【摘要】 目的:探讨不同类型良性阵发性位置性眩晕(BPPV)各体位检查方法的临床应用价值。方法:本研究中后半规管BPPV(PC-BPPV)体位检查方法采用Dix-Hallpike test和Side-lying test;水平半规管(HC-BPPV)体位检查方法采用Roll test和WRW test;上半规管BPPV(SC-BPPV)体位检查方法采用Dix-Hallpike test、Side-lying test和Rahko T manoeuvre。将研究对象共613例随机分为2组,均按照PC-BPPV、HC-BPPV、SC-BPPV的体位检查顺序,先左侧后右侧进行检查,每进行下一项检查前静坐10min以上,两组之间PC-BPPV和HC-BPPV的体位检查方法的检查次序相反。观察并记录每个患者每种体位检查方法下有无眼震及特点。结果:Dix-Hallpike test和Side-lying test对PC-BPPV检出率的差异无统计学意义(P>0.05);Roll test和WRW test对HC-BPPV检出率的差异无统计学意义(P>0.05);Rahko T manoeuvre对SC-BPPV的检出率高于其余2种方法,差异均有统计学意义(均P<0.05)。PC-BPPV和HC-BPPV各体位检查方法两组之间的检出率差异均无统计学意义(均P>0.05),即采用不同的体位检查次序均不影响各方法的敏感性。结论:Dix-Hallpiketest对后半规管可以产生最有效刺激,仍然是PC-BPPV首选的体位检查方法;Side-lying test的敏感性与前者无明显差异且具有良好的操作可控性,可用于怀疑PC-BPPV且不易配合Dix-Hallpike test的患者;Roll test与WRW test对HC-BPPV的检出率无差异且均达到90%以上,但前者操作更安全简便,且检查结果有助于复位手法的选择,故Roll test应作为HC-BPPV的首选体位检查方法,WRW test可作为其补充;Rahko T manoeuvre对SC-BPPV的敏感性明显高于Dix-Hallpike test和Side-lying test,可用于验证2种方法初筛阳性的SC-BPPV患者,或筛查2种方法漏诊的SC-BPPV患者。受累半规管的判断不仅通过体位检查方法,更需注意诱发的眼震特点,以免误诊和漏诊。更多还原

【Abstract】 Objective:To explore the clinical value of different positioning tests for different benign paroxysmal positional vertigo(BPPV).Method:This research applies Dix-Hallpike test and Side-lying test for PC-BPPV,Roll test and WRW test for HC-BPPV,Dix-Hallpike test,Side-lying test and Rahko T maneuvers for SC-BPPV.Six hundred and thirteen cases,who were tested with different positioning tests in the sequence of firstly PC-BPPV then HC-BPPV and finally SC-BPPV,were randomly divided into 2groups.Theorder of positioning tests for PCBPPV and HC-BPPV in the two groups was reversed.Result:There’s no significant difference between the detection rate of Dix-Hallpike test and Side-lying test for PC-BPPV(P>0.05).Similarly,there’s no difference in statistics between the detection rate of Roll test and WRW test for HC-BPPV(P>0.05).However,the detection rate of Rahko T maneuver was higher than the other two tests for SC-BPPV and the differences were statistically significant(P<0.05).The detection rates of different positioning tests for PC-BPPV and HC-BPPV between the two groups were not different in statistics(P>0.05),which implies that the different order had no effect on the sensitivity of each positioning test.Conclusion:Dix-Hallpike test is recommended as the first choice for PC-BPPV for its more efficient stimulus to the posterior semicircular canal,and Side-lying test is recommended as a prior choice to the patients with suspected PC-BPPV but unable to receive Dix-Hallpike test because of its similar sensitivity and more convenient manipulation.The detection rate of Both Roll test and WRW test were higher than 90%and there’s no significant difference between the two tests.In addition,Roll test is easier to perform and helpful for the therapy,so it’s considered as the preferred test for HC-BPPV with WRW test as the supplement test.Nevertheless,for SC-BPPV the sensitivity of Rahko T maneuver was higher than that of the other two tests,so it can be used to confirm the suspected SC-BPPV patients detected or missed diagnosed by the two other tests.To avoid misdiagnosis or missed diagnosis,the judgment of affected semicircular canal is determined not only by positioning test but also by the feature of nystagmus.更多还原