神经内科门诊中老年人群头晕/眩晕患者病因分层特点

 目的 探讨神经内科门诊就诊的中老年头晕/眩晕患者的病因分布。方法 回顾性分析于2021年3-9月就诊于北京朝阳医院京西院区神经内科的中老年头晕/眩晕患者1931例,分为老年组(＞60岁)1005例和中年组(40～60岁)926例,对两组人口学特征、性别分布及病因分布相关数据进行分析。结果 分析以头晕/眩晕为主诉的老年患者病因分布,发现前3位的病因依次为良性发作性位置性眩晕(benign paroxysmal positional vertigo,BPPV)29.9%、精神心理性头晕/持续性姿势-感知性头晕(psychiatric or persistent postural perceptual dizziness, psychogenic/PPPD)28.7%及血管源性头晕20.0%;中年头晕/眩晕患者以BPPV最常见(33.2%),其次是精神心理性头晕/PPPD(30.9%)及前庭性偏头痛(10.0%);中年及老年头晕/眩晕患者病因构成差异有统计学意义,其中血管源性头晕在老年人群中更常见,前庭性偏头痛在中年人群更常见。中年及老年人群中BPPV、精神心理性头晕/PPPD均为女性多于男性(P<0.05),中年人前庭性偏头痛中女性占优势(P<0.05),而在中年人血管源性头晕中男性占优势(P=0.00)。结论 中年及老年头晕/眩晕患者中最常见的病因为BPPV及精神心理性头晕/PPPD,均以女性常见。对于不明原因的老年头晕患者要注意血管源性头晕的识别,特别是脑小血管病。对于反复发作性头晕的中年女性患者不能忽视前庭性偏头痛的可能。     

良性阵发性位置性眩晕复位成功后残留症状特点及其影响因素

 目的 分析良性阵发性位置性眩晕(耳石症)患者复位成功后残留症状的临床特点及其可能的影响因素。方法 通过对本院收集的37例后半规管良性阵发性位置性眩晕患者、28例水平半规管良性阵发性位置性眩晕患者,12例混合半规管(同侧水平半规管合并后半规管)良性阵发性位置性眩晕患者采用SRM-IV型BPPV诊疗系统进行复位,收集复位成功后出现残留症状的临床特点及其相关影响因素。结果 77例良性阵发性位置性眩晕患者经明确诊断及成功复位后,残留症状的发生率为48.1%(37/77),其中头晕者占27%(10/37),不稳者占16.2%(6/37),颈部不适者占21.7%(8/37),合并两种残留症状者占32.4%(12/37),合并三种残留症状者占2.7%(1/37)。残留症状的发生与复位次数有关,而与发病前存在诱发因素(如劳累及睡眠欠佳)、受累半规管、性别、年龄、病程无关。结论 良性阵发性位置性眩晕复位成功后仍有残留症状,主要为头晕、不稳及颈部不适。残留症状的发生与患者所需复位次数有关。     

“和平方舟”医院船住院患者抗生素使用状况分析

目的分析"和平方舟"医院船住院患者抗生素使用状况,为今后灾后医疗救助中的抗生素使用提供参考。方法采用回顾性调查方法统计2013年赴菲律宾人道主义医疗救助过程中"和平方舟"医院船住院患者使用抗生素的人数、种类、天数。结果共39例使用抗生素,其中围手术期用药16例、抗感染治疗23例。围手术期用药1~5 d,抗感染治疗用药1~8 d。第三代头孢菌素、哌拉西林+β内酰胺酶抑制剂使用比例58.97%,第二代头孢菌素使用比例30.76%,第一代头孢菌素、青霉素钠使用比例10.25%,联合用药比例12.82%。结论灾后医疗救助活动,抗生素使用需求较一般医疗服务增多,围手术期抗生素使用指征应适当放宽。     

军事训练伤所致良性阵发性位置性眩晕复位治疗后遗留症状及相关因素研究

目的 探讨军事训练伤所致良性阵发性位置性眩晕(BPPV)复位治疗后遗留症状及相关危险因素。方法 收集联勤保障部队第989医院眩晕门诊2019-01至2021-12确诊的因军事训练伤所致的196例BPPV患者，采用SRM-Ⅳ型诊疗系统进行复位治疗，收集复位治疗后遗留症状的发生率、临床特点及相关危险因素。结果 196例均成功复位，遗留症状的发生率为31.1%(61/196),其中头晕沉感占34.4%(21/61),活动时不稳感占27.9%(17/61),颈部发紧不适感占21.3%(13/61),躺在床上有漂浮感占8.2%(5/61),合并两种遗留症状者占4.9%(3/61),合并3种为1.6%(1/61),合并4种为1.6%(1/61)。遗留症状的发生与病史长短和复位次数有关，与性别、受累半规管类型无关。结论 训练伤所致BPPV复位成功后仍有头晕沉感、活动时不稳感、颈部发紧不适感等遗留症状，残留症状的发生与病程、复位次数有关，与性别、受累半规管类型无关。     

