良性阵发性位置性眩晕残余症状的影响因素及oVEMP分析

Factors related to residual symptoms of benign paroxysmal positional vertigo and the predictive value of oVEMP

目的分析良性阵发性位置性眩晕(BPPV)患者耳石复位治疗后残余症状的影响因素,并探讨患者眼肌前庭诱发肌源性电位(oVEMP)对残余症状的预测价值。方法选取2018年1至12月中国人民武装警察部队海警总队医院收治的BPPV患者274例,均采用耳石复位方法治疗。根据复位治疗成功后第3天有无残余头晕症状,患者分为残余症状组107例和无残余症状组167例。分析患者残余症状的独立危险因素,比较两组患者耳石复位治疗前后眩晕残障量表(DHI)评分和oVEMP各项参数。结果BPPV病程及发病月份为患者残余症状的独立危险因素(均P<0.05)。耳石复位治疗前、治疗1周、治疗半个月时,两组患者DHI评分比较差异均无统计学意义(均P>0.05);复位治疗1个月后,残余症状组DHI评分低于无残余症状组(P<0.05),oVEMP患侧的振幅比健侧增高(P<0.05)。结论耳石复位治疗后部分BPPV患者会有残余症状,残余症状可能与病程、发病月份、复位次数、是否合并内科疾病等因素有关,在临床工作中应重视并对其进行适当的干预。患者oVEMP的耳间振幅增高与残余症状有关,临床或可把oVEMP检测作为残余症状的预测方法。

Objective To analyze the influencing factors of residual symptoms in patients with benign paroxysmal positional vertigo(BPPV)after otolith reduction treatment,and to explore the predictive value of ocular muscle vestibular evoked myogenic potentials(oVEMP).Methods A total of 274 BPPV patients admitted to the Chinese People's Armed Police Force Marine Police Corps Hospital and treated with otolith reduction from January to December 2018 were enrolled in the study.There were 107 patients with residual symptoms 3d after otolith reduction and 167 patients without residual symptoms.The risk factors of residual symptoms were analyzed,and the vertigo and disability scale(DHI)scores and oVEMP parameters of the two groups were compared before and after otolith reduction treatment.Results The duration of BPPV course and the month of onset were independent risk factors for the residual symptoms(both P<0.05).There was no significant difference in DHI scores between patients with or without residual symptoms before reduction treatment,1 week and half a month after treatment(P>0.05).While the DHI score of the residual symptom group was lower than that of no-residual symptom group one month after reduction treatment(P<0.05).The amplitude of oVEMP of the affected side was higher than that of the normal side(P<0.05).Conclusion After otolith reduction treatment,some patients with BPPV would have residual symptoms.The residual symptoms are related to the course of the disease and month of onset.The increased interaural amplitude of oVEMP may predict the occurrence of residual symptoms.