理筋通督手法治疗颈性眩晕临床研究

目的:观察理筋通督手法治疗颈性眩晕的临床疗效。方法:将120例颈性眩晕患者随机分成3组,理筋通督组、传统手法组及安慰剂组。理筋通督组采用理筋通督手法;传统手法组采用传统手法;安慰剂组口服维生素C。结果:理筋通督手法可显著减缓患者基底动脉舒张期最低血流速度(P0.05)。理筋通督组有效率为93.67%,传统手法组有效率为67.5%,安慰剂组有效率为17.5%,3组比较差异有统计学意义(P0.05),理筋通督组明显优于其他两组。结论:理筋通督手法治疗颈性眩晕临床疗效显著。     

Reproducibility (test–retest) of vestibular evoked myogenic potential

IntroductionThere is still no consensus in the literature as to the best acoustic stimulus for capturing vestibular evoked myogenic potential (VEMP). Low-frequency tone bursts are generally more effective than high-frequency, but recent studies still use clicks. Reproducibility is an important analytical parameter to observe the reliability of responses.ObjectiveTo determine the reproducibility of p13 and n23 latency and amplitude of the VEMP for stimuli with different tone-burst frequencies, and to define the best test frequency.MethodsCross-sectional cohort study. VEMP was captured in 156 ears, on the sternocleidomastoid muscle, using 100 tone-burst stimuli at frequencies of 250, 500, 1000, and 2000 Hz, and sound intensity of 95 dB nHL. Responses were replicated, that is, recorded three times on each side.ResultsNo significant difference was observed for p13 and n23 latencies of the VEMP, captured at three moments with tone-burst stimuli at 250, 500, and 1000 Hz. Only the frequency of 2000 Hz showed a difference between captures of this potential (p < 0.001). p13 and n23 amplitude analysis was also similar in the test–retest for all frequencies analyzed.Conclusionp13 and n23 latencies and amplitudes of VEMP for tone-burst stimuli at frequencies of 250, 500, and 1000 Hz are reproducible.     

范金茹教授治疗颈性眩晕经验举隅

范金茹教授为首批全国优秀中医临床人才,在诊治眩晕类疾病方面积累了丰富经验。颈性眩晕多表现为眩晕、头颈部疼痛、恶心、呕吐、耳鸣等,严重影响了人们的生活质量。范师认为颈性眩晕为本虚标实之证,病位在头颈,肝肾亏虚为本,病性因素多为痰瘀。强调分急性期、缓解期治疗,注重气之升降--引痰饮血瘀下行而出,津气上行以荣脑。自拟颈痹眩晕方,为升降散合泽泻汤加减而成,组方精当,临床运用每获良效。     

半夏白术天麻汤治疗眩晕高血压病举隅

高血压病是我国发病率较高的疾病之一,西医治疗以长期服用降压药物为主要治疗方式,但常因依从性差的原因导致血压控制不佳,而用中医辨证治疗对于首次发现高血压的患者,可明显有效地降低高血压的发病率。高血压病在中医学中属"眩晕",在临床中常常会用半夏白术天麻汤来治疗眩晕,本文通过跟师医案及临床收集介绍半夏白术天麻汤治疗高血压眩晕临证方药的运用。     

Vestibular Function Measurement Devices

Vestibular function laboratories utilize a multitude of diagnostic instruments to evaluate a dizzy patient. Caloric irrigators, oculomotor stimuli, and rotational chairs produce a stimulus whose accuracy is required for the patient response to be accurate. Careful attention to everything from cleanliness of equipment to threshold adjustments determine on a daily basis if patient data are going to be correct and useful. Instrumentation specifications that change with time such as speed and temperature must periodically be checked using calibrated instruments.     

