水平半规管良性阵发性位置性眩晕患者反转相眼震的观察

Observation of the Reverse Phase Nystagmus in Patients with Horizontal Semicircular Canal Benign Paroxysmal Positional Vertigo

目的观察水平半规管良性阵发性位置性眩晕(benign paroxysmal positional vertigo,BPPV)患者位置试验中反转相眼震的发生率和特征,探讨反转相眼震对于手法复位疗效的影响。方法回顾性分析2019年1月~2020年10月收治的76例水平半规管BPPV患者的临床资料,分析滚转试验时眼震的方向、潜伏期、持续时间、眼震强度,根据是否有反转相眼震分为有反转相眼震组和无反转相眼震组,对比两组患者的眼震参数和眼震特征;并比较两组行手法复位后的疗效,评价反转相眼震对疗效的影响。结果76例水平半规管BPPV患者中,6例为水平半规管嵴帽结石症,均未观察到反转相眼震,余70例水平半规管管石症患者中,51例(72.86%,51/70)出现反转相眼震,占67.11%(51/76),其中16例双侧均有反转相眼震,35例仅单侧出现反转相眼震。产生反转相眼震可能与患者的年龄、性别、病程、罹患半规管的侧别无关(均为P>0.05)。所有产生反转相眼震的患者眼震强度明显大于无反转相眼震患者(P<0.01),仅单侧出现反转相眼震的患者,反转相眼震总是出现在眼震较强的一侧(即患侧),且强度显著小于第一相眼震强度(P<0.01),但持续时间较长(P<0.01),绝大多数患者反转相眼震的持续时间超过1分钟,部分患者持续时间大于3分钟,显示为持续性眼震。经手法复位治疗后,反转相眼震组即时评估的总有效率为90.20%,无反转相眼震组总有效率为89.47%,两组疗效无统计学差异(χ^(2)=0.051,P=0.975)。结论在水平半规管BPPV患者中,反转相眼震的发生率高,第一相眼震强度大的患者易出现反转相眼震,且反转相眼震持续时间较长;反转相眼震可能不影响手法复位的疗效。

Objective To observe the incidence and characteristics of the reverse phase nystagmus in the positional test of patients with horizontal semicircular canal benign paroxysmal positional vertigo,and to evaluate the effect of the reverse phase nystagmus on the treatment of the repositioning maneuver.Methods A total of 76 patients with horizontal semicircular canal BPPV admitted from January 2019 to October 2020 were collected.The nystagmus parameters during roll test were recorded,including direction,latency,duration and intensity of nystagmus.According to whether there was reverse phase nystagmus,they were divided into two groups nystagmus group with reverse phase and nystagmus group without reverse phase.The nystagmus parameters of the two groups were compared,and the nystagmus characteristics of reverse phase nystagmus were summarized.The curative effect after repositioning maneuver was recorded and compared.Results Of the 76 patients with horizontal semicircular canal BPPV,6 were patients with horizontal semicircular canal cupulolithiasis,and no reverse phase nystagmus was observed in the 6 patients.Of the 70 patients with horizontal semicircular canal canalithiasis,51 patients presented reverse phase nystagmus,accounting for 72.86%(51 to 70)of canalithiasis patients,accounting for 67.11%of all horizontal semicircular canal BPPV(51 to 76),of which 16 patients presented bilateral reverse phase nystagmus and 35 patients presented unilateral reverse phase nystagmus.The occurrence of reverse phase nystagmus did was not related to the patient's age,gender,time to visit the doctor and the lateral difference of semicircular canal(P>0.05).The intensity of nystagmus in all patients with reverse phase nystagmus was significantly greater than that in patients without reverse phase nystagmus(P<0.01).In patients with unilateral reverse phase nystagmus,the reverse phase nystagmus always occurred on the side of nystagmus(the affected side),while the intensity of reverse phase nystagmus was smaller,significantly lower than that of the first phase nystagmus(P<0.01),but lasted longer(P<0.01).The duration of reverse phase nystagmus in most patients was more than 1 minute,and the duration of some patients exceeded 3 minutes,which shows persistent nystagmus.After repositioning maneuver treatment,the total effective rate of patients in the reverse phase nystagmus group was 90.20%,while that in the non-reverse phase nystagmus group was 89.47%(χ^(2)=0.051,P=0.975).Conclusion In patients with horizontal semicircular canal BPPV,the incidence of reverse phase nystagmus is high.Patients with high intensity of the first phase nystagmus are prone to show reverse phase nystagmus,mean while the duration of reverse phase nystagmus is longer.The reverse phase nystagmus may not affect the curative effect of repositioning maneuver.