眼震电图对周围性眩晕与中枢性眩晕临床特征的鉴别诊断研究

Differential diagnosis and analysis of clinical features of peripheral vertigo and central dizziness by electronystagmography

目的:探讨周围性眩晕与中枢性眩晕的临床特征及鉴别诊断。方法:选择收治的65例中枢性眩晕和65例周围性眩晕患者。所有患者给予对症处理,病情较轻者给予马来酸桂哌齐特注射液,病情较重给予盐酸倍他司汀注射液和盐酸消旋山莨菪碱注射液,视频眼震视图检查。观察两组临床疗效、视频眼震电图异常情况。结果:中枢性眩晕组视频眼震电图异常率为89.23%明显高于周围性眩晕组的75.38%(χ~2=4.279,P=0.039);中枢性眩晕组视测距障碍试验、视动性眼震试验异常率明显高于周围性眩晕组,而变位性眼震、冷热试验则低于周围性眩晕组(均P<0.05)。中枢性眩晕组有效率为92.31%明显低于周围性眩晕组93.85%(Z=-3.125,P=0.002)。结论:眩晕症诊疗方案的确定应建立在充分考虑患者临床特征、眩晕类型的基础上,以便降低临床漏诊及误诊率。

Objective:To explore the clinical features of peripheral vertigo and central vertigo.Method:Sixty-five patients with central vertigo and 65 patients with peripheral vertigo admitted to the hospital from March 2016 to September 2018 were selected as subjects.All patients were given symptomatic treatment. The patients with milder disease were given cinepazide maleate injection. The more serious patients were given a dose of betahistine hydrochloride injection and racemic anisodamine hydrochloride injection, and video nystag view check. The clinical efficacy and abnormality of video nystagmus were observed.Results:The video nystagmus electrocardiogram abnormal rate was 89.23% in the central vertigo group,which was significantly higher than 75.38%of the peripheral vertigo group ( P <0.05). In the central vertigo group, the abnormal rate of visual distance measurement and visual nystagmus test was significantly higher than that of peripheral vertigo, while the displaced nystagmus and cold heat test were lower than the peripheral vertigo group (both P <0.05).However, there was no significant difference in the rate of spontaneous nystagmus, gaze test and visual follow-up test between the two groups of vertigo patients ( P >0.05).The effective rate was 50.77% in the central vertigo group, which was significantly lower than that in the peripheral vertigo group (69.23%)( P <0.05). The overall clinical effect of the peripheral vertigo group was significantly better than that in the central vertigo group ( P <0.05).Conclusion: The diagnosis and treatment of vertigo should be based on the consideration of the patient's clinical characteristics and vertigo type in order to reduce the rate of clinical missed diagnosis and misdiagnosis.