中华耳鼻咽喉头颈外科杂志
中華耳鼻嚥喉頭頸外科雜誌
중화이비인후두경외과잡지
Chinese Journal of Otorhinolaryngology Head and Neck Surgery
2015年
9期
724-728
,共5页
林颖%高林溪%韩丽萍%卢连军%陈阳%查定军%邱建华
林穎%高林溪%韓麗萍%盧連軍%陳暘%查定軍%邱建華
림영%고림계%한려평%로련군%진양%사정군%구건화
前庭疾病%前庭功能试验%反射,前庭眼%眼扫视%半规管
前庭疾病%前庭功能試驗%反射,前庭眼%眼掃視%半規管
전정질병%전정공능시험%반사,전정안%안소시%반규관
Vestibular diseases%Vestibular function tests%Reflex,vestibulo-ocular%Saccades%Semicircular canals
目的 探讨视频头脉冲检查(video head impulse test,vHIT)在外周前庭病变患者前庭眼动反射功能评估中的临床价值.方法 25名无眩晕病史的健康自愿者作为对照组,男16例、女9例,年龄18 ～60岁.2014年4-5月在第四军医大学西京医院耳鼻咽喉头颈外科就诊的55例眩晕患者作为外周前庭病变组,根据病史及相关检查分别诊断为:前庭神经炎11例、突发性聋伴眩晕12例、前庭神经鞘瘤(听神经瘤)6例、梅尼埃病12例、双侧前庭功能低下15例.采用vHIT仪对受试者进行检查,利用软件记录补偿性扫视,计算瞬时增益(平均眼动和头动角速度比值)、眼动与头动速度回归方程的增益及不对称性.结果 健康对照组vHIT水平半规管40、60、80 ms的瞬时增益分别为0.88 ±0.17(均数±标准差,下同)、0.94±0.13、0.96±0.13.60 ms时左右侧眼动与头动速度回归方程的增益为0.99 ±0.11,不对称性为5.6±3.5.60 ms瞬时增益的正常范围为＞0.73,回归方程增益的正常范围为＞0.80.不同前庭疾病vHIT出现异常的比例依次为:前庭神经鞘瘤100％、前庭神经炎90.9％、双侧前庭功能低下86.7％、梅尼埃病40.0％、突发性聋伴眩晕38.5％.所有出现的补偿性扫视中,12.5％为孤立的隐性扫视(5/40),45.0％为孤立的显性扫视(18/40),42.5％为同时有隐性与显性扫视(17/40).结论 vHIT操作简便,可通过增益值及扫视评估前庭眼反射功能,不同前庭疾病的阳性率差异较大.隐性扫视仅能通过vHIT发现,因此床旁头脉冲检查存在漏诊的风险.
目的 探討視頻頭脈遲檢查(video head impulse test,vHIT)在外週前庭病變患者前庭眼動反射功能評估中的臨床價值.方法 25名無眩暈病史的健康自願者作為對照組,男16例、女9例,年齡18 ～60歲.2014年4-5月在第四軍醫大學西京醫院耳鼻嚥喉頭頸外科就診的55例眩暈患者作為外週前庭病變組,根據病史及相關檢查分彆診斷為:前庭神經炎11例、突髮性聾伴眩暈12例、前庭神經鞘瘤(聽神經瘤)6例、梅尼埃病12例、雙側前庭功能低下15例.採用vHIT儀對受試者進行檢查,利用軟件記錄補償性掃視,計算瞬時增益(平均眼動和頭動角速度比值)、眼動與頭動速度迴歸方程的增益及不對稱性.結果 健康對照組vHIT水平半規管40、60、80 ms的瞬時增益分彆為0.88 ±0.17(均數±標準差,下同)、0.94±0.13、0.96±0.13.60 ms時左右側眼動與頭動速度迴歸方程的增益為0.99 ±0.11,不對稱性為5.6±3.5.60 ms瞬時增益的正常範圍為＞0.73,迴歸方程增益的正常範圍為＞0.80.不同前庭疾病vHIT齣現異常的比例依次為:前庭神經鞘瘤100％、前庭神經炎90.9％、雙側前庭功能低下86.7％、梅尼埃病40.0％、突髮性聾伴眩暈38.5％.所有齣現的補償性掃視中,12.5％為孤立的隱性掃視(5/40),45.0％為孤立的顯性掃視(18/40),42.5％為同時有隱性與顯性掃視(17/40).結論 vHIT操作簡便,可通過增益值及掃視評估前庭眼反射功能,不同前庭疾病的暘性率差異較大.隱性掃視僅能通過vHIT髮現,因此床徬頭脈遲檢查存在漏診的風險.
