【作者】 高颖；

【导师】 孙秀珍；

【作者基本信息】 大连医科大学 ， 耳鼻咽喉科学， 2007， 硕士

【摘要】 目的:检测不同年龄段正常人前庭诱发性肌源性电位(Vestibular-evoked myogenic potential, VEMP),探讨不同年龄段振幅的关系,潜伏期及振幅的比较,建立正常范围,为异常情况下VEMP的改变提供标准;应用于临床,对于某些疾病的诊断提供依据,估计病变的累及范围及预后。对象及方法:实验对象: 67名健康受试者,男37人,女30人,年龄于10～60岁之间,平均(30.184±13.886)岁,无耳蜗及前庭的急慢性病史,纯音听阈正常,分为三组,第一组:10～20岁,23人;第二组:21～40岁,24人;第三组:41～60岁,20人,进行各参数关系分析。实验方法:用脑干诱发电位仪(IHS,SmartEP-ASSR)进行检测:受试者仰卧,去枕,将测试部位用酒精脱脂,银盘电极:参考电极于胸骨上窝,记录电极于双侧胸锁乳突肌中点对称的位置,地极于前额正中下部,靠近眉心位置,极间电阻<3欧姆。疏波短声0.1ms,短声强度:100 dB nHL,刺激率:3.1次/ s,带通滤波的范围:30～3000Hz。每次叠加128次,重复2次,频率:500Hz ,记录时间:给声时到给声后80 ms之间,分析时间:100 ms/刺激,同时矫正记录到的肌电活动,测试时患者头抬高离床约15~20cm,以充分收缩双侧胸锁乳突肌。建立VEMP实验室正常范围,利用统计分析软件SPSS13.0对三组实验对象所测的数据进行统计分析,比较三组参数之间的区别与联系。结果:(1)正常值范围:潜伏期(ms):右侧:P13:12.045±1.360,N23:19.466±2.209;左侧:P13:12.316±1.375,N23:19.354±2.158,耳间振幅差异(|双侧振幅差|/双侧振幅和):0.162±0.146,双侧振幅比:0.986±0.324。(2)三组数据比较:双耳潜伏期比较:左-右耳潜伏期无明显差异,三个年龄段潜伏期无明显差异;各组男女受试者潜伏期及振幅无明显差异;不同年龄段振幅有明显差异:年龄与振幅有明显相关性,呈负相关:随年龄的增大,振幅逐渐减小。结论:1、本试验检测了不同年龄段的VEMP的引出情况。能够正常引出的条件:双侧胸锁乳突肌始终保持一定的紧张状态;前庭神经传导通路的完整性。2、不同年龄段,各组双侧VEMP的潜伏期均无明显差异,无男女差异,振幅波动较大,不单独作为判断的标准,但耳间振幅差异及双侧振幅比较为稳定,可作为临床参考。不同的年龄段VEMP的振幅值有明显差异,年龄与振幅之间有明显的负相关性。年龄对于左-右差异无明显相关性,用非病变侧的参数来评估病变侧,当一侧前庭受累时是有效的,但若双侧前庭受累,则应把年龄的因素也考虑进去。3、VEMP是一种检查球囊-丘脑反射通路较为成熟的方法。可以用于动态观察前庭神经病变后的恢复情况。更多还原

【Abstract】 Objective: We examined vestibular-evoked myogenic potential (VEMP) in different ages of healthy adult volunteers, to investigate the effects of age on the vestibular-evoked myogenic potential, and the relationship between the potentials and the amplitude in different ages and set up the range of normal values, then use it in clinic in the future. We chose some typical case to examine their VEMPs, and estimate the extent of disease and the prognosis.Methods: Sixty-seven healthy adult volunteers (37 male and 30 female) were investigated in this study. The subject age was distributed between 10 and 60 years old, the average was 30.184±13.886 years old. They all had never disease in both ears and vestibular system. They were divided in three groups according to their age, group 1:10~20 years old,23 volunteers; group 2:21~40 years old,24 volunteers; group 3:41~60 years old,20 volunteers; then examined their VEMPs, analyzed the parameters.EMG activity was recorded from the upper half of the SCM muscle using surface electrodes, with a reference electrode on the upper edge of the sternum and a ground electrode on the forehead. Care was taken to place the bilateral electrodes symmetrically. During each recording session, the subject raised the head 15~20cm away from the bed to keep the SCM muscle under tension. Rarefaction clicks of 0.1-millisecond duration were presented at a rate of 3.1 per second through a headphone. The EMG signal was amplified and band pass filtered (30 to 3000Hz) and it was averaged on computer using the SmartEP software package .The analysis window was 100 ms wide and the sampling rate was 500 Hz per second. The responses to 128 stimuli were averaged and repeated twice.Results:1. The range of normal values (ms): the right side: P13:12.045±1.360, N23 :19.466±2.209; the left side:P13:12.316±1.375,N23:19.354±2.158, IAD ( interaural amplitude difference): 0.162±0.146, the amplitude ratio: 0.986±0.324.2. No significant latencies differences among the three groups, No gender-related differences were detected in the VEMP. There was a significant correlation between age the p13n23 amplitude of the VEMP, it was negative correlation between age and the p13n23 amplitude, whereas no significant correlation was observed between age and left-right differences of the VEMP.Conclusions:1. We examined vestibular evoked myogenic potential (VEMP) in different ages of healthy adult volunteers, drew the conclusion that to keep the SCM muscle under tension during each recording session and the integrality of the vestibular neural pathways are necessary.2. No significant latencies difference among the three groups, No gender-related differences were detected in the VEMPs. The amplitude fluctuated greatly, but the IAD and the amplitude ratio are stabilization, which can use in clinical widely. There was a significant correlation between age the p13n23 amplitude of the VEMP, which was negative correlation between age and the p13n23 amplitude, whereas no significant correlation was observed between age and left-right differences of the VEMP. It is safe to evaluate the VEMP using the value of the non-affected side when assessing unilateral lesions. However, it may be necessary to take age into account in evaluating the VEMP when bilateral lesions are suspected.3. VEMP is an important method in clinical, which can detective the function of the sacculus and thalamencephalon, and the development of the vestibular system.更多还原