脑中1H-MRS在前庭周围性眩晕中的诊断价值

目的探讨脑中氢质子磁共振波谱(1 H-MRS)技术在前庭周围性眩晕中的诊断价值。方法对22例患者和17例健康志愿者进行MRI和1 H-MRS检查,分别测量患者及健康志愿者双侧小脑半球及脑干内主要代谢产物N-乙酰天门冬氨酸(NAA)、肌酸(Cr)、胆碱(Cho)、磷酸肌酸(Cr2)峰值及NAA/Cr、Cho/Cr、Cr2/Cr的浓度比值。结果患病组与健康对照组脑干主要代谢产物含量的差异没有统计学意义(P>0.05);患病组双侧小脑半球内的NAA峰及Cr峰较对照组均有不同程度下降。结论 1 H-MRS可以反映前庭周围性眩晕患者双侧小脑半球内不同病理变化所致部分生化代谢产物的改变,对前庭周围性眩晕患者前庭传导通路中脑组织内神经功能损伤的评估并对该疾病的诊断有一定的价值。     

前庭诱发肌性电位检测的最佳声刺激参数研究

目的通过比较不同的声刺激模式对前庭诱发肌性电位的影响,确定前庭诱发肌性电位检测的最佳声刺激模式。方法9名健康志愿者被随机分成三组,按3×3拉丁方析因设计,对3个不同频率（250、500、750Hz）、3个不同刺激重复率（5、7、10Hz）、3个不同平台时间（2、5、10ms）的短纯音诱发的前庭诱发肌性电位（VEMP）进行测试,每人以随机次序进行9次测试。比较前庭诱发肌性电位的诱发率、潜伏期、波间幅度及双侧幅度不对称比。结果不同短纯音频率对双侧VEMP的潜伏期及幅度及双侧幅度不对称比均有影响,按500、250、750Hz顺序,双侧P13／N23潜伏期依次增加}双侧P13／N23幅度依次减少;双侧幅度不对称比依次增加。500Hz短纯音刺激时双侧幅度最大且双侧幅度不对称比最小;5、7、10Hz3种不同刺激重复率对双侧VEMP的潜伏期、波间幅度及双侧幅度不对称比均无影响,2、5、10ms 3种短纯音不同平台持续时间对双侧VEMP的幅度有影响,按10、5、2ms顺序,双侧VEMP的幅度逐渐增加。而3种短纯音不同平台持续时间对双侧VEMP的潜伏期、双侧幅度不对称比未有明显影响。结论VEMP的最佳声刺激参数为平台时间2ms、频率500Hz、刺激重复率5Hz。     

前庭刺激对心血管自主神经调节及立位耐力的影响

目的观察前庭刺激前后被动直立位耐力试验心率、血压和压力感受器敏感性等指标的变化,了解前庭刺激对心血管自主神经调节功能及直立位耐力的影响。方法对15名男性健康志愿者在转椅刺激前、后进行被动直立位耐力检查。被动直立位耐力实验全程监测心电图和左手中指逐跳血压,在试验的第20,21,23,25,30,35,40,41,45 min测量常规血压、心率和压力感受器反射敏感性指标(BRS)。结果前庭刺激前直立位耐力检查结果均正常,刺激后有两人发生晕厥前症状;常规血压(SBP、DBP)检查在大部分实验时间无统计学差异,心率在检测的大部分时间点有统计学差异;BRS指标仅在直立位25～min段、30～min段有统计学差异,其余检测时间段没有统计学差异。结论前庭刺激可能会削弱机体心血管压力感受器反射调节功能的稳定性,造成部分志愿者直立位耐力的降低。     

