军事飞行员视频头脉冲试验临床正常值的建立
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摘要
目的通过分析军事飞行员视频头脉冲试验(video head impulse test, vHIT)的各种参数,建立军事飞行员vHIT的正常参考值范围。方法选取40名健康的改装体检飞行员作为受试者进行vHIT试验,分析前庭-眼反射(vestibular ocular ref lex,VOR)平均增益值及各半规管的不对称比,即vHIT的增益值(vHIT-G)的正常值范围及双侧各半规管功能对比情况。结果 40名健康飞行员右侧水平半管、前半规管和后半规管的平均vHIT-G分别为1.02±0.04、0.84±0.09、0.87±0.12,左侧水平半管、前半规管和后半规管的平均vHIT-G分别为0.97±0.10、0.88±0.10、0.88±0.08,40名健康飞行人员均未见代偿性扫视,6个半规管vHIT-G均符合正态分布,双侧水平之间及前、后半规管之间差异无统计学意义(P>0.05),但双侧水平半规管和左前右后及左后右前共轭半规管的vHIT-G之间差异有统计学意义(P<0.01)。双侧水平、前、后半规管vHIT试验不对称比分别为6.00±4.33、9.24±5.85、10.24±5.32,对应半规管的不对称比值均符合正态分布,其中水平半规管的不对称比与前、后半规管的不对称比之间差异有统计学意义(P<0.05)。结论本研究建立了军事飞行员vHIT参数标准的常模,为飞行学员选拔、飞行员体检的航空医学鉴定及前庭功能障碍飞行员的前庭康复训练及医学鉴定提供客观依据。
Objective To investigate the various parameters of video head impulse test(vHIT)for Chinese military pilots so as to establish the normal values of vHIT related to Chinese military pilots. Methods Forty healthy Chinese military pilots were recruited as the subjects. The vHIT of these subjects was recorded to analyze the gain of the vestibularocular ref lex(VOR)slow phase, ie, the normal range of the gain value of vHIT(vHIT-G), and the compensatory saccade(CS)and compare the functions of the bilateral semicircular canal. Results The vHIT-G averages of the right side of horizontal, anterior, and posterior semicircular canals were 1.02±0.04, 0.84±0.09 and 0.87±0.12, respectively.The vHIT-G averages of the left side of horizontal, anterior, and posterior semicircular canals were 0.97±0.10, 0.88±0.10 and 0.88±0.08, respectively. There was no compensatory saccade in any of the 40 subjects(P>0.05).The difference in values of vHIT-G of the horizontal semicircular canals in the 40 subjects was statistically significant between anterior and posterior semicircular canals(P<0.01). The asymmetrical ratios of the functions of the horizontal, anterior, and posterior semicircular canals on both sides were 6.00±4.33、9.24±5.85 and 10.24±5.32 respectively. The difference between the asymmetrical ratio of functions of the bilateral horizontal semicircular canals and the bilateral anterior semicircular canals and the posterior semicircular canals was st atistically sig nif icant(P<0.05). Conclusion T he nor mal values of vHIT in Chinese military pilots have been established, which provides data for the aviation medical identification during the selection of f light attendants, medical examination of pilots, vestibular rehabilitation training and medical identif ication of vestibular dysfunction of military pilots.
Objective To investigate the various parameters of video head impulse test(vHIT)for Chinese military pilots so as to establish the normal values of vHIT related to Chinese military pilots. Methods Forty healthy Chinese military pilots were recruited as the subjects. The vHIT of these subjects was recorded to analyze the gain of the vestibularocular ref lex(VOR)slow phase, ie, the normal range of the gain value of vHIT(vHIT-G), and the compensatory saccade(CS)and compare the functions of the bilateral semicircular canal. Results The vHIT-G averages of the right side of horizontal, anterior, and posterior semicircular canals were 1.02±0.04, 0.84±0.09 and 0.87±0.12, respectively.The vHIT-G averages of the left side of horizontal, anterior, and posterior semicircular canals were 0.97±0.10, 0.88±0.10 and 0.88±0.08, respectively. There was no compensatory saccade in any of the 40 subjects(P>0.05).The difference in values of vHIT-G of the horizontal semicircular canals in the 40 subjects was statistically significant between anterior and posterior semicircular canals(P<0.01). The asymmetrical ratios of the functions of the horizontal, anterior, and posterior semicircular canals on both sides were 6.00±4.33、9.24±5.85 and 10.24±5.32 respectively. The difference between the asymmetrical ratio of functions of the bilateral horizontal semicircular canals and the bilateral anterior semicircular canals and the posterior semicircular canals was st atistically sig nif icant(P<0.05). Conclusion T he nor mal values of vHIT in Chinese military pilots have been established, which provides data for the aviation medical identification during the selection of f light attendants, medical examination of pilots, vestibular rehabilitation training and medical identif ication of vestibular dysfunction of military pilots.
引文
[1]张道宫,樊兆民.前庭功能检查在眩晕症诊断中的意义及临床应用[J].临床耳鼻咽喉头颈外科杂志,2015,29(1):5-8.
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[7]梅雪霜,孔维佳.摇头试验的临床应用[J].临床耳鼻咽喉头颈外科学杂志,2006,20(16):766-768.
[8]吴子明,杜一,刘兴建,等.规范前庭功能检查与临床应用[J].中华医学杂志,2018,98(16):1 209-1 212.
