良性阵发性位置性眩晕的急性期处理策略

Treatment strategy in acute benign paroxysmal positional vertigo

目的探讨良性阵发性位置性眩晕(benign paroxysmal positional vertigo,BPPV)急性期临床特点、处理策略。方法回顾性分析福建医科大学附属第一医院耳鼻咽喉头颈外科2010年10月~2014年10月期间诊断为急性期BPPV患者46例,予口服抗眩晕治疗,分析急性期处理策略、手法复位的相关风险及并发症。结果 46例急性期BPPV患者予口服抗眩晕治疗,1周后复诊时症状消失痊愈18例,症状改善有效27例,无效者1例;对仍有眩晕的28例予手法复位,眼震、症状均消失。另外报道1例急性期BPPV在手法复位过程中,出现腰椎骨折,予对应处理;1例在耳石复位后出现耳石嵌顿现象并短暂性脑缺血发作。结论BPPV因发病病程长短、自愈性、急性期BPPV手法复位可能存在的风险,应充分评估患者全身情况;对骨质疏松、围绝经期患者,复位过程中应充分告知手法复位风险并采取相应预防性措施,避免副损伤。

OBJECTIVE To explore the clinical features and the strategy of management in acute benign paroxysmal positional vertigo(BPPV). METHODS A retrospective study was conducted on 46 patients who were diagnosed with acute BPPV between October 2010 and October 2014.All the patients were given with anti-vertigo drugs in acute stage of BPPV in the first week.The strategy of the treat ment and the complications of the canalith repositioning procedures(CRP) were analysed. RESULTS In the 46 cases with acute BPPV who were treated with medicine,18 were recovered, 27 had effects, and 1 was ineffective.Twenty-eight patients were performed CRP,whose nystagmus and symptoms were disappeared finally. In addition,one case was reported about the fracture of the lumbar spine in CRP process in acute stage of BPPV,and another case developed both canalith jam and transient ischemic attack after CRP. CONCLUSION Due to the course of BPPV which is self-limited, the CRP performed in the acute BPPV may be potentially risky.We should fully evaluate general condition of the patients.The patients with osteoporosis or in menopausal transition should be fully informed of the risk of the CRP and taken preventive measures to avoid adverse injury.