高性能战斗机飞行员前庭习服训练效果观察

目的 通过前庭习服训练,提高高性能战斗机飞行员前庭稳定性,以降低空晕病的发生.方法 应用VTS-0型电动转椅对45例前庭稳定性评定等级为D、E级的高性能战斗机飞行员进行每天1次,持续2周的前庭习服训练,记录训练前后前庭稳定性评定中的Coriolis加速度耐受值及训练耐受时间.结果 训练后,45例高性能战斗机飞行员的前庭稳定性较训练前有不同程度提高,均达到C级以上,Coriolis加速度耐受值和训练耐受时间明显提高,且有统计学意义(t=14.55、12.66,P＜0.01).结论 前庭习服训练对提高高性能战斗机飞行员的前庭稳定性效果明显. Abstract： Objective To explore the effects of vestibular accliratization training of highperformance fighter pilots for improving their vestibular stability and reducing airsickness. Methods Forty-five high-performance fighter pilots, who were graded as D and E in vestibular stability evaluation, performed vestibular acclimatization training by VTS-0 rotational chair once a day for 2weeks. In vestibular stability evaluation, tolerated Coriolis acceleration value and endurable duration of rotation were compared between the states before and after training.Results All 45 pilots'vestibular stability was variously improved and reached or exceeded grade C by training. Tolerated Coriolis acceleration value and endurable duration were significantly increased (t=14.55, 12.66, P＜0.01).Conclusions Vestibular acclimatization training shows significant effects on improving the vestibular stability of high-performance fighter pilots.     

Effects of Vestibular Stimulation on Cardiovascular Autonomic Nerve Regulation and Orthostatic Ttolerance

目的 观察前庭刺激前后被动直立位耐力试验心率、血压和压力感受器敏感性等指标的变化,了解前庭刺激对心血管自主神经调节功能及直立位耐力的影响.方法 对15名男性健康志愿者在转椅刺激前、后进行被动直立位耐力检查.被动直立位耐力实验全程监测心电图和左手中指逐跳血压,在试验的第20,21,23,25,30,35,40,41,45 min测量常规血压、心率和压力感受器反射敏感性指标(BRS).结果 前庭刺激前直立位耐力检查结果均正常,刺激后有两人发生晕厥前症状;常规血压( SBP、DBP)检查在大部分实验时间无统计学差异,心率在检测的大部分时间点有统计学差异;BRS指标仅在直立位25～min段、30～ min段有统计学差异,其余检测时间段没有统计学差异.结论 前庭刺激可能会削弱机体心血管压力感受器反射调节功能的稳定性,造成部分志愿者直立位耐力的降低.     

短臂离心机不同转速暴露时躯体重力错觉及前庭自主神经反应对比

目的观察短臂离心机不同转速暴露时躯体重力错觉诱发效果及前庭自主神经反应情况,寻求短臂离心机用于地面模拟训练的适合转速。方法在SAC-Ⅲ型短臂离心机不同转速下,对105名健康歼击机飞行员进行躯体重力错觉模拟,对比错觉诱发情况及前庭自主神经反应情况。结果短臂离心机启动加速、匀速运行及制动减速阶段可分别诱发出前倾扭转错觉、前倾错觉及后倾错觉等躯体重力错觉,3种转速下各躯体重力错觉形态表现相同,但错觉强度随离心机转速加快而增强。37 r/min暴露时,各错觉诱发率均大于30 r/min和21 r/min暴露时的诱发率(P0.01);30 r/min和21 r/min暴露时,各错觉诱发率差异均无统计学意义P0.05)。3种转速下前庭自主神经反应评分分值随转速增加有增高趋势,但差异无统计学意义(P0.05)。结论 37 r/min短臂离心机暴露时躯体重力错觉的诱发率高,且前庭自主神经反应较轻,此转速用于飞行人员躯体重力错觉的地面模拟训练较为适合。     

军事飞行员前庭功能稳定性训练前后效果观察

目的对军事飞行员前庭功能稳定性进行评价, 为军事飞行员前庭功能稳定性训练提供依据。方法应用电动转椅对军事飞行员进行前庭功能稳定性训练。按照入院顺序, 分别选取21～30岁、31～40岁、41～50岁、≥51岁年龄段各30名飞行员, 比较不同年龄段飞行员训练前后前庭功能稳定性的优秀率、良好率、合格率、不合格率以及耐受时间变化, 并分析年龄与耐受时间的相关性。结果 31～40岁、≥51岁组飞行员训练前后不合格率比较差异有统计学意义(χ2=4.32、4.80, P=0.038、0.028)。飞行员前庭功能稳定性训练后不合格率较训练前降低, 差异有统计学意义(χ2=13.02, P<0.001)。总耐受时间均较训练前增加, 差异有统计学意义(t=17.61, P<0.001)。不同年龄组飞行员前庭功能训练后其稳定性耐受时间均较训练前增加, 差异有统计学意义(t=6.50、8.82、9.48、13.56, P均<0.001)。随着年龄的增加, 前庭功能稳定性逐步减退, 年龄与训练耐受时间呈负相关(r=-0.38, P<0.001)。结论电动转椅训练可增强军事飞行员前庭功能...     

