水平半规管管结石型良性阵发性位置性眩晕单纯复位与联合药物治疗的对比研究

Comparison of simple canalith repositioning treatment and medication therapeutic alliance in the management of canalithiasis associated with benign paroxysmal positional vertigo of the horizontal semicircular canal

目的：对比单纯复位与联合药物治疗管结石型水平半规管良性阵发性位置性眩晕（HSC—BPPV）的疗效和复发情况。方法：将62例通过roll-maneuver试验诊断为管结石型HSC—BPPV的患者随机分为单纯复位组（32例）和联合药物组（30例），单纯复位组予以单纯复位，联合药物组在复位治疗后加用前列地尔、桂哌齐特及倍他司汀等药物治疗。观察首次治疗7d、28d后的疗效及病情转归，并统计3个月时的复发率。结果：治疗7d后单纯复位组痊愈率62．5％，总有效率75．0％；联合药物组痊愈率73．3％，总有效率96．7％。联合药物组痊愈率高于单纯复位组，但无统计学差异；联合药物组总有效率高于单纯复位组，差异有统计学意义（x2=5．858，P〈0．05）。单纯复位组治疗7d后有8例出现病变类型变化，联合药物组有1例出现病变类型变化，两组比较差异有统计学意义（x2=4．061，P％0．05）。治疗28d后单纯复位组痊愈率100％，总有效率100％；联合药物组痊愈率100％，总有效率100％，总有效率无统计学差异（P〉0．05）。随访3个月，单纯复位组2例（6．25％）复发，联合药物组2例（6．67％）复发，两组比较差异无统计学意义（P〉0．05）。结论：复位法是治疗管石型HSC-BPPV的首选方法，联合药物治疗对痊愈率及复发率并无明显影响，仅可以增加有效率和减少在复位过程中病变类型的转化。

Objective：To compare the therapeutic efficacy and the recurrence rate between the simple repositioning method and the reposition manoeuvre plus medication in the treatment of horizontal semicircular canal otolith benign paroxysmal positional vertigo（HSC-BPPV）.Method：Sixty-two patients diagnosed with otolith HSC BPPV by roll maneuver test were randomly divided into canalith repositioning group（32 patients）and reposition plus drug treatment group（30 patients）.Patients in the canalith repositioning group were treated only with Barbecue reposition maneuver;patients in the reposition plus drug treatment group were treated firstly with Barbecue reposition maneuver and then were given Alprostadil,Cinepazide and Betahistine drug treatment.Both groups were evaluated after 7 days and 28 days treatment,and the recurrence rate was analyzed after 3 months.Result：After 7 days of the treatment,the recovery rate of the two groups was 62.5% and 73.3%,respectively.There＇s no significant difference between the two groups.However,the total effective power of the reposition plus drug treatment group was 96.7%,which was significantly higher than that of the canalith repositioning group（75.0%）（χ^2=5.858,P〈0.05）.There were 8 patients in the canalith repositioning group showed changes of BBPV types after treatment,while only 1patient in the reposition plus drug treatment group showed lesion changes.The difference was statistically significant（χ^2=4.061,P〈0.05）.After 28 days of the treatment,the recovery rate and the total effective power of the two groups was 100%,respectively.There is no statistical difference in the total effective rate between the two groups.After 3 months follow-up,2 patients in the canalith repositioning group（6.25%）and in the reposition plus drug treatment group（6.67%）showed BBPV recurrence,and no significant difference in the recurrence rate was found between the two groups（P〉0.05）.Conclusion：The repositioning maneuver is the preferred method for treating HSC BPPV.Canalith reposition maneuver plus medication has no obvious effect on the recovery rate and the recurrence rate,it only increases the effective rate and reduces the changes of the BBPV types.