简易问卷调查在诊断良性阵发性位置性眩晕中的应用

Application of a simple questionnaire in the diagnosis of benign paroxysmal positional vertigo

目的 设计一种简易问卷并探讨其诊断良性阵发性位置性眩晕(BPPV)的准确性和可行性。方法2021年9—11月因“头晕或眩晕”就诊于我院,经门诊排除中枢性眩晕的380例患者,在行耳石复位仪检查前完成问卷调查。基于BPPV临床特点,问卷共设计6个问题,前4个问题用以初步确诊(全都为肯定回答)或排除(有否定回答)BPPV,后2个问题用于判定BPPV的部位和侧别。以耳石复位仪能诱发典型眼震为诊断标准,对问卷诊断结果进行统计学分析。结果 经问卷调查初步确诊BPPV174例,其中149例(85.6%)最终确诊为BPPV;初步排除BPPV206例,24例(11.7%)最终确诊为BPPV。该问卷的准确度、敏感度和特异度分别为87.1%、86.1%和87.9%。其中4.7%的患者耳石复位仪初次检查未诱发出典型眼震,而问卷调查初步诊断BPPV,嘱患者休息30 min后复查确诊。结论 该问卷简易可行,准确率高,不仅有助于降低BPPV的漏诊率,也有利于眩晕门诊初筛BPPV,促使患者得到及时治疗。

Objective To design a simple questionnaire and to explore its accuracy in the diagnosis of benign paroxysmal positional vertigo(BPPV).Methods From September to November in 2021,380 outpatients who complained dizziness or vertigo accepted the questionnaire survey before positional tests.The questionnaire included six questions.The first four questions were used to diagnose or exclude BPPV.The latter two questions were used to determine the exact location of BPPV.Diagnostic results were collected and statistically analyzed.Typical nystagmus induced by positional tests was set as the diagnostic criteria.Results Among the 174 patients diagnosed as BPPV by the questionnaire,149 cases(85.6%)were confirmed BPPV and among the 206 patients who were initially excluded BPPV,only 24 cases(11.7%)were finally diagnosed with BPPV.The accuracy,sensitivity and specificity of the questionnaire was 87.1%,86.1%and 87.9%respectively.Among the diagnosed group,4.7%patients were not induced typical nystagmus in initial positional tests and finally confirmed after rest for 30 minutes.Conclusions This questionnaire is simple,feasible,and has a high accuracy rate.It helps to reduce misdiagnosis,facilitate initial diagnosis and promote timely treatment of BPPV.