眩晕副本分析报告.ppt

良性位置性眩晕 病因　 ? 自发性 ? 颅脑损伤 ? 病毒性神经迷路炎 ? 长期卧床 Saunders Manual of Medical practice, 2nd edition, 2000, p1320 被认为是 器官碎片 (耳石) 聚集在一侧半规 管的内淋巴液中-- 典型的在后半规管 由于耳石的存在, 半规管的内淋巴液 流动相对缓慢，导致眩晕。 American Family Physician 1996; 53 (8):2613-2616 良性位置性眩晕 ? 高发年龄: 50 to 70 岁 ? 眩晕持续时间小于1分钟 ? 由头部快速运动引起 ? 根据病史就可以做出诊断 ? 被Dix-Hallpike 试验证实 良性位置性眩晕 Step 1: 开始先坐在检查桌上 Step 2: 将头部向患耳方向转45度 Step 3: 快速仰卧使头部降至水平线以下， 维持此头位(仍转45度) Step 4: 观察眼球震颤 Step 5: 按同样方法在另一侧再做一次 Family Practice News: January 15, 2001 Dix-Hallpike Test 试验阳性: ?出现眩晕和眼震. Dix-Hallpike Test Dix-Hallpike Test 眼震的特征: ? 病耳向下时被引出 ? 多数是旋转性的 ? 快相指向低的耳朵 ? 潜伏期为1～5秒 ? 短暂的：通常小于20秒 ? 易疲劳性 American Family Physician 1996; 53 (8):2613-2616 良性位置性眩晕的自然病程 ?自发性缓解 ? 然而, 症状持续时间可长达数月 Consultant Jan. 2001:29-34 良性位置性眩晕的治疗 Epley’s 手法复位: 使内淋巴中的耳石移出半规管 而至前庭迷路，那里不受影响 . * * Assumption of the upright posture results in the pooling of 500 to 1000 mL of blood in the lower extremities and splanchnic circulation, which initiates the following sequence: A rapid decrease in venous return to the heart The ensuing reduction in ventricular filling results in diminished cardiac output and blood pressure The fall in blood pressure and thoracic volume provokes a compensatory reflex mediated by the central nervous system that increases sympathetic and reduces parasympathetic outflow (ie, baroreceptor reflex). The increase in sympathetic outflow rises peripheral vascular resistance, venous return, and cardiac output, thereby limiting the fall in blood pressure. 内耳包括两部分. 骨迷路和膜迷路 骨迷路是颞骨内的网状空腔. 它包括3部分: 半规管, 前庭，耳蜗,. 在骨迷路里有一连串的膜管，叫膜迷路。 和骨迷路一样，也包括三部分，半规管，前庭，耳蜗。 BPV is generally a disease of the elderly. Peaks at ages of 50 and 70. Vertigo is rotational with concomitant rotatory nystagmus. Vertigo is precipitated by rapid head tilt toward the affected ear or by head extenation. This typically occurs when turning over in bed, extending the neck to look up or li