摘要：

目的: 探讨前庭康复治疗对伴主观视觉垂直偏斜的急性脑干梗死患者主观视觉垂直、平衡信心、头晕/眩晕程度及步行能力的疗效及其相关性。方法: 纳入2022年7月至2023年7月天津市环湖医院收治的45例伴主观视觉垂直偏斜的急性脑干梗死患者，随机分为前庭康复组（25例）和常规康复组（20例），于康复治疗前和治疗后2周采用水桶试验测量主观视觉垂直偏斜角度，特异性活动平衡信心量表（ABC）评估患者完成各项任务时平衡信心，头晕/眩晕视觉模拟评分（VAS）评估头晕/眩晕程度，功能性步行分级量表（FAC）评估步行能力。结果: 前庭康复组与常规康复组主观视觉垂直偏斜角度（F=4.356，P=0.043）、ABC评分（F=4.389，P=0.042）、头晕/眩晕VAS评分（F=4.138，P=0.048）差异有统计学意义，其中治疗后前庭康复治疗组主观视觉垂直偏斜角度（t=-2.139，P=0.038）、头晕/眩晕VAS评分（t=-2.952，P=0.005）低于常规康复治疗组，ABC评分高于常规康复治疗组（t=2.920，P=0.006）；两组治疗前后主观视觉垂直偏斜角度（F=196.923，P=0.000）、ABC评分（F=89.050，P=0.000）、头晕/眩晕VAS评分（F=81.803，P=0.000）、FAC分级（F=72.866，P=0.000）差异亦有统计学意义，其中前庭康复组和常规康复组治疗后主观视觉垂直偏斜角度（t=0.763，P=0.000；t=0.972，P=0.000）和头晕/眩晕VAS评分（t=8.815，P=0.000；t=5.107，P=0.000）低于治疗前，ABC评分（t=0.689，P=0.001；t=0.703，P=0.001）和FAC分级（t=-6.721，P=0.000；t=-5.772，P=0.000）高于治疗前。相关分析显示，伴主观视觉垂直偏斜的急性脑干梗死患者治疗前主观视觉垂直偏斜角度与头晕/眩晕VAS评分呈正相关（r=0.627，P=0.000）。结论: 前庭康复治疗可以有效改善伴主观视觉垂直偏斜的急性脑干梗死患者主观视觉垂直偏斜、平衡信心、头晕/眩晕症状，且主观视觉垂直偏斜角度与头晕/眩晕程度密切相关。

关键词: 脑干梗死, 重力感知, 神经康复, 前庭，迷路

Abstract:

Objective: To investigate the rehabilitation effects of vestibular rehabilitation in acute brainstem infarction patients with subjective visual vertical (SVV) tilting, and the correlation between the SVV, balance confidence, dizziness/vertigo and walking function. Methods: All 45 acute brainstem infarction patients with SVV tilting who were hospitalized in Tianjin Huanhu Hospital from July 2022 to July 2023 were collected. Patients were divided into vestibular rehabilitation group (n = 25) and general rehabilitation group (n = 20), Bucket Test was used to test SVV tilting angle, Activities - Specific Balance Confidence Scale (ABC) was used to evaluate balance confidence, Visual Analog Scales (VAS) was used to evaluate dizziness/vertigo and Functional Ambulation Category Scale (FAC) was used to evaluate walking function before and after 2 weeks of treatment. Results: The SVV tilting angle (F = 4.356, P = 0.043), ABC score (F = 4.389, P = 0.042), dizziness/vertigo VAS score (F = 4.138, P = 0.048) were significantly different between vestibular rehabilitation group and general rehabilitation group. After treatment, the SVV tilting angle (t = - 2.139, P = 0.038) and the dizziness/vertigo VAS score (t = - 2.952, P = 0.005) in vestibular rehabilitation group were lower than those in general rehabilitation group, and the ABC score was higher than that in general rehabilitation group (t = 2.920, P = 0.006). SVV tilting angle (F = 196.923, P = 0.000), ABC score (F = 89.050, P = 0.000), dizziness/vertigo VAS score (F = 81.803, P = 0.000), FAC grade (F = 72.866, P = 0.000) were statistically significant. The SVV tilting angle (t = 0.763, P = 0.000; t = 0.972, P = 0.000) and dizziness/vertigo VAS score (t = 8.815, P = 0.000; t = 5.107, P = 0.000) after treatment were lower than those before treatment of 2 groups, and the ABC score (t = 0.689, P = 0.001; t = 0.703, P = 0.001) and FAC grade (t = - 6.721, P = 0.000; t = - 5.772, P = 0.000) were higher than those before treatment of 2 groups. Correlation analysis showed a positive correlation between SVV tilting angle and dizziness/vertigo VAS score in acute brainstem infarction patients with SVV tilting (r = 0.627, P = 0.000). Conclusions: Vestibular rehabilitation can effectively improve the SVV tilting, balance confidence and dizziness/vertigo symptoms of acute brainstem infarction patients with SVV tilting, and the SVV tilting angle is closely related to the degree of dizziness/vertigo.

Key words: Brain stem infarctions, Gravity sensing, Neurological rehabilitation, Vestibule, labyrinth