老年继发性良性阵发性位置性眩晕的临床研究

Clinical study of aged patients with secondary benign paroxysmal positional vertigo

目的 探讨老年继发性良性阵发性位置性眩晕（BPPV）患者的临床特点和手法复位的治疗效果.方法 回顾性分析2013年6月至2015年9月山东中医药大学第二附属医院诊治的32例老年继发性BPPV患者（继发组,其中男13例,女19例,年龄60-89岁）的临床表现和手法复位疗效,与同期治疗的121例老年原发性BPPV患者（原发组,其中男39例,女82例,年龄60-86岁）进行对比,并追踪随访12个月.采用SPSS 19.0对数据进行统计分析.结果 继发组占同期全部老年BPPV患者的20.92%（32/153）.继发组与原发组性别构成比及发病年龄差异无统计学意义（性别：χ2=0.79,P〉0.05;年龄：t=0.37,P〉0.05）.继发组中2个或2个以上半规管受累率为21.88%（7/32）,高于原发组的6.61%（8/121）,组间差异有统计学意义（χ2=6.67,P〈0.05）.继发组中有5例为双侧半规管发病,发生率为15.63%（5/32）;原发组中有4例双侧发病,发生率为3.31%（4/121）;组间差异有统计学意义（χ2=6.94,P〉0.05）.继发组中首次复位有效率为57.50%（23/40）,原发组为82.31%（107/130）,差异有统计学意义（χ2=10.46,P〈0.05）.继发组中多次复位有效率为87.50%（35/40）,原发组为91.54%（119/130）,组间差异无统计学意义（χ2=0.59,P〉0.05）.继发组首次复位成功时所需平均循环次数为（3.9±1.3）次,而原发组为（2.1±1.1）次,差异有统计学意义（t=3.15,P〈0.05）.随访12个月后继发组的复发率为37.50%（15/40）,原发组为16.15%（21/130）,差异具有统计学意义（χ^2=8.35,P〈0.05）.结论 老年继发性BPPV在临床工作中并不少见,常继发于突发性聋及头部外伤;双侧及多个半规管受累率较高;首次复位有效率较低,所需循环次数较多,多次复位后有效率与原发组无明显差异但复发率较高.

Objective To investigate the clinical features and evaluate the efficacy of manual reduction in treatment of age patients with secondary benign paroxysmal positional vertigo （s-BPPV）.Methods Thirty-two cases of aged patients （the s-BPPV group： including 19 cases of female and 13 males,age from 60 to 86 years old）with secondary benign paroxysmal positional vertigo from Jul.2013 to Sep.2015 in our hospital were retrospectively analyzed.The results were compared with 121 patients（the primary group： including 82 cases of female and 39males,aged from 60 to 86 years old）with aged primary benign paroxysmal positional vertigo（p-BPPV）.All the patients were followed up for 12 months.Statistical data analysis was carried out with SPSS 19.0.Results 20.92%（32/153）of all the observed elderly patients with BPPV was the aged s-BPPV.The sex ratio and onset age had no significant difference between the two groups（χ2=0.79,P＆gt;0.05;t=0.37,P〉0.05）.The rate of two or more semicircular canal involvement in the secondary group（21.88%） was higher than that in primary group（6.61%）（χ2=6.67,P〈0.05）.Bilateral semicircular canals were involved in 5 of the 32 cases in secondary group（15.63%） and 4 of the 121 cases in aged primary group（3.31%）,The difference was significant（χ2=6.94,P〈0.05）.The effective rate after first manual reduction was 57.50%（23/40）in secondary group and 82.31%（107/130）in primary group,the difference was significant（χ2=10.46,P〈0.05）.The total effective rate were 87.50%（35/40） after more than once manual reduction in secondary group and 91.54%（119/130） in primary group,the difference was not significant（χ2=0.59,P〉0.05）.The numbers of circulation of the first successful manual reduction management were （3.9＆#177;1.3）times in secondary group and （2.1±1.1）times in primary group,the difference was significant（t=3.15,P〈0.05）.The recurrence rate was 37.50%（15/40） in the secondary group and 16.15%（21/130）in primary group after during follow-up for 12 months,the difference was statistically significant（χ2=8.35,P〈0.05）.Conclusions It＇s shown that the aged patients with secondary BPPV is not rare in clinical practice,sudden deafness and head trauma are frequent more than other reasons.The aged patients with secondary BPPV are prone to injury in multi-semicircular and bilateral canal compared with the primary BPPV.The effective rate after first manual reduction of secondary BPPV is lower than primary BPPV,it＇s needed more circulation of first success in manual reduction management.The total effective rates are not significant in two groups and recurrence rate is relatively high in secondary group.