良性阵发性位置性眩晕手法复位的临床观察

Clinical observation of manual reduction for benign paroxysmal positional vertigo

目的探究手法复位治疗对良性阵发性位置性眩晕(benign paroxysmal positional vertigo,BPPV)患者近期治疗效果和远期复发率的影响及安全性。方法选取来我院耳鼻喉科门诊及住院患者122例良性阵发性位置性眩晕患者作为研究对象,分为两组,对照组59例,采用体位限制法配合药物治疗,观察组63例,根据病变部位采用适应的手法复位治疗,观察所有患者治疗1周后、2周后的临床疗效,治疗2周后电话随访并统计两组治疗有效患者在1个月、3个月及半年的累计复发率状况。结果在近期治疗效果上,治疗1周后,对照组总有效率为71.18%,观察组总有效率为90.48%,差异有统计学意义(P<0.05),治疗2周后,对照组总有效率为81.35%,观察组有效率为96.83%,差异有统计学意义(P<0.05);在远期复发率上,在1个月后,对照组复发率为7.14%,观察组复发率为1.75%,差异无统计学意义(P>0.05),在3个月后,对照组复发率为19.05%,观察组复发率为5.26%,差异有统计学意义(P<0.05),在半年后,对照组复发率为28.57%,观察组复发率为7.02%,差异有统计学意义(P<0.01);观察组有1例患者在治疗第2天无人监护情况下自我复位时,眩晕发作并滚下床,无严重外伤。结论根据病变部位采用适宜手法复位治疗对良性阵发性位置性眩晕患者近期治疗效果显著,远期复发率低,且安全性高,值得推广。

Objective To explore the effects and safety of manual reduction on the short-term curative effect and longterm relapse rate for patients with benign paroxysmal positional vertigo（BPPV）. Methods A total of 122 patients with BPPV who were admitted to the E.N.T. Outpatient Clinic and Inpatient Department in our hospital were selected as research subjects. They were divided into two groups. 59 patients in the control group were given the treatment of postural restriction combined with medication. 63 patients in the observation group were given the treatment of adaptive manual restriction according to the lesion positions. The clinical effects of all the patients after 1 week and 2 weeks of treatment were observed. Telephone follow-up was performed 2 weeks after the treatment, and the accumulative relapse rates in 1 month, 3 months and half a year were statistically collected in the two groups of patients responding to the treatment. Results For the short-term curative effect, after 1 week of treatment, the total effective rate in the control group was 71.18%, and the total effective rate in the observation group was 90.48%. There was significant difference between the two groups（P〈0.05）. After 2 weeks of treatment, the total effective rate in the control group was 81.35%,and the total effective rate in the observation group was 96.83%. There was significant difference between the two groups（P〈0.05）; for the long-term relapse rate, after 1 month, the relapse rate in the control group was 7.14%, and the relapse rate in the observation group was 1.75%. The was no significant difference between the two groups（P〉0.05）.After 3 months, the relapse rate in the control group was 19.05%, and the relapse rate in the observation group was5.26%. There was significant difference between the two groups（P〈0.05）. After half a year, the relapse rate in the control group was 28.57%, and the relapse rate in the observation group was 7.02%. There was significant difference between the two groups（P〈0.01）; 1 patient in the observation group was undergone vertigo and fell off the bed during self-reduction on the second day of the treatment without monitoring, and no severe injury was detected. Conclusion Appropriate manual reduction based on the lesion positions in the treatment of the patients with BPPV has significant short-term curative effects and low long-term relapse rate. It is also with high safety and is worthy of promotion.