不同体位短臂离心机暴露时心血管及前庭功能的改变

目的 通过观察和比较不同体位下短臂离心机暴露所引起的心血管及前庭功能反应,进一步明确短臂离心机暴露下体位因素对心血管和前庭功能的影响. 方法 10名健康男性,依次进行75°、45°、15°后倾体位的短臂离心机暴露,且每体位先后进行2 G、3 G(足水平)人工重力暴露;采用便携式无创逐跳血压监测仪(Portapres)全程监测,并记录受试者血压、心率,通过Beatscope分析软件计算心脏泵血功能和总外周阻力;同时进行前庭功能评价,比较不同体位短臂离心机暴露对心血管、前庭系统的影响. 结果 2 G、3 G短臂离心机分别暴露时,15°体位下6名受试者出现严重运动病症状被迫终止试验;75°和45°两种体位下受试者血压、心率较基础值增高(F=2.79～16.44,P<0.05);心输出量则无显著变化.3 G暴露75°和45°两种体位时,每搏量显著降低(F=2.25、8.35,P<0.05).3 G暴露45°体位时总外周阻力较基础值增高(F=2.61,P<0.05);相同G值短臂离心机暴露时,75°体位下心血管功能变化较45°体位差异无统计学意义,而前庭功能评分则随着体位角度的减小而逐渐增高,15°体位下评分较45°和75°体位增高,差异有统计学意义(P<0.05). 结论 短臂离心机暴露时,45°和75°两种体位对心血管功能的影响无统计学意义,但不同体位对前庭功能的影响却差异较大.暴露体位越趋近于坐位,引起的运动病程度越重. Abstract： Objective To investigate the changes of human cardiovascular and vestibular functions when exposed to the artificiaI gravity generated by short-arm centrifuge with different body positions.Methods Ten healthy male volunteers were exposed to the artificial gravity at three different body positions:foot towards to the radial direction off the rotation center respectively with 75°,45°and 15°back tilting.Each position underwent on short-arm centrifuge with two sessions that were at 2 G and 3 G (at foot level) respectively.Beat-by-beat arterial blood pressure (BP) and heart rate (HR) were measured before and during the experiment by means of Portapres and calculated parameters,such as stroke volume (SV),cardiac output (CO) and total peripheral resistance (TPR),were obtained by Beatscope software.A subjective scoring was taken for assessing vestibular sensations. Results Six of 10 subjects with 15°posture were terminated both in 2 G and 3 G exposure due to their serious motion sickness symptoms.Comparing to the measurements before exposure,subjects with 45°and 75°posture showed significant increased BP and HR (F=2.79 to 16.44,P<0.05) but SV (F=2.25 or 8.35,P<0.05) while CO had no obvious change.Comparing to the measurements before exposure,subjects with 3 G (45°posture) showed significant incleased TPR (F=2.61,P<0.05).3 G exposure resulted in higher HR than that in 2 G.No significant changes of BP,HR,CO,SV and TPR were found between 45°and 75°postures under same exposure.The scores of vestibular assessment showed increased tendency with the decreased tilt angle.Significantly higher scores were got for 15°posture exposures comparing to others and indicated stronger vestibular stimuli.Conclusions The results suggested that the smaller tilted angle posture would result in mole serious vestibular symptoms.     