[9]Curthoys IS,MacDougall HG,McGarvie LA,et al.The video head impulse test(vHIT).Balance Function Assessment and Management[M].2nd ed.San Diego:Plural Publishing,2014:391-430.
[10]Crane BT,Demer JL.Human gaze stabilization during natural activitis:translation,rotation,magnification and target distance sffects[J].J Neurophysiol,1997,78:2 129-2 144.
[11]Grossman GE,Leigh RJ,Bruce EN,et al.Performance of the human vestibuloocular ref lex during locomotion[J].JNeurophysiol,1989,62:264-272.
[12]Pozzo T,Berthoz A,Lefort.Head stabilization during various locomotor tasks in humans[J].I.Normal subjects.Exp Brain Res,1990,82:97-106.
[13]Brey RH,McPherson JH,Lynch RM.Background and int roduction to whole body rotational testing.Balance Function Assessment and Management[M].San Diego:Plural Publishing,2008:253-280.
[14]MacDougall HG,McGarvie LA,Halmagyi GM,et a1.A new saccadic indicator of peripheral vestibular function based on the video head inpulse test[J].Neurology,2016,87(4):410-418.
[15]Mossman B,Mossman S,Purdie G,et al.Age dependent normal horizontal VOR gain of head impulse test as measured with video-oculography[J].J Otolaryngol Head Neck Surg,2015,44:29.
[16]林颖,高林溪,韩丽萍,等.视频头脉冲检查在评价外周前庭病变中的作用[J].中华耳鼻咽喉头颈外科杂志,2015,20(9):724-728.
[17]Macdougall HG,McGarvie LA,Halmagyi GM,et al.The video head impulse test(vHIT)detects vertical semicircular canal dysfunction[J].PLoS One,2013,8(4):e61 488.
[18]Yang CJ,Lee JY,Kang BC,et al.Quantitative analysis of gains and catch-up saccades of video-head impulse testing by age in normal subjects[J].Clin Otolaryngol,2015,41(5):532-538.
[19]McGarvie LA,MacDougall HG,Halmagyi GM,et al.The video head impulse test(vHIT)of semicircular canal function-agedependent normative values of VOR gain in healthy subjects[J].Front Neurol,2015,6:154.
[2]王,周玉娟,余菁,等.优势偏向在外周性眩晕患者前庭功能评估中的意义[J].中华耳鼻咽喉头颈外科杂志,2017,52(3):200-204.
[3]徐先荣,薛善益,安定一,等.阻尼旋转摆动试验对前庭功能的评价[J].中华耳鼻咽喉科杂志,1990,25(3):162-164.
[4]于立身.前庭功能检查技术[M].西安:第四军医大学出版社,2013.
[5]Albernaz PL,Cusin FS.The video head impulse test in a case of suspected bilateral loss of vestibular function[J].Int Arch Otorhinolaryngol,2016,20(1):84-86.
[6]严小艳,王凯,韩玉梁.前庭自旋转试验非对称性异常对眩晕性疾病临床诊断意义[J].中国卒中杂志,2017,12(9):827-830.
[7]梅雪霜,孔维佳.摇头试验的临床应用[J].临床耳鼻咽喉头颈外科学杂志,2006,20(16):766-768.
[8]吴子明,杜一,刘兴建,等.规范前庭功能检查与临床应用[J].中华医学杂志,2018,98(16):1 209-1 212.
[9]Curthoys IS,MacDougall HG,McGarvie LA,et al.The video head impulse test(vHIT).Balance Function Assessment and Management[M].2nd ed.San Diego:Plural Publishing,2014:391-430.
[10]Crane BT,Demer JL.Human gaze stabilization during natural activitis:translation,rotation,magnification and target distance sffects[J].J Neurophysiol,1997,78:2 129-2 144.
[11]Grossman GE,Leigh RJ,Bruce EN,et al.Performance of the human vestibuloocular ref lex during locomotion[J].JNeurophysiol,1989,62:264-272.
[12]Pozzo T,Berthoz A,Lefort.Head stabilization during various locomotor tasks in humans[J].I.Normal subjects.Exp Brain Res,1990,82:97-106.
[13]Brey RH,McPherson JH,Lynch RM.Background and int roduction to whole body rotational testing.Balance Function Assessment and Management[M].San Diego:Plural Publishing,2008:253-280.
[14]MacDougall HG,McGarvie LA,Halmagyi GM,et a1.A new saccadic indicator of peripheral vestibular function based on the video head inpulse test[J].Neurology,2016,87(4):410-418.
[15]Mossman B,Mossman S,Purdie G,et al.Age dependent normal horizontal VOR gain of head impulse test as measured with video-oculography[J].J Otolaryngol Head Neck Surg,2015,44:29.
[16]林颖,高林溪,韩丽萍,等.视频头脉冲检查在评价外周前庭病变中的作用[J].中华耳鼻咽喉头颈外科杂志,2015,20(9):724-728.
[17]Macdougall HG,McGarvie LA,Halmagyi GM,et al.The video head impulse test(vHIT)detects vertical semicircular canal dysfunction[J].PLoS One,2013,8(4):e61 488.
[18]Yang CJ,Lee JY,Kang BC,et al.Quantitative analysis of gains and catch-up saccades of video-head impulse testing by age in normal subjects[J].Clin Otolaryngol,2015,41(5):532-538.
[19]McGarvie LA,MacDougall HG,Halmagyi GM,et al.The video head impulse test(vHIT)of semicircular canal function-agedependent normative values of VOR gain in healthy subjects[J].Front Neurol,2015,6:154.