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视眼动-前庭眼动平衡功能检查在中枢与周围性眩晕诊断中的作用 被引量:8

Visual Eye movement-vestibular ocular balance assessment in the diagnosis of central and peripheral vertigo
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摘要 目的 探讨视眼动-前庭眼动平衡功能检查在中枢与周围性眩晕诊断中的作用.方法选择2015年1月至2016年6月在开滦总医院接受诊治的中枢性眩晕患者162例,男124例,女38例,年龄(64.09±10.98)岁;周围性眩晕患者166例,男75例,女91例,年龄(52.13±12.20)岁.应用红外视频眼震电图仪和静态平衡姿势仪完成自发眼震试验、凝视试验、位置试验、扫视试验、平稳视跟踪试验、视动单速试验、视动正弦试验、转椅旋转-急停试验、睁-闭眼坚硬平板直立试验、睁-闭眼海绵软底直立试验的平衡功能电生理检测.结果病理性自发眼震和病理性凝视眼震检出率,中枢性眩晕组均高于周围性眩晕组(χ^2值分别为5.674、16.458,P均〈0.05);而位置性眼震出现率,周围性眩晕组高于中枢性眩晕组(χ^2=48.896,P〈0.001).扫视试验异常率、平稳视跟踪试验异常率、视动单速和正弦试验异常率、静态平衡姿态试验异常率,中枢性眩晕组均高于周围性眩晕组(χ^2值分别为137.169、166.972、150.877、150.877、27.273,P均〈0.001);而转椅旋转急停试验异常率,周围性眩晕组高于中枢性眩晕组(χ^2=51.000,P〈0.001).异常结果类型两组比较,中枢性眩晕组主要为扫视欠冲、慢扫视(χ^2值分别为103.846、4.296,P均〈0.05),Ⅲ、Ⅳ型平稳视跟踪曲线(χ^2值分别为147.389、4.296,P均〈0.05),视动单速和正弦试验眼震增益单侧、双侧减弱(χ^2值分别为47.531、44.477、52.529、53.255,P均〈0.001),转椅旋转急停试验诱发反向和垂直眼震以及静态平衡姿势的本体觉异常(χ^2值分别为11.847、23.778,P均〈0.001);而周围性眩晕组则以转椅旋转急停试验诱发眼震增益单侧减弱为主要表现(χ^2=79.771,P〈0.001).结论周围性眩晕患者具有明显的体位性自发前庭反应和前庭眼动系统功能异常,而中枢性眩晕患者主要为视眼动系统功能异常,并可伴有前庭眼动系统和前庭骨髓反射功能异常. Objective To explore the role of visual oculomotor-vestibular eye balance function in the diagnosis of central and peripheral vertigo. Methods From January 2015 to June 2016,one hundred and sixty-two patients with central vertigo who were treated at Kailuan General Hospital were enrolled in the study, including 124 males and 38 females, aged ( 64. 09 ± 10. 98 ) years old; there were 166 cases of peripheral vertigo,75 males and 91 females,aged (52. 13±12. 20) years old. Spontaneous nystagmus test,gaze test,position test, saccade test, smooth visual tracking test, visual single-speed test, visual sinus test, swivel chair rotation- emergency stop test using infrared video nystagmus and static balance posture instrument,open-closed eye hard plate erect test, open-closed eye sponge soft bottom erect test balance function electrophysiological test were conducted. Results The detection rate of pathological spontaneous nystagmus and pathological gaze nystagmus was higher in the central vertigo group than that in the peripheral vertigo group (χ^2=5. 674,16. 458,P〈0. 05) . The occurrence rate of positional nystagmus was higher in peripheral vertigo group than that in central vertigo group (χ^2=48. 896,P〈0. 001). The abnormal rate of scanning test,stable visual tracking test,visual movement single speed and sinusoidal test,and static balance posture test were higher in the central vertigo group than those in the peripheral vertigo group (χ^2 =137. 169, 166. 972, 150. 877, 150. 877, 27. 273, P〈0. 001 ) , while the abnormal rate of rotating chair sudden stop test was higher in the central vertigo group than that in the peripheral vertigo group (χ^2=51. 000,P〈0. 001) . The abnormal results were mainly scanned underflush and slow scan in central vertigo group (χ2=103. 846,4. 296,P〈0. 05),stable visual tracking curve (χ^2=147. 389,4. 296,P〈0. 05) in type III-IV,and the gain of nystagmus decreased unilaterally and bilaterally (χ^2=47. 531,44. 477, 52. 529,53. 255,P〈0. 001) . Anomalies of proprioception in reverse and vertical nystagmus and static balance posture were induced by rotating chair sudden stop test (χ^2=11. 847, 23. 778, P〈0. 001 ) , while peripheral vertigo group showed unilateral decrease of nystagmus gain induced by rotating chair sudden stop test. (χ^2=79. 771, P 〈 0. 001 ) . Conclusion The patients with peripheral vertigo have obvious body position spontaneous vestibular response and vestibular oculomotor system dysfunction, while the patients with central vertigo mainly have visual and oculomotor system dysfunction,and may be accompanied by vestibular oculomotor system and vestibular spinal reflex dysfunction.
作者 张萍淑 侯秀香 周立富 朱旭红 钱琳琳 元小冬 王京 Zhang Pingshu;Hou Xiuxiang;Zhou Lifu;Zhu Xuhong;Qian Linlin;Yuan Xiaodong;Wang Jing(Department of Neurology,Kailuan General Hospital,Tangshan 063000,China)
出处 《中国综合临床》 2018年第6期502-506,共5页 Clinical Medicine of China
基金 河北省医学适用技术跟踪项目(GL201677)
关键词 眩晕 视频眼震电图 静态平衡姿势 Vertigo Videonystagmography Static equilibrium posture
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