李珂;徐辉;

• 1:濮阳市安阳地区医院
• 2:郑州大学第二附属医院

摘要(Abstract)：

目的观察外半规管嵴帽型良性阵发性位置性眩晕急性期眼震及残余症状是否对治疗敏感,能否降低其复发。方法纳入2017-09—2019-09安阳地区医院90例外半规管嵴帽型良性阵发性位置性眩晕患者,对照组和治疗组各45例,对照组单纯采用Gufoni手法复位,治疗组在Gufoni手法复位的基础上联合药物治疗,比较2组眼震持续时间,残余症状的持续时间,复发率及复位后当天、第7天、第30天的眩晕障碍量表(DHI)得分。结果治疗组眼震持续时间中位数为4 d,残余症状持续时间中位数为22 d,均明显低于对照组(P<0.01)。治疗组复位结束7 d、30 d的DHI评分逐渐下降,与复位后当天比较差异有统计学意义(P<0.01);与对照组治疗后同一时间段对比,DHI评分差异有统计学意义(P<0.01)。对照组复位结束7 d、30 d的DHI评分逐渐下降,但与复位后当天比较差异无统计学意义(P>0.05)。随访期间,治疗组复发率明显低于对照组(χ²=4.194,P=0.04)。结论 Gufoni复位联合药物治疗可明显缩短外半规管嵴帽型良性阵发性位置性眩晕急性期眼震、复位后的残余症状持续时间,降低其复发率。

关键词(KeyWords)： 外半规管;嵴帽型耳石症;残余症状;复发率;山莨菪碱;Gufoni复位

Abstract:

Keywords:

基金项目(Foundation): 国家自然科学基金委员会青年基金（编号：81900436）

作者(Authors): 李珂;徐辉;