氟桂利嗪在偏头痛性眩晕预防治疗中的疗效观察

目的观察及评价氟桂利嗪在偏头痛性眩晕(MV)预防治疗中的临床疗效。方法对2010年9月—2011年5月眩晕门诊确诊的MV患者25例,予以氟桂利嗪5 mg,每晚口服1次。每月观察1次疗效并进行评价,共观察及评价3个月。结果经随访观察,予以氟桂利嗪干预后第1、2、3月总体有效率分别为84%、88%、88%,且不良反应轻,耐受性良好。结论氟桂利嗪在预防治疗MV中疗效明显,不良反应小。     

良性阵发性位置性眩晕

良性阵发性位置性眩晕(BPPV)是一种与体位改变密切相关的自限性外周性眩晕.其病因尚未完全明确,大部分为特发性.发病机制中"半规管结石学说"为大家所广泛认同.诊断上根据其典型的眩晕病史和变位实验诱发的眼震特点进行分型和定侧.手法复位是治疗BPPV的主要方法.     

寰枢关节不对称、钩突增生与中青年颈性眩晕的相关性

目的 探讨寰枢关节不对称、钩突增生与中青年颈性眩晕的相关性.方法 选取中青年颈性眩晕患者222例为眩晕组,无症状者203例为对照组.所有研究对象均摄取颈椎张口位及正侧位X线片,对其寰枢关节不对称及钩突增生情况做相关性分析.结果 颈性眩晕组中207例寰枢关节不对称,异常率93.24%;53例钩突增生,增生率23.87%.对照组中48例寰枢关节不对称,异常率23.65%;65例钩突增生,增生率32.02%.寰枢关节不对称与中青年颈性眩晕呈显著的负相关(r=-0.710,P＜0.01);钩突增生与中青年颈性眩晕无相关性(r=0.091,P＞0.05).结论 寰枢关节不对称与中青年颈性眩晕密切相关,是引起中青年颈性眩晕的重要因素之一.     

TCD、CDFI对头晕、眩晕患者检测的临床意义

目的分析头晕、眩晕患者的TCD、CDFI检测资料,探讨引起头晕、眩晕症状的血管性病因。方法采用RIMED公司生产的Trans-Link9000型TCD检测仪,以2MHz、4MHz探头分别检测颅内外各血管;采用PHILIPS公司生产的IU22彩色多普勒超声,分别用线阵探头和凸阵探头观察椎动脉颅外段（VAE）的走行、内径、内膜、血流充盈、血流方向等情况。结果 320例头晕、眩晕患者中,46例存在血管狭窄,占14.5%;双侧椎动脉管径不对称112例,占35.0%;椎动脉走行扭曲12例,占3.75%。头晕患者血管狭窄的发生率为12.25%,眩晕患者为17.85%,两者比较差别显著（P〈0.01）。头晕患者中椎-基底动脉狭窄发生率为3.85%,眩晕患者为14.28%,两者比较差别显著（P〈0.01）。结论 TCD、CDFI可以为临床探求头晕、眩晕患者的血管性病因提供线索,并能为治疗及预后提出建议。     

所谓梅尼埃病84例分析

通过纯音和导抗测听、前庭功能检查、颈椎X线检查、血压动态测量、眼底检查等系统诊查，必要时还加用脑干电反应测听和颅脑CT检查，在84例发作性眩晕患者中被认定为耳源性者30例，其中仅16例(19%)考虑为梅尼埃病。导致眩晕发作的病因在老年患青主要为脑动脉硬化和颈椎病(64.7%)，而年轻患者、尤其青年女性，其病因以低血压为主(45.5%)。可以得出这样的结论，耳性眩晕与由于脑血循环障碍引致的眩晕在本文资料呈1：1．7，因此．建议在处理此类患者时应采用改善中枢血供措施，以更有效地治疗眩晕患者。     

以孤立性眩晕为临床表现的延髓梗死1例临床分析

头晕／眩晕是椎－基底动脉缺血（ vertebrobasilar ischemia, VBI）常见症状。眩晕发作而不伴有其他神经系症状、体征往往考虑非VBI原因,其中48％的VBI患者初始症状表现为眩晕,且部分患者仅表现孤立性眩晕症状［1］。本文报道1例以孤立性眩晕为临床表现的延髓梗死,结合眩晕相关的解剖生理进行分析,旨在帮助同道及时识别前庭中枢性眩晕（恶性眩晕）,避免发生灾难性后果。     

MRI in the assessment of the supportive soft tissues of the cervical spine in acute trauma in children

