小剂量劳拉西泮治疗老年人良性阵发性位置性眩晕成功复位后残余头晕的疗效评估

Effect of small-dose Lorazepam on residual dizziness in elderly benign paroxysmal positional vertigo after successful particle repositioning maneuver

目的探讨小剂量抗焦虑药劳拉西泮治疗老年人良性阵发性位置性眩晕（BPPV）成功复位后残余头晕的疗效。方法选择268例管石复位成功的60岁及以上BPPV患者随机分为治疗组和对照组，治疗组给予劳拉西泮（O．25mg／次、3次／d）l周，对照组不给予任何药物。管石复位前和复位后1周采用汉密尔顿焦虑量表（HAMA）评估患者的焦虑状态，并采用中文版眩晕障碍量表（DHI）和活动平衡信心量表（ABC）评估小剂量抗焦虑药劳拉西泮对老年BPPV患者管石复位术后残余症状的作用。结果治疗组和对照组复位前HAMA评分比较差异无统计学意义（t=0．316，P=0．753），复位后治疗组和对照组HAMA评分均较复位前有改善（t=19．931、26．930，均P=0．000），治疗组复位后HAMA评分低于对照组（t=14．967，P=0．000）。治疗组和对照组复位后DHI总评分、功能、情感、躯体各亚组评分较复位前均有改善（治疗组t=43．661、32．326、31．981、14．330，均P=0．000；对照组t=46．282、32．117、34．563、13．182，均P=0．000）；复位后治疗组DHI总评分以及功能、情感和躯体亚组的评分均低于对照组（t=5．994、3．206、4．757、2．85l，P=0．000、0．002、0．000、0．005）。复位后治疗组和对照组ABC评分较复位前均有改善（t=-23．248、-24．536，均P=0．000），且治疗组ABC评分高于对照组（t=2．678，P=0．008），差异有统计学意义。结论老年BPPV患者伴有焦虑情绪，小剂量抗焦虑药劳拉西泮有助于减轻老年患者成功复位后的残余头晕。

Objective To evaluate the effect of small-dose Lorazepam on residual dizziness in elderly patients with benign paroxysmal positional vertigo （BPPV） after successful particle repositioning maneuver （PRM）. Methods A total of 268 patients aged 60 years and over, who were diagnosed as BPPV and underwent successful treatment of PRM, were randomly assigned to medication group and control group. The patients in the medication group were prescribed low-dose lorazepam for 1 week （0.25 mg/time, 3 times/d）, whereas the patients in the control group were not prescribed any medication. Hamilton Anxiety Scale （HAMA） was employed to evaluate the anxiety status of patients before and after PRM, and the effect of small dose lorazepam on residual dizziness was accessed by using the Dizziness Handicap Inventory （DHI） scale and the Activities-specific Balance Confidence （ABC） scale in elderly BPPV patients after PRM. Results No difference in HAMA scores was found between the two groups （t=- 0. 316, P = 0. 753） before PRM. The medication group （t=19.931, P=0.000） and the control group （t=26.930, P=0.000） showed a significant improvement in HAMA scores after PRM versus before PRM. However, HAMA scores after PRM was lower in the medication group than in the control group （t=14. 967, P=0. 000）. The medication group had significant improvements after PRM versus before PRM in the following： DHI scores （t=43. 661, P=0. 000）, functional （t=32. 326, P=0. 000981）, emotional （t=31. 981, P= 0. 000）, physical （t= 14. 330, P=0. 000） subscale scores, as well as in the ABC scores （t=-23. 248, P=0. 000）. The improvements were also found in the control group in DHI scores （t= 46. 282, P= 0. 000）, functional （ t= 32. 117, P= 0. 000）, emotional （ t= 34. 563, P = 0. 000）, physical （t=13. 182, P=0. 000） subscale scores, as well as in the ABC scores（t=-24. 536, P= 0. 000）after PRM versus before PRM. However, after PRM the total DHI score, functional, emotional and physical subscale scores were lower in medication group than in control group （ t = 5. 994, 3. 206, 4. 757 and 2. 851, respectively, P= 0. 000, 0. 002, 0. 000 and 0. 005）. The ABC scores were higher in medication group than in control group （t=2. 678, P=0. 008） after PRM. Conclusions The elderly patients with BPPV are often accompanied by symptoms of anxiety. The small-dose Lorazepam can alleviate residual dizziness in elderly BPPV patients after successful PRM.