平肝定眩汤治疗肝阳上亢型后循环缺血性眩晕60例临床观察

目的:观察平肝定眩汤对肝阳上亢型后循环缺血性眩晕的疗效。方法:选取2017年6月-2018年10月烟台业达医院收治的后循环缺血性眩晕的患者120例,按随机数字表法分为治疗组和对照组。治疗组和对照组各60例,两组一般的资料经统计学方法,差异无统计学意义(P>0.05),具有可比性。两组均给予改善循环,控制血压、血糖,调节血脂,抗血小板聚集等基础治疗。治疗组给予平肝定眩汤,对照组给予平眩胶囊。两组疗程均为4周,观察两组患者治疗前后总体症状,脑血流速度、血脂、血糖等指标改善情况。采用SPSS 11.0统计学软件进行计算。结果:治疗组总有效率91.7%(55/60),对照组总有效率61.6%(37/60),两组疗效比较有统计学意义(P<0.05)。治疗组三酰甘油(Triglyceride,TG)、血清总胆固醇(Serum Total Cholesterol,TC)、HDL-C、LDL-C治疗后显著改善,与治疗前比较,差异有统计学意义(P<0.05);对照组TG及TC治疗前后差异有统计学意义(P<0.05),高密度脂蛋白胆固醇(High Density Liptein Cholesterol,HDL-C)及低密度脂蛋白胆固醇(Low Density Liptein Cholesterol,LDL-C)治疗前后比较,差异无统计学意义(P>0.05)。两组治疗后TC比较,差异有统计学意义(P<0.05)。两组治疗后空腹血糖(Fasting Plasma Glucose,GLU)明显降低(P<0.05),两组间的治疗后比较,差异无统计学意义(P>0.05)。治疗组治疗后椎动脉(Vertebral Artery,VA)、基底动脉(Basilarartery,BA)平均血流速度(Mean Blood Flow Velocity,VM)明显提高,与对照组治疗后相比较,差异具有统计学意义(P<0.05)。结论:平肝定眩汤治疗后循环缺血性眩晕在改善患者症状、降低血液黏稠度,改善脑血流状况方面疗效显著。     

Does the video head impulse test replace caloric testing in the assessment of patients with chronic dizziness? A systematic review and meta-analysis

IntroductionCaloric testing is the most frequently used test to assess peripheral vestibular function since the beginning of the 20th century. However, the video head impulse test, vHIT, has gained prominence in the field of neurotology, as it is a faster examination, easier to perform and less uncomfortable for the patient.ObjectiveTo compare, through systematic review and meta-analysis, the proportion of altered cases between vHIT tests and caloric testing in patients with chronic dizziness, in addition to assessing the sensitivity and specificity of vHIT, with caloric testing as the gold standard.MethodsThe literature search was carried out in the PubMed, Scopus, BVS-Bireme, Web of Science, Embase, Cochrane and ProQuest indexed databases, with no restrictions regarding the publication period. All articles that contained the results of the two tests were included in the evaluation of patients with dizziness. Two researchers independently conducted data selection and extraction from the studies, strictly following the inclusion and exclusion criteria defined in the research protocol. In case of disagreement during the selection, a discussion was carried out with a third evaluator.ResultsEleven of the 1293 initial articles met the eligibility criteria and were analyzed. 2670 patients were evaluated, of which 1112 (41.6%) were males and 1558 (58.4%) females, with a mean age of 51.6 years. The proportion of altered results in the vHIT was 21% (95%CI 9% –33%), and 55% in the caloric testing (95%CI 43% –67%).ConclusionThe vHIT does not substitute for caloric testing. The tests are complementary in assessing the patient with dizziness, as they describe the tonotopy of the ampullary crest at different frequency ranges of stimulation. In chronic cases, the vHIT has a low sensitivity and high diagnostic specificity in comparison to caloric testing.     

Attentional demands of continuously monitoring orientation using vestibular information.

The aim of this series of experiments was to determine whether attention is normally required for continuously processing vestibular information concerning orientation, or is required only when orientation is disrupted (eg by vestibular dysfunction or by conflicting visual and vestibular orientation cues). In the first two studies, healthy subjects were passively oscillated, and indicated when they perceived they were passing through their starting position. There was only weak evidence for interference between performance on this 'continuous orientation monitoring task' and on concurrent mental tasks. However, a third study showed that when patients with vestibular imbalance carried out the continuous orientation monitoring task their performance on a concurrent mental arithmetic task was substantially impaired. This dual task interference was correlated with inaccuracy in judging orientation on the continuous orientation monitoring task, which in turn correlated with severity of recent vestibular symptomatology (assessed by questionnaire). In a fourth experiment, disorientation was induced in healthy subjects by rotating the visual field about the line of sight. Bidirectional interference was observed between monitoring orientation (assessed by accuracy in setting a rod to the perceived vertical) and performance of an arithmetic task. Dual task interference was correlated with baseline levels of disorientation induced by the visual field, as indicated by inaccuracy in judging the visual vertical. These findings suggest that monitoring orientation makes significant demands upon cortical processing resources when disorientation is induced, whether the disorientation results from deficient sensory functioning or from ambiguous perceptual information.