摘要：

良性阵发性位置性眩晕是临床最常见的周围性眩晕性疾病，本文旨在从前庭病理生理学角度阐述其临床特点，首先介绍良性阵发性位置性眩晕相关前庭病理生理学，包括耳石和内淋巴比重及其与半规管空间位置关系、Flourens 定律、Ewald 第二定律、耳石移动致内淋巴动力学改变、半规管耦联作用、半规管与眼外肌的耦联关系和中枢速度储存机制；其次从前庭病理生理学角度剖析眩晕发作特征和眩晕眼震发作机制，水平半规管与后半规管良性阵发性位置性眩晕的差异，手法复位过程中眼震变化规律；最后基于前庭病理生理学，对两种类型耳石的判断、手法复位和前半规管良性阵发性位置性眩晕诊断的注意事项提出观点。

关键词: 眩晕, 前庭, 迷路, 病理学, 生理学, 综述

Abstract:

This paper aims to explain the clinical features of benign paroxysmal positional vertigo (BPPV), the most common peripheral vertigo disease, from the view of vestibular pathophysiology. Firstly, it overviews several important principles in vestibular pathophysiology, including the relative density of otolith and endolymph and its spatial position relation with semicircular canal, Flourens' law, Ewald's second law, endolymph hydrodynamics caused by otolith shift, semicircular canals working as pairs, coupling of semicircular canal-extraocular muscle and central velocity storage. Secondly, use these principles to explain the clinical features of BPPV, differences between posterior and horizontal semicircular canal BPPV and the nystagmus characteristics during maneuver therapy. Finally, it presents some opinions on the diagnosis and treatment of BPPV, also based on these principles, including the differences between canalithiasis and cupulolithiasis, repositioning maneuver method and diagnosis of anterior semicircular canal BPPV.

Key words: Vertigo, Vestibule, labyrinth, Pathology, Physiology, Review