后半规管良性阵发性位置性眩晕病程对复位成功后残余症状的影响

Effect of the course of posterior semicircular canal benign paroxysmal positional vertigo on residual symptoms after successful canalith repositioning procedure

目的:探讨后半规管良性阵发性位置性眩晕(BPPV)的病程对耳石成功复位后残余症状的影响。方法:选取2020年7月-2021年3月确诊的原发性后半规管BPPV患者56例,根据发病至复位治疗之间的病程长短分为短病程组和长病程组。所有患者均采用转椅辅助下的Epley复位治疗,经成功复位治疗后7~10 d进行复诊。所有患者在治疗前和治疗后均采用眩晕障碍量表(DHI)进行评估,比较2组在治疗前和治疗后DHI各维度评分及总分的差异。结果:(1)成功复位后,轻度残余症状患者中,短病程组与长病程组的比率分别是68.6%和31.4%;中重度残余症状患者中,短病程组与长病程组的比率分别是20%和80%,差异均有统计学意义(P<0.05)。(2)复位前,两组躯体(DHI-P,7项)及功能(DHI-F,9项)2个维度的分值差异无统计学意义(P>0.05),情感维度(DHI-E,9项)及DHI总分差异有统计学意义(P<0.05)。复位后,2组DHI-P评分差异无统计学意义(P>0.05),DHI-F、DHI-E及DHI总分比较差异有统计学意义(P<0.05)。复位前后比较,2组的DHI-P、DHI-F、DHI-E评分及DHI总分与治疗前比较差异均有统计学意义(P<0.05)。(3)复位前后短病程组与长病程组DHI不同维度的差值及总分的差值比较差异无统计学意义(P>0.05)。结论:病程的长短不影响后半规管BPPV复位治疗的短期疗效,但是长病程患者在成功复位后更容易出现中重度以上的残余症状,主要表现在社会功能及情感心理方面。

Objective: To investigate the effect of the course of posterior semicircular canal benign paroxysmal positional vertigo(BPPV) on residual symptoms after successful canalith repositioning procedure(CRP). Methods: A total of 56 patients with posterior semicircular canal BPPV were selected from July 2020 to March 2021. They were divided into the short course group and the long course group according to the duration of disease from symptom onset to CRP treatment. All patients were treated with mechanical Epley repositioning procedure with rotary chair assistance. After successful repositioning treatment, they were followed up for seven to ten days. All patients were assessed using the vertigo disorder scale(DHI) before and after treatment, the differences of each dimension score and total score of DHI before and after successful CRP were compared between these two groups. Results:(1) After successful CRP, in patients with mild residual symptoms, the ratio between short course group and long course group were 68.6% and 31.4%, respectively. While in patients with moderate to severe residual symptoms, the ratio between short course group and long course group was 20% and 80%, respectively. The difference was statistically significant(P<0.05).(2)Before CRP, there was no significant difference in Physical dimension(DHI-P, 7 items) and in Function dimension(DHI-F, 9 items) between the two groups(P>0.05), but there was significant difference in Emotion dimension(DHI-E, 9 items) and in total DHI score between the two groups(P<0.05, respectively). After treatment, there was no significant difference in DHI-P score between the two groups(P>0.05), but there were significant differences in DHI-F, DHI-E and DHI total score between the two groups(P<0.05,respectively). Compared with the scores of DHI-P, DHI-F, DHI-E and DHI total score before and after successful CRP, the significant differences were found between the short course group and long course group(P<0.05,respectively).(3)There was no significant difference in the difference of DHI dimensions and total score between the short course group and the long course group before after reduction(P>0.05,respectively). Conclusion: The duration of posterior semicircular canal BPPV(P-BPPV) does not affect the short-term efficacy of P-BPPV repositioning treatment, but patients with long course of P-BPPV are more likely to have moderate to severe residual symptoms after successful CRP,mainly in social function and emotional psychology.