前庭自旋转试验对前庭神经炎患者康复疗效的评价
|
摘要
目的分析前庭神经炎患者前庭自旋转试验的特征表现及临床意义,以及在前庭康复治疗中的价值。方法选择2016年9月至2017年12月共42例前庭神经炎患者,分别以增益、相移、非对称性偏向作为前庭自旋转试验的评价参考指标。结果本组42例患者增益降低占73.81%(31/42)、相移延迟占61.90%(26/42)、非对称性偏向占19.05%(8/42),与对照组相比,增益降低(χ~2=17.890,P=0.000)和相移延迟(χ~2=12.446,P=0.001)组间差异具有统计学意义,而非对称性偏向组间差异无统计学意义(χ~2=0.010,P=0.920)。康复治疗3个月后,前庭自旋转试验显示联合治疗组患者增益降低与相移延迟基本恢复至正常值范围,增益降低(χ~2=8.005,P=0.005)和相移延迟(χ~2=8.400,P=0.004)发生率较单纯药物治疗组降低且差异具有统计学意义。结论前庭自旋转试验可用于分析前庭神经炎患者的高频区间半规管功能状态,有助于前庭康复训练效果的评价;于前庭神经炎早期施行前庭康复训练可有效改善患者预后。
Objective To analyze the characteristics and clinical significance of vestibularautorotation test(VAT) in patients with vestibular neuritis(VN) and the role of VAT in vestibular rehabilitation. Methods A total of 42 patients with VN(VN group) from September 2016 to December 2017 and 37 healthy employees(control group) in our hospital were enrolled in this study. Patients were treated with drug treatment(N=21, drug group) and drug treatment combined with vestibular rehabilitation(N=21, combined group). VAT was performed in 42 patients and 30 healthy controls. The parameters including gain, phase and eye asymmetry were evaluated. The positive result of test could be defined if any of the parameters was abnormal, which indicated abnormal functional status of semicircular canal at highfrequency range(2-6 Hz). Results In VN group, the proportion of decreased gain was 73.81%(31/42),the proportion of prolonged phase was 61.90%(26/42) and the proportion of eye asymmetry was 19.05%(8/42). Compared with control group, there was significant difference on decreased gain(χ~2= 17.890, P =0.000) and prolonged phase(χ~2= 12.446, P = 0.001), but no significant difference on eye asymmetry(χ~2=0.010, P = 0.920). Three months after vestibular rehabilitation treatment, VAT showed the decreased gain and prolonged phase in combined group recovered to normal range, and the occurrence rate of decreased gain(χ~2=8.005, P =0.005) and prolonged phase(χ~2=8.400, P =0.004) was significantly lower than that in drug group. Conclusions VAT can analyze the high-frequency semicircular canal function of patients with VN and evaluate the effect of vestibular rehabilitation. Early vestibular rehabilitation can improve theprognosis of VN patients.
Objective To analyze the characteristics and clinical significance of vestibularautorotation test(VAT) in patients with vestibular neuritis(VN) and the role of VAT in vestibular rehabilitation. Methods A total of 42 patients with VN(VN group) from September 2016 to December 2017 and 37 healthy employees(control group) in our hospital were enrolled in this study. Patients were treated with drug treatment(N=21, drug group) and drug treatment combined with vestibular rehabilitation(N=21, combined group). VAT was performed in 42 patients and 30 healthy controls. The parameters including gain, phase and eye asymmetry were evaluated. The positive result of test could be defined if any of the parameters was abnormal, which indicated abnormal functional status of semicircular canal at highfrequency range(2-6 Hz). Results In VN group, the proportion of decreased gain was 73.81%(31/42),the proportion of prolonged phase was 61.90%(26/42) and the proportion of eye asymmetry was 19.05%(8/42). Compared with control group, there was significant difference on decreased gain(χ~2= 17.890, P =0.000) and prolonged phase(χ~2= 12.446, P = 0.001), but no significant difference on eye asymmetry(χ~2=0.010, P = 0.920). Three months after vestibular rehabilitation treatment, VAT showed the decreased gain and prolonged phase in combined group recovered to normal range, and the occurrence rate of decreased gain(χ~2=8.005, P =0.005) and prolonged phase(χ~2=8.400, P =0.004) was significantly lower than that in drug group. Conclusions VAT can analyze the high-frequency semicircular canal function of patients with VN and evaluate the effect of vestibular rehabilitation. Early vestibular rehabilitation can improve theprognosis of VN patients.