短臂离心机不同转速暴露时飞行员前庭性错觉及前庭自主神经反应对比

目的 观察飞行员短臂离心机不同转速暴露时前庭性错觉诱发效果及前庭自主神经反应情况,寻求利用短臂离心机进行前庭性错觉地面模拟训练时的合适转速. 方法 90名健康歼击机飞行员根据不同离心机转速（21、30、37 r/min）分为3组,每组30人.参考电动转椅的前庭性错觉模拟训练方案,采用适合短臂离心机运行特点的前庭性错觉诱发方法,在SAC-Ⅲ型短臂离心机上进行反旋转错觉及科里奥利错觉模拟.每组仅进行1个转速下的错觉模拟.对比不同转速下飞行员错觉诱发情况及前庭自主神经反应情况. 结果 ①离心机不同转速时飞行员反旋转错觉、科里奥利翻转错觉（包括头右旋及左旋时）及科里奥利旋转错觉（包括头前倾和回靠时）的诱发率差异均有统计学意义（X2 ＝6.477～20.000,P＜0.01或P＜0.05）.21 r/min暴露时的诱发率低于30 r/min和37 r/min暴露时（x2＝0.073～0.351,P＞0.05）.②3种转速下,离心机反旋转错觉形态表现相同,但错觉强度随离心机转速加快而增强.科里奥利翻转错觉形态表现稳定,3种转速下其表现分布差异无统计学意义（（x2＝0.090、0.056,P＞0.05）.科里奥利旋转错觉形态表现较为多样,3种转速下头前倾时错觉形态表现分布差异无统计学意义（X2＝1.810,P＞0.05）;头回靠时错觉发生例数较少,未行统计学处理.③3种转速下前庭自主神经反应评分分值随转速增加而增高,且差异有统计学意义（F＝ 15.058,P＜0.01）;37 r/min暴露时的分值明显高于21 r/min和30 r/min暴露时（P＜0.01或P＜0.05）;30 r/min与21 r/min暴露时的分值差异无统计学意义（P＞0.05）. 结论 臂长2 m的短臂离心机上以30 r/min暴露时,飞行员前庭性错觉的诱发率较高,且前庭自主神经反应较轻,此转速用于飞行人员前庭性错觉的地面模拟训练较为合适.     

盐酸氟桂利嗪在前庭性偏头痛预防性治疗中的疗效及安全性

目的 探究盐酸氟桂利嗪在前庭性偏头痛预防性治疗中的疗效及安全性.方法 选择64例前庭性偏头痛患者进行分组治疗,研究组(32例)对照组(32例),对照组采用甲磺酸倍他司汀片进行治疗,研究组采用盐酸氟桂利嗪进行治疗,比较患者治疗有效率、头痛次数、头痛频率、并发症情况.结果 (1)研究组治疗有效率96.88％,高于对照组治疗有效率78.13％;(2)治疗后研究组患者头痛次数以及头痛程度少于对照组;(3)研究组不不良反应发生6.25％低于对照组25.01％,差异有统计学意义(P＜0.05).结论 前庭性偏头痛预防性治疗中使用盐酸氟桂利嗪可提高临床疗效,改善患者头痛症状,且药物不良反应较低.     

飞行员前庭下神经炎一例（摘要）

飞行员的空间定向障碍是引起许多致命性飞行事故的首要原因。空间定向是本体、前庭和视觉输入整合的结果。前庭神经炎（VN）可能导致飞行员突然的空中失能。VN一般通过单侧冷热反应丧失所显示的前庭功能丧失表现得到诊断。但是冷热试验只测试前庭上神经的功能,单纯前庭下神经受损的患者可能会漏诊。我们报告了一个海军飞行员病例,其症状显示是前庭神经炎,但冷热试验正常,而单侧前庭诱发肌源性电位（VEMP）缺失,我们认为该飞行员患有单纯的前庭下神经炎。     

Prediction of the origin of intracanalicular neoplasms with high-resolution MR imaging