목적 탐토시빈두맥충검사(video head impulse test,vHIT)재외주전정병변환자전정안동반사공능평고중적림상개치.방법 25명무현훈병사적건강자원자작위대조조,남16례、녀9례,년령18 ～60세.2014년4-5월재제사군의대학서경의원이비인후두경외과취진적55례현훈환자작위외주전정병변조,근거병사급상관검사분별진단위:전정신경염11례、돌발성롱반현훈12례、전정신경초류(은신경류)6례、매니애병12례、쌍측전정공능저하15례.채용vHIT의대수시자진행검사,이용연건기록보상성소시,계산순시증익(평균안동화두동각속도비치)、안동여두동속도회귀방정적증익급불대칭성.결과 건강대조조vHIT수평반규관40、60、80 ms적순시증익분별위0.88 ±0.17(균수±표준차,하동)、0.94±0.13、0.96±0.13.60 ms시좌우측안동여두동속도회귀방정적증익위0.99 ±0.11,불대칭성위5.6±3.5.60 ms순시증익적정상범위위＞0.73,회귀방정증익적정상범위위＞0.80.불동전정질병vHIT출현이상적비례의차위:전정신경초류100％、전정신경염90.9％、쌍측전정공능저하86.7％、매니애병40.0％、돌발성롱반현훈38.5％.소유출현적보상성소시중,12.5％위고립적은성소시(5/40),45.0％위고립적현성소시(18/40),42.5％위동시유은성여현성소시(17/40).결론 vHIT조작간편,가통과증익치급소시평고전정안반사공능,불동전정질병적양성솔차이교대.은성소시부능통과vHIT발현,인차상방두맥충검사존재루진적풍험.
Objectives The function of the semicircular canal receptors and the pathway of the vestibulo-ocular reflex (VOR) can be diagnosed with the clinical head impulse test.The aim of the study was to investigate the horizontal VOR by means of video head impulse test in peripheral vestibular disorders.Methods Using the vHIT,we examined horizontal semicircular canal VOR in a group of 55 patients and a control group of 20 healthy subjects.The group of patients included 10 cases of vestibular neuritis (VN),6 cases of vestibular schwannoma (VS),12 cases of Meniere's disease (MD),and 15 cases of bilateral vestibulopathy (BV),as well as 13 cases of idiopathic sudden hearing loss with vertigo(ISHL).Results Instantaneous gains of 40 ms,60 ms and 80 ms of horizontal VOR were 0.88 ± 0.17,0.94 ± 0.13 and 0.96 ±0.13,respectively.Regression gain at 60 ms was 0.99 ± 0.11,and asymmetry was 5.6 ± 3.5.Normal range of 60 ms instantaneous gain was ＞ 0.73,normal range of regression gain was ＞ 0.80.AbnormalvHIT was found in VS (100％),VN (90.9％),BV (86.7％),MD (40.0％) and ISHL (38.5％).Three conditions of refixation saccades occurred in cases with abnormal VOR:isolated covert saccades (12.5％),isolated overt saccades (45.0％) and the combination of overt and covert saccades (42.5％).Conclusions The vHIT detects abnormal VOR changes in the combination of gain assessment and refixation saccades.Since isolated covert saccades in VOR changes can only be seen with vHIT,peripheral vestibular disorders are likely to be misdiagnosed with the HIT.