引文
[1]Hirata T, Sekitani T, Okinaka Y, Matsuda Y. Serovirologicalstudy of vestibular neuronitis[J]. Acta Otolaryngol Suppl, 1989,468:371-373.
[2]Baloh RW. Clinical practice:vestibular neuritis[J]. N Engl JMed, 2003, 348:1027-1032.
[3]Goodwin TM, Nwankwo OA, O'Leary LD, O'Leary D, Romero hyperemesis gravidarum has abnormalities in thevestibuloocular reflex pathway[J]. Am J Obstet Gynecol, 2008,199:417.
[4]Tian JR. Diagnosis and treatment of dizziness[M]. Beijing:People's Medical Publishing House, 2015:81-95[.田军茹.眩晕诊治[M].北京:人民卫生出版社, 2015:81-95.]
[5]Li YJ, Xu XR. Advances in diagnosis and treatment of vestibular neuritis[J]. Zhonghua Er Ke Xue Za Zhi, 2016, 14:515-520[.李远军,徐先荣.前庭神经炎的研究进展[J].中华耳科学杂志, 2016, 14:515-520.]
[6]Yu LS. Examination technique of vestibular function[M].Beijing:People's Military Medical Publishing House, 1994:126-127[.于立身.前庭功能检测技术[M].北京:人民军医出版社, 1994:126-127.]
[7]Aw ST, Fetter M, Cremer PD, Karlberg M, Halmagyi GM.Individual semicircular canal function in superior and inferiorvestibular neuritis[J]. Neurology, 2001, 57:768-774.
[8]Yang AP, Zhang DG, LüYF, Li YW, Xu JL, Liu XF, Li YL,Fan ZM. The clinical value of vestibular autorotation test in the diagnosis of otogenic vertigo[J]. Lin Chuang Er Bi Yan HouTou Jing Wai Ke Za Zhi, 2016, 30:617-620[.杨爱萍,张道宫,吕亚峰,李亚伟,徐继良,刘贤峰,李远令,樊兆民.前庭自旋转试验在耳源性眩晕疾病诊断中的应用价值[J].临床耳鼻咽喉头颈外科杂志, 2016, 30:617-620.]
[9]Fetter M, Zee DS. Recovery from unilateral labyrinthectomy in Rhesus monkeys[J]. J Neurophysiol, 1988, 59:370-393.
[10]Mathog RH, Peppard SB. Exercise and recovery from vestibular injury[J]. Am J Otolaryngol, 1982, 3:397-407.
[11]Igarashi M, Levy JK, O-Uchi T, Reschke MF. Further study of physical exercise and locomotor balance compensation afterunilateral labyrinthectomy in squirrel monkeys[J]. ActaOtolaryngol, 1981, 92:101-105.
[12]Horak FB, Jones-Rycewicz C, Black FO, Shumaway-Cook A.Effects of vestibular rehabilitation on dizziness and imbalance[J]. Otolaryngol Head Neck Surg, 1992, 106:175-180.
[13]Herdman SJ, Clendaniel RA, Mattox DE, Holliday MJ, Niparko JK. Vestibular adaptation exercises and recovery:acute stageafter acoustic neuroma resection[J]. Otolaryngol Head Neck Surg, 1995, 113:77-87.
[14]Yan XY, Wang K, Chen F, Wang M. Effect of vestibular rehabilitation on the recovery of vestibular neuritis[J]. BeijingYi Xue, 2017, 39:774-776[.严小艳,王凯,陈丰,汪敏.前庭康复对前庭神经炎患者平衡功能恢复的作用[J].北京医学,2017, 39:774-776.]
[15]Chen Y, Zhao ZX, Zhuang JH, Xie XW, Li F, Jin Z. Effect of vestibular rehabilitation in acute treatment of vestibular neuritis[J]. Yi Xue Yan Jiu Za Zhi, 2015, 44:61-63[.陈瑛,赵忠新,庄建华,谢雪微,李斐,靳哲.前庭康复在急性前庭神经炎治疗中的效果评价[J].医学研究杂志, 2015, 44:61-63.]
