伴发良性阵发性位置性眩晕的急性前庭神经炎的临床特点分析

Clinical Characteristics of Benign Paroxysmal Positional Vertigo in Patients with Vestibular Neuritis

目的:了解前庭神经炎(VN)合并良性阵发性位置性眩晕(BPPV)的临床特点。方法:收集VN患者236例的临床资料,根据是否伴发BPPV分为对照组(不伴BPPV)和观察组(伴发BPPV),分析2组的临床特征、冷热实验结果;观察VN伴发BPPV的手法复位治疗效果;并于治疗前、治疗第10、20和30天采用眩晕残障程度评定量表(DHI)分析2组疗效。结果:本组236例VN患者中发病1月内伴发BPPV 23例,发生在VN同侧18例,发生在对侧5例;其中20例为后半规管BPPV,3例为水平半规管BPPV;其中5例经1次手法复位后体位性眩晕明显缓解,10例经2次手法复位后缓解,8例经3次手法复位后缓解。冷热实验异常率对照组为65.87%,显著低于观察组的86.96%(P<0.05)。2组治疗前和治疗10 d时DHI评分差异无统计学意义,治疗20和30 d时观察组DHI评分显著高于对照组(P<0.05)。结论:VN患者中部分会伴发BPPV,伴发BPPV的VN患者冷热实验结果异常率较高,病情缓解慢,手法复位多需2次以上。

Objective： To investigate the clinical characteristics of Benign Paroxysmal Positional Vertigo （BPPV） in patients with vestibular neuritis （VN）. Methods： Clinical data of of 236 patients diagnosed with VN werecollected and divided based on occurrence of BPPV into the control group （without BPPV） and observation group （with BPPV）. The clinical characteristics and caloric test results of the two groups were analyzed. The effectiveness of manual maneuvers in VN with BPPV was observed. The Dizziness Handicap Inventory （DHI） was applied before treatment and on Days 10, 20, and 30 of treatment to analyze treatment effectiveness.Results： Of the 236 VN cases studied, 23 cases developed BPPVwithin one month of disease onset. Of these,18 cases were limited to the ipsilateral side of VN and 5 cases were limited to contralateral side of VN. In all, 20 cases were PC-BPPV and 3 were HC-BPPV. Five cases showed significant improvement in BPPV after 1 maneuver treatment; 10 cases showed improvement after 2 maneuver treatments; 8 cases showed improvement after 3 maneuver treatments. The rate of abnormal caloric test results within the control group was 65.87%,which was significantly lower than the 86.96% within the observation group （P〈0.05）. There was no significant difference between the two groups in the DHI scores obtained pre-treatment and on Day 10 of treatment. DHI scores on Days 20 and 30 of treatment were significantly higher in the observation group than those in the control group （P〈0.05）. Conclusion： VN is accompanied by BPPV in some patients. In VN patients with BPPV, the incidence of abnormal caloric test results is relatively high, recovery is slow, and 2 or more manual maneuver treatments are generally needed.