外半规管后臂管石症中反转相眼震的临床观察

Clinical Observation of Reversal Phase Nystagmus in Lateral Semicircular Postal-Canalithiasis

目的分析外半规管后臂型管石症中出现反转相眼震与无反转相眼震患者的参数特点,探讨其在临床诊断中的意义。方法回顾性分析外半规管后臂型管石症68例,滚转试验中是否出现反转相眼震进行分组,应用眼震视频记录仪,记录和分析眼震参数,比较出现反转相眼震组中第一相眼震和反转相眼震参数及有无反转相眼震患者患侧眼震参数差异有无统计学意义。结果在68例外半规管后臂型管石症中,48例出现反转相眼震,其中17例为双侧,31例为单侧。第一相眼震强度明显大于反转相眼震,反转相眼震持续时间明显长于第一相眼震,两者的潜伏期、持续时间及强度差异均有统计学意义(t=-9.814、-10.851、13.485,P<0.05)。典型的反转相眼震也有渐强渐弱的过程,但达峰速度较第一相眼震减慢,减弱时间也明显延长。48例有反转相眼震者与20例无反转相眼震者比较,潜伏期、持续时间差异无统计学意义(t=0.623、1.692,P>0.05),强度差异有统计学意义(t=6.113,P<0.05)。结论反转相眼震在外半规管后臂型管石症中较常见,出现反转相眼震的通常为患侧,滚转试验时建议延长观察时间,反转相眼震的出现能帮助识别责任半规管。

Objective To report characteristics of reverse phase and non-reverse phase nystagmus in lateral semicir-cular postal-canalithiasis,and discuss their significance in clinical diagnosis.Methods A retrospective analysis of 68 cas-es of lateral semicircular postal-canalithiasis was conducted.Cases with reversal nystagmus during rolling test were iden-tified.Nystagmus parameters recorded via video-nystagmusgraph,including first phase nystagmus and reverse phase nystagmus,were compared between patients with and without.Results Of the 68 cases,reversal phase nystagmus was identified in 48 cases,of which 17 showed bilateral reverse phase nystagmus and 31 showed unilateral reverse phase nys-tagmus.The intensity of first phase nystagmus was significantly greater than that of reverse phase nystagmus,but the du-ration of reverse phase nystagmus was significantly longer than that of first phase nystagmus.The difference in latency,duration and intensity between the two was statistically significant(t=-9.814,-10.851 and 13.485,P<0.05).Reversal phase nystagmus showed a typical crescendo and fading pattern,with slower peaking than first phase nystagmus.The difference in latency and duration between patients with reversal nystagmus and those without was not statistically sig-nificant(t=0.623 and 1.692,P>0.05),while the difference in intensity was statistically significant(t=6.113,P<0.05).Conclusion Reversal phase nystagmus is common in lateral semicircular postal-canalithiasis and usually locating to the affected side.Extended observation time during rolling test is recommended.Occurrence of reversal phase nystagmus can help identify the responsible semicircular canal.