眩晕患者冷热实验荚形图的结果可靠性分析

Reliability of Pod Shape Diagram from Caloric Test in Vertigo Patients

目的分析眩晕患者冷热实验荚形图类型,了解冷热实验结果的准确性及可靠性,为前庭系统功能评估提供更准确可靠的依据。方法总结分析眩晕诊疗中心2021年7月至2022年5月528例眩晕患者的冷热实验结果,按照荚形图形态及单侧反应减弱(unilateral weakness,UW)分为荚形图冷热对称组、左右对称组、单值显著异常组、双侧数值减下组以及荚形图形态不能分类组,通过比较不同组别UW的结果,对其进行解释及归纳,来辨识不可靠数据,从而减少不可靠数据对临床诊疗的干扰。结果冷热对称的荚形图(439例)表现为双侧前庭功能对称(273例)及一侧前庭功能减低(166例),同侧耳双温刺激冷热气刺激慢相角速度(SPV)差异无统计学意义(P>0.05);左右侧别对称荚形图(14例)包括双侧前庭功能对称(11例)和一侧减低(13例),同侧耳双温刺激SPV值差异有统计学意义(P<0.05);单值显著异常荚形图(36例)包括一侧前庭功能减低(25例)和双侧前庭功能对称(11例),同侧耳双温刺激SPV值差异有统计学意义(P<0.05);双侧数值减低荚形图(34例)可表现为双侧前庭功能对称(25例)及一侧减低(9例),同侧耳双温刺激SPV差异无统计学意义(P>0.05);荚形图形态不能分类(5例)提示干扰因素较多。结论冷热实验显示双耳外周前庭功能对称且正常时,要警惕荚形图中温度效应的存在,需考虑对灌注器的检视及灌注温度的校准;冷热实验提示一侧前庭功能减低时,要注意荚形图中单个数值显著增高或减低的情况,建议重复灌注,仍无改变时,建议重复另一耳此温度下的灌注,甚至重复整个冷热实验;冷热实验荚形图提示双耳外周前庭功能减低时,UW值不能真实反应双侧前庭功能的状态,可改用水灌注重复,并结合病史及其他辅助检查做出正确判断。荚形图的形态结合UW值来综合判断冷热实验的有效性有重要意义。

Objective To understand the reliability of caloric test results through the analysis of the pod shape diagram types of caloric test and to provide a more accurate and reliable basis for vestibular system function evaluation.Methods The results of caloric test in 528 patients from July 2021 to May 2022 in vertigo diagnosis and treatment center were analyzed.According to pod pattern and unilateral weakness(UW),the patients were divided into five groups:cold and warm test symmetrical group,left and right side asymmetry group,single value significant abnormal group,bilateral hypoplasia group and pod morphology unable to be classified group.Unreliable data can be identified by comparing,explaining,and summarizing the results of UW of different groups,so as to reduce the interference of unreliable data to clinical diagnosis and treatment.Results Cold and warm test symmetric group(n=439)included patients with symmetry of bilateral vestibular function(n=273)and decreased vestibular function of one side(n=166).Left and right symmetrical groups included pationts with bilateral symmetric vestibular function(n=11)and unilateral reduction(n=13).Single value significant abnormal group showed cases with unilateral vestibular function reduction(n=25)and bilateral symmetric vestibular function(n=11).Bilateral hypolasion group showed cases with bilateral symmetric vestibular function(n=25)and unilateral reduction(n=9).Pod morphology unclassified group(n=5)suggested varions interference factors.Conclusion When the function of the peripheral vestibular is symmetrical and normal,we should be alert to the existence of temperature effect,and should consider the inspection of the perfusion apparatus and the calibration of the irrigation temperature.When the function of the peripheral vestibular shows unilateral weakness,repeating the irrigation is recommended when the single value of the caloric test significantly increases or decreases.If there is no change,repeating the irrigation at the same temperature in the other ear or even repeating the whole caloric test are recommended.The UW value could not truly reflect the state of peripheral vestibular function when the caoric test produces bilateral weakness.Therefore,water irrigation could be used to make a correct judgment based on the medical history and other auxiliary examinations.It is of great significance to judge the effectiveness of caloric test comprehensively by combining the morphology of pod diagram with UW value.