良性阵发性位置性眩晕手法复位后疗效观察

Observation of Curative Effect of Benign Paroxysmal Positional Vertigo Manual Reduction

目的:探讨良性阵发性位置性眩晕(BPPV)的病例特点,并对1年内随访复发情况进行分析。方法:选取2017年1月-2017年12月期间在南华大学附属第一医院耳鼻喉科门诊眩晕中心经眼震视图检查诊断为BPPV并通过手法复位治疗后的患者,收集患者资料,从性别、年龄、发病时间分析并总结出患者临床特点。按复位后1周、3个月、1年进行电话随访。部分患者通过现场验证方式随访,统计患者手法复位1年内随访后复发情况。按复发与否分为两组,对两组的资料进行回顾性分析。结果:共有220例BPPV患者纳入研究,对以上病例进行电话随访,随访183人,失访37人。未复发组118例,复发组65例,1年内复发率为35.5%,其中因眩晕再次来门诊就诊并通过位置试验现场诊断为耳石13例,占总人数5.9%,其中复发1次10人,复发2次2人,复发3次1人。两组患者性别、受累半规管类型比较,复发率差异无统计学意义(P>0.05),两组患者平均年龄、受累半规管数目、就诊时眩晕持续时间比较,差异有统计学意义(P<0.05)。结论:对不同类型的管石,采用相应的耳石手法复位治疗,1周后随访总有效率为78.6%,3个月后随访总有效率为87.7%。BPPV患者就诊时眩晕持续时间越长,越容易复发,患者年龄越大,越容易复发,患者多管耳石较单管耳石更容易复发。对于混合型耳石(即多管耳石),根据眼震特点采用联合手法复位,准确、联合、多次复位后,其疗效较首次复位后疗效提高。

Objective:To investigate the case characteristics of benign paroxysmal positional vertigo(BPPV)and analyze the recurrence in one year.Methods:Patients were selected from January to December,2017 in Otolaryngology Outpatient Dizziness Center of the First Affiliated Hospital of University of South China who were diagnosed with BPPV by eye shock view were treated by manual reduction.By collecting patient data,the clinical characteristics of patients were summarized,from the analysis of gender,age and the time of onset,telephone follow-up was conducted according to the reset for 1 week,3 months and 1 year.Some patients were followed up by on-site verification.According to the data of two groups,the patients were analyzed retrospeetively.Results:A total of 220 patients with BPPV were admitted to the study.The cases above were followed up by telephone,including 183 patients and 37 missed patients.There were 118 cases in the non-recurrence group,and 65 cases in the recurrence group.The recurrence rate in 1 year was 35.5%.Among them,13 cases of otolith were once again visited by the clinic due to vertigo and diagnosed on the site of the positional test,accounting for 5.9%of the total number,of which 10 cases recurred once,2 cases recurred two times,and 3 cases recurred three times.There was no statistically significant difference between two groups in terms of sex and type of involved semicircular canals(P>0.05).There were significant differences between the two groups in the mean age,the number of involved semicircular canals and the duration of vertigo(P<0.05).Conclusion:For different types of otoliths,the corresponding reduction treatment of otoliths was adopted.The total effective rate of follow-up 1 week after reset was 78.6%,and the total effctive rate of follow-up 3 months after reset was 87.7%.The study shows that the longer the duration of vertigo is,the more likely the BPPV patients will relapse;and the older the patients are,the more likely to relapse are.Multiple tube otolith is more likely to relapse than single tube otolith.For mixed otolith,according to the characteristics of the eye shock,the combined reduction is used.After accurate,combined and multiple repositions,the curative effect is better than that of the first reduction.