持续性姿势-知觉性头晕的诊疗回顾及体会

Review of persistent postural-perceptual dizziness and experience of diagnosis and treatment

随着慢性主观性头晕(chronic subjective dizziness,CSD)和持续性姿势-知觉性头晕(persistent postural-perceptual dizziness,PPPD)概念;在国内的普及,神经科及耳科医生对于功能性头晕的知晓率和诊断率均得到很大提高,但接踵而至是P PPD诊断的泛化、功能性头晕异质性的大量增加以及部分结构性头晕的漏诊。据权威机构德国国家眩晕中心统计,功能性头晕在眩晕/头晕疾病谱中构成比约为15%;,国际其他医疗机构报告为23%~29%;。近几年国内的学术会议和研讨会中,部分眩晕中心报告PPPD的构成比达40%~50%甚至更高。

The concept and diagnostic standard of persistent postural-perceptual dizziness(PPPD) improve the ability of clinical workers to recognize these diseases to some extent. However, the diagnosis of PPPD mainly depends on the identification of postural symptoms and the elimination of structural vestibular diseases, so the subjectivity is relatively strong. Moreover, the lack of objective criteria and a slight carelessness will lead to generalized diagnosis or omission diagnosis and misdiagnosis. At present, there is a lack of domestic large sample epidemiological investigation and other related studies, therefore it is a problem for diagnosing generalization of persistent posture perception dizziness and needed to be alert and corrected. Only those items meeting the criteria of the diagnostic standards can be carried out for diagnosis. The treatment needs to ensure sufficient dose and full therapy course. Generally, the medication should not be less than half a year.