Correct diagnosis of intracanalicular neoplasms is important to avoid unnecessary operations or an unsuitable surgical approach. We investigated the capability of high-resolution three-dimensional MR imaging in predicting the origin of intracanalicular neoplasms. Twenty cases underwent three-dimensional Fourier-transformation (3DFT) constructive interference in steady state and contrast-enhanced 3DFT-fast low angled shot MR imaging and surgery. Seventeen cases underwent caloric test. MR diagnosis on the origin of intracanalicular neoplasms was compared with surgical results. For MR diagnosis, the origin of intracanalicular neoplasms was predicted according to the location of the tumor in the internal auditory canal (IAC) in two ways, i.e., determining (1) a single specific nerve of origin and (2) whether the tumor originated from the superior or inferior aspect of the IAC. Surgery could determine the nerve of origin in 16 cases (14 inferior and 2 superior vestibular schwannomas), but it was indeterminate in 4. Comparison between MR prediction and surgical results on a single nerve origin revealed exact agreement in five, but inconsistent in three. Regarding whether the tumor was derived from superior or inferior aspect of the IAC, agreement was found in 10 of the 16 cases (62.5%). Caloric test was abnormal in all patients examined but one with superior vestibular schwannoma. 3DFT-MR imaging was not particularly useful in predicting a precise nerve of origin of intracanalicular neoplasms. The prediction on whether the tumor originated in the superior or inferior aspect of the IAC was superior to caloric test, which might have clinical significance in treatment planning especially for hearing preservation surgery.     

SRM-Ⅳ眩晕诊疗系统对前庭神经元炎引起的眩晕辅助治疗效果

 目的 评价SRM-Ⅳ眩晕诊疗系统辅助治疗前庭神经元炎引起眩晕的疗效。方法 选取2017-01至2018-12医院收治的诊断为前庭神经元炎患者144例进行随机分组,对照组72例行对症药物治疗,治疗组72例在对症治疗基础上接受SRM-Ⅳ眩晕诊疗系统辅助治疗,并在治疗后对两组眩晕等症状的改善及取得疗效时间进行评价和比较。结果 治疗组总有效率为95.8%,对照组总有效率为79.2%,两者差异有统计学意义(χ²=9.143,P=0.002);治疗组取得疗效中位时间眩晕2 d短于对照组4 d(Z=2.060,P=0.000),呕吐1 d短于对照组2 d(Z=1.873,P=0.002)。结论 常规对症治疗基础上行SRM-Ⅳ眩晕诊疗系统辅助治疗能减轻前庭神经元炎引起的眩晕,并能缩短眩晕和呕吐持续时间。     

帕金森病患者前庭功能的改变及意义

为了探讨帕金森病患者前庭功能的改变及意义，作者对54例帕金森病患者和20名健康老人（作为对照）用眼震电图（ENG）仪进行视动系统反应、自发眼震、冷热试验反应、位置试验检查。结果发现，帕金森病患者组前庭功能减退占81．4％，正常老年人组前庭功能减退占30％，两组之间差异有显著性意义（P＜0．01）。研究表明，帕金森病平衡障碍与前庭功能减嫁有一定关系，ENG可提供客观检测。     

Static monocular visual cues can decrease the vestibular-evoked balance response at low frequencies

BackgroundThe balance system continually integrates and processes diverse sensorimotor cues to maintain upright posture. Yet, little is known about how monocular visual cues may modulate the vestibular control of standing balance.Research questionTo determine how visual cues, specifically monocular vision, modulate the vestibular-evoked myogenic and whole-body balance response.MethodsSeventeen (12 female) healthy subjects (age: 24.8 ± 5.3years) were exposed to a random, continuous electrical vestibular stimulation (EVS) signal (±3.5 mA, 0–20 Hz). Subjects stood quietly during four experimental (no vision, non-dominant eye, dominant eye, binocular) conditions. The EVS-medial-lateral ground reaction force (ML GRF) acting on the body and EVS-medial gastrocnemius electromyography (EMG, bilateral) responses were evaluated in the frequency (coherence) and time (cumulant density) domains.ResultsCoherence was increased for no vision compared to binocular, dominant eye, and non-dominant eye visual cues, respectively, with the most pronounced increases occurring at lower frequencies. For cumulant density, the EVS-ML GRF medium-latency peak amplitude was increased 45, 26 and 18% with no vision compared to binocular, dominant eye and non-dominant eye visual cues, respectively (p < .05). The EVS-EMG medium-latency peak amplitude during no vision was greater than binocular (p < .05) for both gastrocnemii, but binocular and dominant eye monocular vision was not different (p > .05). The EVS-ML GRF and EVS-EMG (right medial gastrocnemius) medium-latency peak amplitude was greater for non-dominant eye monocular vision compared to binocular vision (p < .05).SignificanceMonocular visual cues, at least for the dominant eye, can depress the vestibular-evoked balance response at low frequencies akin to binocular vision with limited differences exhibited between dominant and non-dominant eye.     

