前庭性偏头痛诱发因素调查及健康教育对复发影响的研究

investigation on the triggers and the effect of healthy education on recurrence of vestibular migraine

目的:探讨前庭性偏头痛(VM)的诱发因素以及健康教育对复发的影响,为扩大VM患者的知晓率和降低复发率提供科学依据。方法:通过问卷调查、记生活日记、定期随访等形式了解VM患者可能的诱发因素;运用抑郁自评量表(SDS)、焦虑自评量表(SAS)评估患者精神心理状态,运用视觉模拟量表评分法(VAS)评估眩晕严重程度;通过诊室面对面、发放资料、现代多媒体等方式对VM患者进行健康宣教,比较宣教前后患者的疾病知晓率、焦虑恐惧心理状态、眩晕复发频率、眩晕持续时间和严重程度。结果:103例研究对象中,宣教前100例(97.1%)有不同程度的睡眠障碍,96例(93.2%)有明确的眩晕或者眩晕伴头痛家族史,90例(87.4%)有晕动病史,90例(87.4%)有密闭空间不耐受史,82例(79.6%)反复发作诱发焦虑恐惧心理,80例(77.7%)缺乏运动,79例(76.7%)自诉生活或工作压力过大,53例(51.5%)有饮食偏好,8例(7.8%)认为雨水多潮湿气候时发作较频繁,7例(6.8%)认为在春季或春夏交换的季节发作较多。健康宣教后,随访时间6个月~2年,中位时间15个月,不良生活方式和饮食习惯(即缺少运动、压力过大、饮食偏好至少有1项)从89.4%(92例)下降至32.1%(33例);83.5%(86例)的患者复发频率减少1次及以上,焦虑恐惧心理比例从79.6%(82例)下降至7.8%(8例),SAS评分从47.9±4.4下降至45.5±4.2,SDS评分从39.7±3.6下降至38.2±3.8;患者对VM的知晓率从12.6%(13例)上升到98.0%(101例),半年内无复发比例从1%(1例)上升至15.5%(16例),宣教前复发频率为(3.5±0.1)次/半年,宣教后下降至(2.2±0.1)次/半年;48.5%(50例)发作持续时间缩短20%及以上,宣教前发作持续时间为(17.4±1.4)h,宣教后下降至(10.5±0.9)h;86.4%(89例)复发严重程度VAS评分降低2分及以上,宣教前VAS为(6.6±0.1)分,宣教后下降至(4.5±0.1)分。宣教前与宣教后比较,以上均差异有统计学意义(P<0.01)。结论:睡眠障碍、密闭空间不耐受、压力过大、缺乏运动、饮食偏好可能是诱发VM发作的相关因素;健康教育可明显提高患者对VM的知晓率、促使患者改变不良生活方式和饮食习惯,可明显改善患者的焦虑、恐惧心理状态、减少发作频率、缩短发作持续时间、减轻自评严重程度,值得临床推广。

Objective:The aim of this study is to investigate the predisposing factors and the effect of healthy education on recurrence of vestibular migraine(VM),so as to provide a scientific basis for increasing the knowledge rate and reducing the recurrence rate of VM patients.Method:Questionnaires,memory diary,regular follow-up,etc.were used to understand the possible predisposing factors of VM patients.Self-assessment depression scale(SDS)and self-assessment anxiety scale(SAS)were used to evaluate patients'mental and psychological status,and visual analogue scale(VAS)was used to evaluate the severity of vertigo.Health education was conducted for VM patients through face-to-face consultation,material distribution,modern multimedia and other methods.The knowledge rate,anxiety and fear psychological state,recurrence frequency of vertigo,duration and severity of vertigo were compared before and after the healthy education.Result:Of 103 cases of the object of study,100 patients(97.1%)with different degree of sleep disorders,96 cases(93.2%)had a clear family history with vertigo or dizziness headache,90 cases(87.4%)had history of motion sickness,90 cases(87.4%)had confined space history of intolerance,82 cases(79.6%),recurrent cause psychological anxiety,fear,80 cases(77.7%),lack of exercise,79 cases(76.7%)under pressure from life or work,53(51.5%)had food preference,8 cases(7.8%)think much rain attacks more frequent when humid climate,seven(6.8%)reported more episodes during the spring or spring/summer exchanges.After health education,patients were followed up for 6 months to 2 years with a median of 15 months,and their knowledge rate of VM was increased from 12.6%(13 cases)to 98%(101 cases).The psychological ratio of anxiety and fear decreased from 79.6%(82 cases)to 7.8%(8 cases).The SAS score decreased from 47.9±4.4 to 45.5±4.2,and the SDS score decreased from 39.7±3.6 to 38.2±3.8.The unhealthy lifestyle and eating habits(lack of exercise,stress,and eating preferences at least 1 item)decreased from89.4%(92 cases)to 32.1%(33 cases).The recurrence rate of 83.5%(86 cases)of the patients was reduced by 1 time or more,and the rate of no recurrence increased from 1%(1 case)to 15.5%(16 cases)within half a year.The duration of the attack was reduced by 20%or more in 48.5%(50 cases),The mean duration of the attack declined from(17.4±1.4)hours before healthy education to(10.5±0.9)hours after healthy education.The VAS score of 86.4%(89 cases)with recurrence severity decreased by 2 points or more.The average VAS score before and after education was(6.6±0.1)points and(4.5±0.1)points respectively.The above differences were statistically significant(P<0.01)compared with those before and after education.Conclusion:Sleep disorder,airtight space intolerance,excessive stress,lack of exercise,and dietary preference may be related factors to trigger VM attacks.Healthy education can significantly improve the awareness of VMs,and promote patients to change their lifestyle and eating habits.It can significantly improve patients'anxiety and fear psychological state,reduce the frequency of attack,shorten the duration of attack,and reduce the severity of self-assessment,which is worthy of clinical promotion.