49例良性阵发性位置性眩晕诊疗体会

Diagnosis and treatment of 49 patients with benign paroxysmal positional vertigo

目的 探讨良性阵发性位置性眩晕（benign paroxysmal positional vertigo,BPPV）的诊疗方法.方法 对2007年9月-2009年10月期间诊断的49例BPPV采用管石手法复位治疗,其中后半规管性BPPV采用Epley颗粒复位法,无效者改用Semont法,前半规管性BPPV采用反向Epley法,水平半规管性BPPV采用Barbecue翻滚法.结果 PC-BPPV 33例（67.3%）,HC-BPPV12例（24.5%）,AC-BPPV 2例（4.1%）,混合型2例（4.1%）;治疗随访时间4～8个月,痊愈44例（89.8%）;改善3例（6.1%）.复发2例（4.1%）再次治疗有效.结论 通过不同变位试验可对BPPV进行诊断并明确区分耳石所沉积的半规管,以便采用正确的复位法达到有效的治疗目的 ,对同时发生多个半规管及伴发突聋的患者应避免漏诊.

Objective To explore the diagnosis and treatment of benign paroxysmal positional vertigo （BPPV）. Methods Fority-nine patients with BPPV were diagnosised between September 2007 and October 2009. After the type and the effect side were determined, appropriate repositioning maneuvers were selected, posterior canal （PC） BPPV treatmented with Epley＇s canalith respositioning maneuver or Semont liberatory maneuver, horizonial canal （HC） BPPV with Barbecue maneuver and anterior canal （AC） involve- ment with reverse Epley＇s maneuver. Results Of 49 patients, 33 cases （67.3%） was in PC involvement, 12 cases （24.5%） in HC involvement, 2 cases （4.1 %） in AC involvement and 2 cases （4.1 %） in the mixed type. After follow -up of 4 to 8 months, the total cure rate was 89.8%, the improvement rate was 6.1 % and recurrence rate was 6.1 %. Conclusions Different types of BPPV incoulding variant canals can be diagnosised according to the nystagmic characteristics of the appropriate provoking maneuvers, and it is necessary to apply the appropriate repositioning maneuvers. Missed diagnosis should be avoided for multi canal involvement and accompany with sudden deafness.