王正通

【摘要】 目的：分析眩暈症患者致病原因分布及临床特征，为误诊原因及预防措施提供参考。方法：选取2018年5月-2019年10月本院收治的眩晕症患者98例。根据患者症状表现、头颅CT、经颅多普勒超声（TCD）以及Dix-Hallpike试验等检查结果分析眩晕症致病原因。分析不同年龄段、持续眩晕时间及血流速度患者的病因构成。分析98例患者相关病史构成。结果：98例患者中，良性发作性位置性眩晕42例，前庭神经元炎4例，梅尼埃病8例，后循环缺血32例，小脑出血2例，神经症10例。20～39岁患者主要病因为良性发作性位置性眩晕（33.3%），其次为神经症与梅尼埃病（22.2%）;40～59岁患者主要病因为良性发作性位置性眩晕（44.0%），其次为后循环缺血（28.0%）;60岁及以上患者主要病因为良性发作性位置性眩晕及后循环缺血（43.6%），其次为神经症（7.7%）。眩晕持续时间1 min以下主要为良性发作性位置性眩晕（81.2%）;持续眩晕时间≥1 min且<30 min主要为椎基底动脉系统TIA（50.0%）;眩晕持续时间≥0.5 h且<24 h主要为神经症（57.1%）;眩晕持续时间72 h以上主要为小脑梗死和脑干梗死（46.7%）。血流速度增快及正常者主要为良性发作性位置性眩晕（43.6%，57.9%）;血流速度减慢者主要为后循环缺血（35.0%）。结论：良性发作性位置性眩晕属于眩晕症的主要病因，不同病因患者病症持续时间存在差异，年龄与眩晕症病因存在一定关系，在眩晕症进行诊断时可结合患者年龄以及眩晕持续时间进行鉴别。

【关键词】 眩晕症 良性发作性位置性眩晕

[Abstract] Objective： To analyze the distribution of pathogenic causes and clinical characteristics of patients with vertigo， and to provide reference for misdiagnosis and preventive measures. Method： A total of 98 patients with vertigo admitted to our hospital from May 2018 to October 2019 were selected. According to the patients symptoms， cranial CT， transcranial Doppler ultrasonography （TCD） and Dix-Hallpike test， the pathogenic causes of vertigo was analyzed. The pathogenic causes of patients with different age， duration of vertigo and blood flow velocity were analyzed. The related medical history of 98 patients was analyzed. Result： Among the 98 patients， there were 42 cases of benign paroxysmal positional vertigo， 4 cases of vestibular neuronitis， 8 cases of Menieres disease， 32 cases of posterior circulation ischemia， 2 cases of cerebellar hemorrhage and 10 cases of neurosis. Benign paroxysmal positional vertigo （33.3%）， followed by neurosis and Menieres disease （22.2%） were the main causes of 20-39 years old patients. Benign paroxysmal positional vertigo （44.0%）， followed by posterior circulation ischemia （28.0%） were the main causes of 40-59 years old patients. Benign paroxysmal positional vertigo and posterior circulation ischemia （43.6%）， followed by neurosis （7.7%） were the main causes of aged 60 years and above patients. Benign paroxysmal positional vertigo （81.2%） was the main causes of vertigo lasting less than 1 min. Vertebrobasilar arterial system TIA （50.0%） was the main causes of vertigo duration ≥1 min and < 30 min. The duration of vertigo ≥0.5 h and < 24 h were mainly neurosis （57.1%）. Cerebellar infarction and brainstem infarction were the main causes of vertigo over 72 h （46.7%）. The patients with rapid and normal blood flow velocity were mainly benign paroxysms positional vertigo （43.6%， 57.9%）. The decrease of blood flow velocity was mainly caused by posterior circulation ischemia （35.0%）. Conclusion： Benign episodic positional vertigo is the main cause of vertigo， and the duration of symptoms in patients with different etiologies is different. There is a certain relationship between age and the etiology of vertigo. In the diagnosis of vertigo， the patients age and the duration of vertigo can be combined to differentiate.

[Key words] Vertigo Benign episodic positional vertigo

First-authors address： Wafangdian Central Hospital， Wafangdian 116300， China

doi：10.3969/j.issn.1674-4985.2021.09.019

眩暈症是目前临床上比较常见的症状表现，这是由于前庭神经核、前庭神经、内耳迷路半规管壶腹嵴神经末梢、大脑皮质投射区、枢神经传入径路受到病变的过强刺激，超过身体当时的代偿能力，自身或外物出现运动性幻觉，属于自身平衡感障碍疾病[1]。引起眩晕的因素比较多，其中主要为颈椎病性、脑源性、心源性等[2]。近年来，国外已有大量研究指出，良性阵发性位置性眩晕是当前临床最为高发的眩晕症类型，但是在国内对良性阵发性位置性眩晕的认识不足，从而导致在对眩晕症患者进行诊断时具有较高的漏诊率以及误诊率，且多数学者认为眩晕症主要是因为椎基底动脉供血不全导致[3]。……