不同变位试验在良性阵发性位置性眩晕的诊断价值

目的：探讨不同变位试验在诊断良性阵发性位置性眩晕（BPPV）中的价值。方法：对我科2000年2月～2004年4月诊断的后半规管（PC）源性良性眩晕72例，采用交叉设计，随机将其中36例先行Dix-Hallpike试验，再行侧卧试验；男36例试验排序与其相反。此后再行仰卧侧头位试验。结果：Dix-Hallpike试验和侧卧试验在诊断PC—BPPV中所得结果具有关联性（P〈0．01），诊断阳性率差异无统计学意义（P〉0．05）；两者裸眼观察到眼震的典型阳性反应分别为77．9％及77．1％，差异亦无统计学意义（P〉0．05）。2种试验诱发眩晕和（或）眼震具有的潜伏期、持续期及性质、方向等特征无差异。1例患者同时仰卧侧头位试验阳性，诊断同时存在PC—BPPV。结论：在诊断PC—BPPV中，侧卧试验与Dix-Hallpike具有相同的客观诊断价值。在活动受限的情形下，侧卧试验更易于操作及更具安全性，可完全取代Dix-Hallpike试验。在前2种试验出现水平眼震时应同时行仰卧头位试验，以确定是否同时伴有或为水平半规管源性病变。

Value of the different positioning tests in diagnosis ofbenign paroxysmal positional vertigo

Objective:To ascertain the value of different positioning tests in diagnosis of benign paroxysmal positional vertigo(BPPV).Method:Seventy-two patients who had determined the diagnosis of the posterior semicircular canal BPPV(PC-BPPV) in our department from Feb.2000 to Apr.2004 was tested with different positioning maneuvers.All cases were randomly divided into 2 groups with cross-over design.Group A with 36 subjects was tested with the Dix-Hallpike maneuver followed up by side-lying maneuver;Group B was test in reverse order.Then,the Roll test was performed.Result:The results had association(P>0.01)between the Dix-Hallpike maneuver and side-lying maneuver,and the positive rate had no significant difference(P<0.01).The features of vertigo and nystagmus provoked by the tests were the same.One patient was found combining with BPPV of horizontal semicircular canal(HC-BPPV)by the Roll test.Conclusion:As the Dix-Hallpike maneuver,the side-lying test has the same diagnotic value in determing the PC-BPPV.Becacause it is safer and easier to perform in the condition of range-of-motion limitations such as spondylosis,it can alter the Dix-Hallpike maneuver.If the horizontal nystagmus provoked in above tests,the Roll test should be perform also to determine whether combining with HC-BPPV or not.