We carried out a retrospective analysis of imaging and clinical findings in 52 children with a history of cervical spinal trauma. No patient had evidence of a fracture on plain films or CT. All had MRI at 1.5 T because of persistent or delayed symptoms, unexplained findings of injury or instability, or as further assessment of the extent of soft-tissue injury. Clinical follow-up ranged from 6 months to 3.5 years. MRI was evaluated for its influence on therapy and outcome. MRI was positive in 16 (31 %) of 52 patients. Posterior soft-tissue or ligamentous injury was the most common finding in the 10 patients with mild to moderate trauma, while acute disc bulges and longitudinal ligament disruption, each seen in one case, were uncommon. MRI was superior to CT for assessment of the extent of soft-tissue injury and for identification of spinal cord injuries and intracanalicular hemorrhage in the six patients with more severe trauma. MRI specifically influenced the management of all four patients requiring surgery by extending the level of posterior stabilization. No patients with normal MRI or any of the 10 with radiographically stable soft-tissue injury on MRI, developed delayed clinical or radiographic evidence of instability or deformity. Received: 5 August 1997 Accepted: 13 October 1997     

5.12汶川地震德阳地区伤员救治体会

回顾分析我院震后10天内收治的1 466例伤员救治情况,反映出组织、指挥在大批量伤员的救治中的重要性,提出平时应急演练是灾难救援的基础,建立创伤救治体系足今后灾难医学救援的发展方向.     

Differences in complication rates among the centres in the SPACE study

Introduction  Despite the high grade of standardisation of study protocols, there is still room for variability among the centres in specific treatment aspects. We evaluated the treatment risk in stent-protected angioplasty of the carotid versus endarterectomy (SPACE) associated with the specific patient enrolment rates of the centres. Materials and methods  The analysed endpoints were ipsilateral stroke or death [primary outcome event (pOE)] and any stroke or death [secondary outcome event (sOE)] until 30 days after treatment. A binary logistic regression analysis with random effects was performed separately for each treatment arm. The centres were secondarily categorised in three classes: I) ≥25 patients enrolled, II) ten to 24 patients and III) <10 patients and a hierarchic log linear model was fitted to test the three-way interaction of treatment, number of patients per class and outcome. Results  The random effects logistic regression analysis in the carotid artery stenting (CAS) arm proved a significant increase in pOE with decreasing number of patients enrolled (−0.0190 ± 0.0085, p = 0.025, deviance 35.7 with 32 df), whereas no such effect was found in the carotid endartectomy (CEA) arm (−0.010 ± 0.008, p = 0.24, deviance 39.78 with 32 df). In the log linear model, there was a significant interaction between treatment, number of patients per centre and sOE (p = 0.023). The odds ratios for sOE in the enrolment classes (CAS vs. CEA) were 0.98 (95% CI 0.50–1.94, p = 0.95) for class I, 1.13 (95% CI 0.47–2.77, p = 0.77) for class II and 11.56 (95% CI 1.40–253.45, p = 0.01) for class III centres. Conclusion  Despite rigorous standardisation and quality requirements for operator qualification, there seemed to be a decrease in complication rate with increasing patient enrolment numbers in the CAS arm while this signal could not be detected in the CEA arm of SPACE.     

Diagnostic errors in the echography of the hip in newborns

Neonatal hip sonography according to Graf employs a standardized image in a frontal section plane ("3-point system") and a good scanner adjustment (the femoral head must be anechoic, like the hyaline cartilage roof triangle). Pathologic conditions can change some of these parameters. The authors examined 6,000 neonatal hips in order to point out the commonest causes of diagnostic error. Two types of error were considered: method errors and interpretation errors. Method errors: they are due to the choice of transducer and frequency, to scanner adjustment and definition of the standard section plane. Their incidence was 2.25% and supported by an uncorrect definition of the standard section plane. Interpretation errors: they come from the wrong localization of some reference points--i.e., lower iliac margin, labrum--, uncorrect evaluation of increased echogenicity of the cartilaginous roof, infant age, application of radiographic criteria and uncorrect measurements of alpha and beta angles. Interpretation errors had 5.5% incidence; they were all due to the uncorrect measurement of alpha (3.18%) and beta (2.33%) angles, especially in pathological hips (68%). To reduce the number of errors, the authors suggest to strictly apply Graf's method, to make a diagnosis based on the morphological changes of the cartilaginous and osseous acetabular roof and, only later on, to measure alpha and beta angles to confirm the diagnosis or in the follow-up.     

踝关节过度运动损伤的影像评估

踝关节过度运动损伤是常见的下肢损伤,包括骨损伤、骨软骨损伤、关节撞击综合征及肌腱、韧带损伤。上述损伤早期症状不明显,正确选择影像检查方法是早期发现损伤、评估损伤程度及指导治疗的重要环节。笔者结合典型影像图片对常见踝关节过度运动损伤的影像特点及损伤分型进行论述。