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目的研究摇头眼震(headshakingnystagmus,HSN)的临床表现形式及其与前庭双温试验之间的交互认证关系,并拟将HSN列入前庭功能的常规检查。方法对眩晕门诊124例患者行HSN检查及前庭双温检查,分别观察HSN的潜伏期与时程,动态观察前庭神经炎的患者HSN的变化。将前庭双温试验与HSN的关系按照半规管轻瘫(canalparesis,CP)值来分类,并进行比较。结果HSN有3种类型:单相眼震41例、双相眼震11例和倒错性眼震7例。单相HSN潜伏期为(2.75±1.41)s;持续时间变化较大,为(32.16±20.30)s;双相HSN,第一相一般没有潜伏期,持续时间为(12.33±4.42)s,也明显短于第二相的(57.00±17.19)s(P<0.01)。前庭双温CP值无摇头眼震者明显低于有摇头眼震者。结论HSN的引出与前庭损伤后前庭代偿的程度密切相关,眼震的持续时间个体间变异大。一侧前庭损伤的急性期,双侧前庭功能明显失衡,摇头眼震有明显的定侧作用,摇头眼震的方向与自发性眼震的方向相同。随着前庭代偿的进展,双相眼震逐渐取代单相眼震,其中第一相眼震方向代表健侧。代偿完成后,不能引出HSN。当引出HSN时,一般提示前庭双温试验CP值大于25%。而当引出倒错眼震时,则可能存在中枢异常。
Objective To study the clinical manifestation of headshaking nystagmus (HSN) and its mutual certification relationship with the vestibular dual-temperature test. It is proposed that HSN be included in the routine examination of vestibular function. Methods 124 patients with vertigo were examined by HSN and vestibular twins. The latency and duration of HSN were observed, and the changes of HSN in patients with vestibular neuritis were observed dynamically. The relationship between vestibular dual-temperature test and HSN was classified according to canalparesis (CP) values and compared. Results There were 3 types of HSN: single-phase nystagmus in 41 cases, bipolar nystagmus in 11 cases and inverted nystagmus in 7 cases. The latency of single-phase HSN was (2.75 ± 1.41) s, the variation of duration was (32.16 ± 20.30) s, while the first phase of biphasic HSN had no latency and the duration was 12.33 ± 4.42 s (57.00 ± 17.19) s in the second phase (P <0.01). Vestibular temperature CP value of shaking his head were significantly lower than those who shake their eyes and shook. Conclusions The lead of HSN is closely related to the degree of vestibular compensation after vestibular injury, and the variation of the duration of nystagmus is large. One side of the vestibular injury in the acute phase, bilateral vestibular function was significantly unbalanced, shaken nystagmus obvious side effects, shaking his head in the direction of nystagmles and spontaneous nystagmus in the same direction. With the progress of vestibular compensation, biphasic nystagmus gradually replaced single-phase nystagmus, in which the nystagmus of the first phase represents the contralateral side. Compensation is completed, can not lead to HSN. When the introduction of HSN, the general tips vestibular temperature test CP value greater than 25%. And when inverted inverted nystagmus, there may be central abnormalities.