面神经炎中医分型治疗效果观察

 目的 观察面神经炎中医分型治疗效果。方法 95例面神经炎患者按1∶1的比例随机分为两组,治疗组48例,对照组47例。两组均按急性期、静止期及恢复期采用不同的针刺方法。同时,治疗组将患者分为风寒客络型、风热袭络型及瘀阻络脉型,在牵正散的基础上风寒客络型加防风、羌活、桂枝、黄芪;风热袭络型加黄芩、菊花、夏枯草;瘀阻络脉型加当归、赤芍、香附等中药治疗。对照组不分证型,只服用牵正散中药。治疗6周后,比较两组的疗效及面神经功能积分。结果 从临床疗效比较,治疗组临床治愈率为83.3%,明显优于对照组74.4%(P＜0.01),而在总有效率方面,两组无统计学差异。治疗6周后,两组患者面神经运动功能、语言功能及综合功能均较前有所提高(P＜0.05),且与对照组相比,治疗组患者面神经运动功能、语言功能及综合功能有所提高(P<0.05)。结论 面神经炎中医分型治疗能显著改善预后。     

Modified head shake sensory organization test: Sensitivity and specificity

The Sensory Organization Test (SOT) of Computerized Dynamic Posturography (EquiTest™ equipment) is a valuable tool for investigating how an individual uses balance system sensory input (vestibular, vision, proprioception/somatosensory) to maintain quiet stance; however, it is limited as a screening tool for identifying peripheral vestibular system dysfunction. Previous research has shown that adding horizontal head-shake to portions of the standard SOT battery improved the identification of peripheral vestibular system asymmetry; however, flaws in the methods were noted. The objective of this work was to evaluate the sensitivity and specificity of the modified head-shake SOT (HS-SOT) protocol for identification of peripheral vestibular system lesion. Fifteen patients with chief complaint of instability, vertigo, and/or lightheadedness, with and without a caloric unilateral weakness (UW) and fifteen age-matched healthy controls were included in the final analysis. Ten of the 15 patients demonstrated a caloric UW ≥ 25%. Participants completed standard conditions 2 and 5 of SOT with head still and during four horizontal head-shaking tasks (i.e., HS-SOT2-60°/s, HS-SOT2-120°/s, HS-SOT5-15°/s, and HS-SOT5-60°/s). Average equilibrium scores decreased as condition difficulty increased (SOT2, HS-SOT2-60°/s, HS-SOT2-120°/s, SOT 5, HS-SOT5-15°/s, and HS-SOT5-60°/s) for each group; as expected, a lower decline was noted for controls (slope = −6.59) compared to patients (slope = −11.69). The HS-SOT5-15°/s condition was superior for identifying peripheral vestibular asymmetry (AUC = 0.90 sensitivity = 70%, specificity = 100%), with the strongest correlation to caloric UW% (r_s = −0.743, p = 0.000006). HS-SOT5-15°/s appears to be a promising screening measure for peripheral vestibular asymmetry.     

麻醉大鼠冰水灌耳交感神经响应在心血管调节中的作用

目的研究冰水灌耳刺激引起的交感神经响应、心率以及血压调节之间的内在联系,探讨前庭刺激在心血管调节中的作用。方法记录正常麻醉（CON）大鼠（n=5）、压力反射去除（SAD）大鼠（n=5）和迷路毁损（VD）大鼠（n=5）在冰水灌耳时内脏大神经传出放电及血压和心率的变化。结果正常麻醉大鼠灌耳后,血压、心率降低,内脏大神经反应由增强到减弱。压力反射去除大鼠灌耳后内脏大神经活动显著高于迷路毁损大鼠,且两组动物血压呈相反方向变化。内脏大神经放电与呼吸的耦合形式受到灌耳刺激的影响。结论半规管输入至少参与了血压的短时调节机制,其作用途径可能涉及呼吸运动的调节机制,在血压调节中压力反射和前庭输入两者作用不同,在某些生理调节过程中可能有协同作用。