良性位置性眩晕眼震图定位诊断

良性阵发性位置性眩晕的眼震图定位诊断

王娜1陈太生2林鹏2宋伟2董红2

1天津医科大学一中心临床学院

2天津市第一中心医院耳鼻咽喉头颈外科；天津市耳鼻喉科研究所（300192）【摘要】目的:探讨眼震图（Videonystagmograph，VNG）对良性阵发性位置性眩晕（BPPV）的定位诊断价值。方法：回顾126例BPPV患者的眼震图资料，分析总结各型BPPV 在Dix- Hallpike 和滚转试验中眼震图上的眼震特点。结果：126例BPPV患者中，后半规管（PSC）BPPV98例(77.8%)、水平半规管（HSC）BPPV17例(13.5%)、前半规管（ASC）BPPV 仅5例(3.9%)、混合型BPPV6例(4.8%)，28例PSC-BPPV记录到反转相眼震。眼震图上显示PSC和ASC管石症Dix- Hallpike悬头位垂直相眼震分别向上、向下，水平相眼震均向对侧，回到坐位时眼震反向。HSC-BPPV滚转试验向两侧转头均可诱发出眼震，眼震与转头方向相同时，可判断为水平半规管管石症，以能够诱发较强眼震的转头侧为患侧；眼震与转头方向相反时，则为水平半规管嵴顶结石症，以能够诱发较弱眼震的转头侧为患侧。结论：眼震图能够客观的记录BPPV患者眼震情况，准确判断耳石所在的半规管，并且保存了眼震数据资料，可以进一步指导临床实践，值得广泛推广。

【关键词】视频眼震图；良性阵发性位置性眩晕；半规管；耳石

通讯作者：陈太生（cts501@）

Positioning diagnosis of benign positional paroxysmal vertigo by VNG Wang Na1, Lin Peng2, Chen Taisheng2 , Song Wei2, Dong Hong2

(1The first center clinic college of Tianjin Medical University, Tianjin, 300192,China; 2Otolaryngology-Head & Neck Surgery, Tianjin First Center Hospital, Tianjin, 300192, China)

【Abstract】Objective To analyze the value of positioning diagnosis of VNG (Videonystagmograph) in patients with benign paroxysmal positional vertigo(BPPV). Methods 126 patients with BPPV were enrolled in this retrospective study. Their positional nystagmus recorded by VNG in Dix-Hallpike and roll tests were analyzed to summarize the characteristics of nystagmus on nystagmograph of various BPPV. Results Of 126 patients with BPPV diagnosed in our center, the posterior semicircular canals(PSC) were involved in 98 patients(77.8%),whereas the horizontal semicircular canal(HSC) and anterior semicircular canal(ASC) were involved in 17(13.5%) and 5(3.9%), respectively.6 patients(4.8%) confirmed combined-BPPV had HSC-BPPV and ipsilateral PSC-BPPV. 28 patients with PSC-BPPV had reversal phase on nystagmograph. The nystagmus of patients with P/ASC-canalithiasis showed upward /downward

on the vertical phase of nystagmograph and orientated the opposite side on horizontal phase in the head hangging position, and the nystagmus reversed when returned to sit. Nystagmus on horizontal phase can be provoked when the head turned to both sides of the roll tests in patients with HSC-BPPV. If the nystagmus and the head-turning shared the same direction, then HSC-canalithiasis was confirmed, and the direction of the head-turning which provoked the stronger nystagmus indicates the lesion side. If the nystagmus and the head-turning had the opposite direction, then HSC-cupulolithiasis was confirmed, and the direction of the head-turning which provoked the weaker nystagmus indicates the lesion side. Conclusion Positional nystagmus can be recorded objectively using VNG. Positioning the semicircular canal involved will be easier and more accurate according to it. The recording conserved also be helpful for clinical diagnosis and repositioning of BPPV.

【Key words】Videonystagmograph (VNG)；benign positional paroxysmal vertigo(BPPV)；

semicircular canal；otolith

Corresponding author: Chen Taisheng (cts501@)

良性阵发性位置性眩晕(benign positional paroxysmal vertigo，BPPV)是头部运动到某一特定位置时诱发的短暂眩晕，是一种具有自限性的周围性前庭疾病[1]。该病发病率较高，约占所有周围性眩晕的17%～20 %[2]。BPPV耳石复位治疗技术已经成熟，成功复位治疗的基础是对耳石累及半规管的准确定位。目前BPPV的定位诊断和复位都基于医者目测患者的眼震，但旋转性眼震的方向常常不易辨别，加之一些细小眼震容易被肉眼所忽略，影响了BPPV 的定位诊断和后续复位治疗。近年来，视频眼震电图（Videonystagmograph，VNG）的普及应用使眼震方向的判断更加客观、方便。我们将其与BPPV诊治相结合，更直观、客观地记录和分析患者在各个体位的诱发眼震，利用眼震图对BPPV进行准确定位诊断和疗效评估，并且保存了眼震数据资料，也有利于进一步指导临床实践和教学和科研工作。

1.材料与方法

1.1 临床资料

2006年1月－2008 年4月在天津市第一中心医院耳鼻咽喉头颈外科眩晕诊疗中心诊断为BPPV的患者126 例，其中女性85例(67.5%)，男性41例(32.5%)，平均年龄为54岁(17～78 岁)。患者从发病到就诊的时间为1 天～20 年，平均59 周。

1.2方法

1.2.1常规检查所有患者均详细询问并记录病史，包括眩晕发作情况、既往史（尤其是相关的耳科疾病史、耳毒性药物应用史、外伤史）、家族史，并进行常规耳科检查。应用VNG(法国Synapsys)进行常规眼震图检查及变位试验、冷热试验等，VNG图上红色为水平相，蓝色为垂直相。对可疑中枢病变患者行相关检查除外中枢性眩晕。

1.2.2变位试验⑴ Dix-Hallpike试验：患者坐于检查床上，头戴视频眼罩，检查者于病人后