手法复位治疗围绝经期良性阵发性位置性眩晕的效果

Effects of canalith repositioning procedure on benign paroxysmal positional vertigo in perimenopausal womenn

目的评价手法复位治疗对围绝经期女性良性阵发性位置性眩晕(BPPV)的临床效果。方法选择2014年1月至2015年10月在西安交通大学第一附属医院耳鼻咽喉头颈外科门诊诊断为BPPV的443例围绝经期患者施行管石复位法(CRP)治疗,观察治疗效果及复发情况,采用汉化版眩晕障碍量表(DHI)对治疗前及治疗后3个月进行生活质量评价。结果对443例患者经手法复位后,治疗有效率为100.0%,1年内总复发率为8.6%。与单次复位治疗相比,2次或3次及以上手法治疗能够显著降低复发率(χ~2=15.535,P<0.001)。合并慢性系统性疾病的BPPV患者,其复位治疗后的复发率显著高于无合并症者(11.6%vs 5.9%,χ~2=4.508,P=0.034)。继发性BPPV复发率显著高于原发性BPPV(14.2%vs 6.0%,χ~2=8.290,P=0.004)。手法复位治疗能够显著降低围绝经期BPPV患者躯体障碍评分(17.8±5.6 vs 3.0±2.1,t=11.412,P<0.001)、功能障碍评分(23.8±8.0 vs 2.4±1.4,t=11.684,P<0.001)、情感障碍评分(18.3±1.5 vs 1.9±1.4,t=7.720,P<0.001)及总体DHI评分(59.7±14.4 vs 7.3±2.4,t=13.263,P<0.001)。结论 CRP是对BPPV的有效治疗方法,有效的手法复位治疗能够提高围绝经期BPPV患者的生活质量。多次CRP治疗、积极治疗合并疾病有助于提高BPPV患者的治疗效果。

Objective To evaluate the clinical effects of canalith repositioning procedure（ CRP） on benign paroxysmal positional vertigo（ BPPV） in perimenopausal women. Methods There were 443 perimenopausal women with BPVV treated with CRP in department of otorhinolaryngology-head and neck clinical surgery of First Affiliated Hospital of Xi ＇an Jiaotong University between January 2014 and October 2015. Treatment effect and recurrence situation were observed,and life quality of patients before treatment and in 3 months after treatment was evaluated by Chinese version of dizziness handicap inventory（ DHI）. Results Effective rate of 443 BPPV patients was100. 0% after being treated with CRP,and one-year recurrence rate was 8. 6%. Recurrence rate of patients receiving CRP for two or three or more times was significantly lower compared with patients receiving CRP only once（ χ~2 = 15. 535,P 0. 001）. Recurrence rate of BPPV patients with chronic disease was significantly higher than that of patients without chronic disease after treatment（ 11. 6% vs 5. 9%,χ~2 =4. 508,P = 0. 034）. Recurrence rate of patients with secondary BPPV was significantly higher than that of patients with primary BPPV（ 14. 2% vs 6. 0%,χ~2 = 8. 290,P = 0. 004）. CRP significantly reduced physical obstacle score（ 17. 8 ± 5. 6 vs 3. 0 ± 2. 1,t = 11. 412,P 0. 001）,dysfunction score（ 23. 8 ± 8. 0 vs 2. 4 ± 1. 4,t = 11. 684,P 0. 001）,affective disorder score（ 18. 3 ± 1. 5 vs 1. 9 ± 1. 4,t = 7. 720,P 0. 001） and total DHI score（ 59. 7 ± 14. 4 vs 7. 3 ± 2. 4,t = 13. 263,P 0. 001） of perimenopausal BPPV patients.Conclusion CRP is an effective treatment for BPPV. Successful CRP can improve life quality of perimenopausal women with BPPV.Several therapies of CRP and active treatment of complications can improve curative effect of BPPV patients.