摘要：

目的: 探讨急性脑干梗死患者前庭症状与平衡和步行功能的相关性。方法: 共纳入2023年11月至2024年12月天津市环湖医院收治的51例功能性步行分级量表>3级的急性脑干梗死患者，采用水桶试验评估主观视觉垂直偏斜角度，头晕/眩晕视觉模拟评分（VAS）评估头晕/眩晕程度，动态视敏度评估前庭眼反射功能，特异性活动平衡信心量表（ABC）评估完成各项任务时的主观平衡信心，动态步态指数（DGI）评估客观动态平衡功能。结果: Spearman秩相关分析显示，ABC评分与主观视觉垂直偏斜角度（r_s = -0.414，P = 0.003）和头晕/眩晕VAS评分（r_s = -0.463，P = 0.000）呈负相关，DGI指数与主观视觉垂直偏斜角度（r_s = -0.347，P = 0.012）、头晕/眩晕VAS评分（r_s = -0.472，P = 0.000）和动态视敏度水平面丢失行数（r_s = -0.326，P = 0.019）呈负相关。多因素线性逐步回归显示，头晕/眩晕VAS评分（标准化偏回归系数= -0.593，P = 0.000）对ABC评分的影响强度约为主观视觉垂直偏斜角度（标准化偏回归系数= -0.268，P = 0.015）的2.21倍；头晕/眩晕VAS评分（标准化偏回归系数= -0.666，P = 0.000）对DGI指数的影响强度是动态视敏度水平面丢失行数（标准化偏回归系数= -0.263，P = 0.010）的2.53倍。进一步Spearman秩相关分析显示，头晕/眩晕VAS评分与步态参数支撑相时间占比呈正相关（r_s = 0.289，P = 0.039）。结论: 急性脑干梗死患者动态平衡功能主要受头晕/眩晕程度的影响，且头晕/眩晕程度与步行支撑相时间占比呈正相关，应引起临床医师和康复治疗师的高度重视。

关键词: 脑干梗死, 前庭, 迷路, 姿势平衡, 步行, 神经康复, 线性模型

Abstract:

Objective: To investigate the correlation between vestibular symptoms and balance/walking function in patients with acute brain stem infarction. Methods: Fifty-one patients with acute brain stem infarction with a Functional Ambulation Category Scale (FAC) grade > 3 admitted to Tianjin Huanhu Hospital between November 2023 and December 2024 were included. The subjective visual vertical skew angle was measured using the Bucket Test. The degree of dizziness/vertigo was evaluated by the Visual Analogue Scales (VAS). The vestibulo-ocular reflex function was assessed by dynamic visual acuity (DVA). The Activities-Specific Balance Confidence Scale (ABC) was used to evaluate the balance confidence during performing various tasks, and the Dynamic Gait Index (DGI) was applied to assess the objective dynamic balance function. Results: Spearman rank correlation analysis showed that the ABC score was negatively correlated with the subjective visual vertical skew angle (r_s = -0.414, P = 0.003) and dizziness/vertigo VAS score (r_s = -0.463, P = 0.000), and the DGI index was negatively correlated with subjective visual vertical skew angle (r_s = -0.347, P = 0.012), dizziness/vertigo VAS score (r_s = -0.472, P = 0.000) and the number of rows lost in the yaw plane of DVA (r_s = -0.326, P = 0.019). Multifactor linear stepwise regression analysis showed that the strength of the effect of dizziness/vertigo VAS score (standardized partial regression coefficient = -0.593, P = 0.000) on ABC score was approximately 2.21 times greater than that of the subjective visual vertical skew angle (standardized partial regression coefficient = -0.268, P = 0.015); the effect of dizziness/vertigo VAS score (standardized partial regression coefficient = -0.666, P = 0.000) was 2.53 times stronger on the DGI index than the number of rows lost in the yaw plane of DVA (standardized partial regression coefficient = -0.263, P = 0.010). Further Spearman rank correlation analysis showed a positive correlation between dizziness/vertigo VAS score and the proportion of the stance phase time of gait parameter (r_s = 0.289, P = 0.039). Conclusions: Dynamic balance function in patients with acute brain stem infarction is mainly affected by the dizziness/vertigo severity. Furthermore, the degree of dizziness/vertigo shows a positive correlation with the proportion of stance phase duration during walking, which warrants heightened attention from both clinicians and rehabilitation therapists.

Key words: Brain stem infarctions, Vestibule, labyrinth, Postural balance, Walking, Neurological rehabilitation, Linear models