快速识别孤立性眩晕型脑梗死临床方法研究

Clinical study on rapid identification of isolated vertigo cerebral infarction

目的研究头脉冲-眼震-扭转偏斜(head impulse,nystagmus,test of skew,HINTS)床旁检查和Essen卒中风险评分(essen stroke risk score,ESRS)量表联合眼动检查对孤立性眩晕型脑梗死识别的敏感性和特异性。方法选取2018年1月至2021年4月收治于东莞市滨海湾中心医院神经内科的急性孤立性眩晕患者为研究对象。记录患者的基本临床资料,由经过培训的急诊内科医师和神经内科医师共同诊断,根据患者HINTS床旁检查和ESRS(≥3分支持后循环卒中)量表的基础上,形成初步诊断,作为对照组诊断资料;在此基础上加做眼动检查(平滑跟踪试验、扫视试验),再次诊断,作为观察组诊断资料,分别记录两次诊断结果,作为统计资料。所有患者诊断为孤立性眩晕型脑梗死者,按照卒中处理,发病24 h内启动绿色通道,急诊完成磁共振三序列[磁共振血管成像(magnetic resonance angiography,MRA)+弥散加权成像(diffusion weighted imaging,DWI)+液体衰减反转恢复(fluid attenuated inversion recovery,FLAIR)]检查,符合条件者进行溶栓和机械取栓治疗;诊断为周围性孤立性眩晕的患者,48 h内完成磁共振三序列检查。以最终临床明确诊断的结果比较两组的诊断符合率,验证观察组方法筛查孤立性眩晕型脑梗死的效率。结果观察组诊断符合率为85.4%,明显高于对照组的64.6%,差异有统计学意义(P<0.05)。观察组对孤立性眩晕型脑梗死诊断的敏感性(85.4%,95%CI:74.2%~93.7%)和特异性(95.1%,95%CI:89.6%~97.2%)明显高于对照组(敏感性64.6%,95%CI:57.9%~72.5%;特异性88.1%,95%CI:74.8%~92.6%),差异有统计学意义(P<0.05)。结论联合眼动检查方法能够快速识别以孤立性眩晕型脑梗死患者,敏感性和特异性更高。

Objective To study the sensitivity and specificity of head impulse,nystagmus,test of skew(HINTS)bedside examination and the Essen stroke risk scale(ESRS)combined with eye movement examination for the identification of isolated vertigo cerebral infarction.Methods Patients with acute isolated vertigo who were admitted to the Department of Neurology of Dongguan Binhaiwan Central Hospital from January 2018 to April 2021 were selected as subjects.The basic clinical data of the patients were recorded and diagnosed jointly by trained emergency physicians and neurologists.The preliminary diagnosis was formed on the basis of patient HINTS bedside examination and ESRS(≥3 points,supporting posterior circulation stroke)scale,which was used as the diagnosis data of the control group.On this basis,eye movement examination(smooth tracking test,saccade test)was added to diagnose again,which was used as the diagnostic data of the observation group,and the diagnostic results of two times were recorded as statistical data.All patients diagnosed as isolated vertigo cerebral infarction were treated as stroke and green channel was activated within 24 h of onset.Three-sequence MRI[magnetic resonance angiography(MRA)+diffusion weighted imaging(DWI)+fluid attenuated inversion recovery(FLAIR)]examinations was completed in the emergency department,and thrombolytic and mechanical thrombolysis were performed in the patients.Patients diagnosed with peripheral vertigo underwent three-sequence MRI examinations within48 h.The diagnostic coincidence rate of the two groups was compared with the final clinical diagnosis results to verify the efficiency of the observation group in screening posterior circulation cerebral infarction.Results The diagnostic coincidence rate of the observation group was 85.4%,significantly higher than that of the control group(64.6%),the difference was statistically significant(P<0.05).The sensitivity(85.4%,95%CI:74.2%-93.7%)and specificity(95.1%,95%CI:89.6%-97.2%)of the observation group were significantly higher than those of the control group(sensitivity 64.6%,95%CI:57.9%-72.5%;specificity 88.1%,95%CI:74.8%-92.6%),the differences were statistically significant(P<0.05).Conclusions HINTS bedside examination and ESRS combined with eye movement examination can quickly identify patients with posterior circulation cerebral infarction caused by isolated vertigo with higher sensitivity and specificity.