参考文献(References)：

• [1]MARTENS C,GOPLEN F K,AASEN T,et al.Dizziness Handicap and Clinical Characteristics of Posterior and Lateral Canal BPPV[J].Eur Arch Otorhinolaryngol,2019,276(8):2181-2189.DOI:10.1007/s00405-019-05459-9.
• [2]UZDAN U Z,DIDEM U Z,AKDAL G,et al.Efficacy of Epley Maneuver on Quality of Life of Elderly Patients with Subjective BPPV[J].J Int Adv Otol,2019,15(3):420-424.DOI:10.5152/iao.2019.6483.
• [3]LOU Y,CAI M,XU L G,et al.Efficacy of BPPVdiagnosis and treatment system for benign paroxysmal positional vertigo[J].Am J Otolaryngol,2020,41(3):102412.DOI:10.1016/j.amjoto.2020.102412.
• [4]VADUVA C,ESTéBAN-SáNCHEZ J,SANZ-FERNáNDEZR,et al.Prevalence and Management of post-BPPV Residual Symptoms[J].Eur Arch Otorhinolaryngol,2018,275(6):1429-1437.DOI:10.1007/s00405-018-4980-x.
• [5]郭小艳，张慧，耿曼英.30例Ramsay-Hunt综合征临床分析[J].中国实用神经疾病杂志，2020,23(4):345-348.DOI:10.12083/SYSJ.2020.04.072.
• [6]VAN DE WYNGAERDE K M,LEE M K,JACOBSON GP,et al.The Component Structure of the Dizziness Handicap Inventory(DHI):A Reappraisal[J].Otol Neurotol,2019,40(9):1217-1223.DOI:10.1097/MAO.0000000000002365.
• [7]郑书芳，张赛赛，刘高红，等.1014例住院头晕患者病因分析[J].中国实用神经疾病杂志，2020,23(24):2199-2203.
• [8]邱冰，尹晓新.老年人良性阵发性位置性眩晕的研究进展[J].中国实用神经疾病杂志，2021,24(2):166-171.
• [9]王雪，李聪颖，杨伟民.良性复发性眩晕的研究现状及进展[J].中国实用神经疾病杂志，2018,21(5):576-580.
• [10]FU W,HAN J,CHANG N,et al.Immediate efficacy of Gufoni maneuver for horizontal canal benign paroxysmal positional vertigo(HC-BPPV):a meta-analysis[J].Auris Nasus Larynx,2020,47(1):48-54.DOI:10.1016/j.anl.2019.05.002.
• [11]WU Z M,ZHANG S Z.Update of BPPV guideline of AAO and rethinking[J].Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi,2019,33(3):207-209.DOI:10.13201/j.issn.1001-1781.2019.03.005.
• [12]DING Y L,ZOU S Z,WANG Y Q,et al.Long-term efficacy observation of BPPV repositioning maneuver[J].Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi,2019,33(8):761-764.DOI:10.13201/j.issn.1001-1781.2019.08.019.
• [13]INSTRUM R S,PARNES L S.Benign Paroxysmal Positional Vertigo[J].Adv Otorhinolaryngol,2019,82:67-76.DOI:10.1159/000490273.
• [14]BOUCCARA D,RUBIN F,BONFILS P,et al.Management of vertigo and dizziness[J].Rev Med Interne,2018,39(11):869-874.DOI:10.1016/j.revmed.2018.02.004.
• [15]HELMINSKI J O.Peripheral Downbeat Positional Nystagmus:Apogeotropic Posterior Canal or Anterior Canal BPPV[J].J Neurol Phys Ther,2019,43:S8-S13.DOI:10.1097/NPT.0000000000000267.
• [16]KIM S K,HONG S M,PARK I S,et al,Mood Disorders are Associated With Increased Risk of BPPV:ANational Sample Cohort[J].Laryngoscope,2021,131(2):380-385.DOI:10.1002/lary.28638.
• [17]JEONG S H,KIM J S,KIM H J,et al.Prevention of benign paroxysmal positional vertigo with vitamin Dsupplementation:A randomized trial[J].Neurology,2020,95(9):e1117-e1125.DOI:10.1212/WNL.0000000000010343.
• [18]CHEN G G,ZHANG C M,GAO W,et al.Clinical characteristics of LC-BPPV patients with bilateral direction-fixed horizontal nystagmus in primary Roll test[J].Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi,2019,33(6):489-492.DOI:10.13201/j.issn.1001-1781.2019.06.003.
• [19]SCARPA A,CASSANDRO C,GIOACCHINI F M,et al.Lateralization of horizontal semicircular canal benign paroxysmal positional vertigo(HSC-BPPV) with the latency test:a pilot study[J].Acta Otolaryngol,2019,139(10):854-859.DOI:10.1080/00016489.2019.1635712.
• [20]CHEN G,LI Y,SI J,et al.Treatment and recurrence of traumatic versus idiopathic benign paroxysmal positional vertigo:a meta-analysis[J].Acta Otolaryngol,2019,139(9):727-733.DOI:10.1080/00016489.2019.1632484.
• [21]MICHAEL P,MU?OZ D,TUMA A,et al.A Chairbased Abbreviated Repositioning Maneuver(ChARM)for fast treatment of posterior BPPV[J].Eur Arch Otorhinolaryngol,2019,276(8):2191-2198.DOI:10.1007/s00405-019-05460-2.
• [22]POLLAK L,HUNA-BARON R,OSHEROV M,et al.In whom does horizontal canal BPPV recur?[J].Am JOtolaryngol,2018,39(4):410-412.DOI:10.1016/j.amjoto.2018.04.003.
• [23]PAL'CHUN V T,GUSEVA A L,KRYUKOV A I,et al.Repositioning maneuver for self-performing by patients in cupulolithiasis of horizontal canal BPPV[J].Vestn Otorinolaringol,2020,85(6):6-12.DOI:10.17116/otorino2020850616.
• [24]POLLAK L,HUNA-BARON R,OSHEROV M,et al.In whom does horizontal canal BPPV recur?[J].Am JOtolaryngol,2018,39(4):410-412.DOI:10.1016/j.amjoto.2018.04.003.
• [25]NADA E H,IBRAHEEM O A,HASSAAN M R.Vestibular Rehabilitation Therapy Outcomes in Patients With Persistent Postural-Perceptual Dizziness[J].Ann Otol Rhinol Laryngol,2019,128(4):323-329.DOI:10.1177/0003489418823017.
• [26]ZAAG-LOONEN H V,BRUINTJES T,LEEUWEN RV.Probable Benign Paroxysmal Positional Vertigo Converts into Definite BPPV in One in Six Patients[J].J Int Adv Otol,2018,14(3):456-458.DOI:10.5152/iao.2018.4862.
• [27]BRODSKY J R,LIPSON S,WILBER J,et al.Benign Paroxysmal Positional Vertigo(BPPV)in Children and Adolescents:Clinical Features and Response to Therapy in 110 Pediatric Patients[J].Otol Neurotol,2018,39(3):344-350.DOI:10.1097/MAO.0000000000001673.