test was as follows： the patient shakes his/her head left to right at the range of 30° in horizontal direction with 3 Hz frequency for 30 times while sitting.Examiners observed with naked eyes for 1 min and recorded head-shaking nystamus and the direction. Results Of the 56 patients,19 showed head-shaking test positive after head-shaking test,and it was more common in apogeotropic type than in geotropic type [71. 4%（ 15/21） vs. 11. 4%（ 4/35）,P〈0. 05 ]. Of the 15 patients with head-shaking test positive in apogeotropic type,14 showed healthy side and 1 affected side,whereas of the 4 patients with head-shaking test positive in geotropic type,2 showed healthy side and 2 affected side. Conclusion Nystagmus induced by head-shaking is common and most contralesional in apogeotropic HC-BPPV,while it is rare and contralesional or ipsilesional in geotropic HC-BPPV.