[16]Herdman SJ. Vestibular rehabilitation[M]//Baloh RW,Halmagyi GM. Disorders of the vestibular system. New York:Oxford University Press, 1996:583-597.
[2]Baloh RW. Clinical practice:vestibular neuritis[J]. N Engl JMed, 2003, 348:1027-1032.
[3]Goodwin TM, Nwankwo OA, O'Leary LD, O'Leary D, Romero hyperemesis gravidarum has abnormalities in thevestibuloocular reflex pathway[J]. Am J Obstet Gynecol, 2008,199:417.
[4]Tian JR. Diagnosis and treatment of dizziness[M]. Beijing:People's Medical Publishing House, 2015:81-95[.田军茹.眩晕诊治[M].北京:人民卫生出版社, 2015:81-95.]
[5]Li YJ, Xu XR. Advances in diagnosis and treatment of vestibular neuritis[J]. Zhonghua Er Ke Xue Za Zhi, 2016, 14:515-520[.李远军,徐先荣.前庭神经炎的研究进展[J].中华耳科学杂志, 2016, 14:515-520.]
[6]Yu LS. Examination technique of vestibular function[M].Beijing:People's Military Medical Publishing House, 1994:126-127[.于立身.前庭功能检测技术[M].北京:人民军医出版社, 1994:126-127.]
[7]Aw ST, Fetter M, Cremer PD, Karlberg M, Halmagyi GM.Individual semicircular canal function in superior and inferiorvestibular neuritis[J]. Neurology, 2001, 57:768-774.
[8]Yang AP, Zhang DG, LüYF, Li YW, Xu JL, Liu XF, Li YL,Fan ZM. The clinical value of vestibular autorotation test in the diagnosis of otogenic vertigo[J]. Lin Chuang Er Bi Yan HouTou Jing Wai Ke Za Zhi, 2016, 30:617-620[.杨爱萍,张道宫,吕亚峰,李亚伟,徐继良,刘贤峰,李远令,樊兆民.前庭自旋转试验在耳源性眩晕疾病诊断中的应用价值[J].临床耳鼻咽喉头颈外科杂志, 2016, 30:617-620.]
[9]Fetter M, Zee DS. Recovery from unilateral labyrinthectomy in Rhesus monkeys[J]. J Neurophysiol, 1988, 59:370-393.
[10]Mathog RH, Peppard SB. Exercise and recovery from vestibular injury[J]. Am J Otolaryngol, 1982, 3:397-407.
[11]Igarashi M, Levy JK, O-Uchi T, Reschke MF. Further study of physical exercise and locomotor balance compensation afterunilateral labyrinthectomy in squirrel monkeys[J]. ActaOtolaryngol, 1981, 92:101-105.
[12]Horak FB, Jones-Rycewicz C, Black FO, Shumaway-Cook A.Effects of vestibular rehabilitation on dizziness and imbalance[J]. Otolaryngol Head Neck Surg, 1992, 106:175-180.
[13]Herdman SJ, Clendaniel RA, Mattox DE, Holliday MJ, Niparko JK. Vestibular adaptation exercises and recovery:acute stageafter acoustic neuroma resection[J]. Otolaryngol Head Neck Surg, 1995, 113:77-87.
[14]Yan XY, Wang K, Chen F, Wang M. Effect of vestibular rehabilitation on the recovery of vestibular neuritis[J]. BeijingYi Xue, 2017, 39:774-776[.严小艳,王凯,陈丰,汪敏.前庭康复对前庭神经炎患者平衡功能恢复的作用[J].北京医学,2017, 39:774-776.]
[15]Chen Y, Zhao ZX, Zhuang JH, Xie XW, Li F, Jin Z. Effect of vestibular rehabilitation in acute treatment of vestibular neuritis[J]. Yi Xue Yan Jiu Za Zhi, 2015, 44:61-63[.陈瑛,赵忠新,庄建华,谢雪微,李斐,靳哲.前庭康复在急性前庭神经炎治疗中的效果评价[J].医学研究杂志, 2015, 44:61-63.]
[16]Herdman SJ. Vestibular rehabilitation[M]//Baloh RW,Halmagyi GM. Disorders of the vestibular system. New York:Oxford University Press, 1996:583-597.