原发性BPPV复位后残余头晕的不同康复干预策略及机制研究

Study on different rehabilitation intervention strategies and mechanisms of residual dizziness after manipulative reduction of primary BPPV

目的探讨原发性良性阵发性位置性眩晕(BPPV)复位后残余头晕(RD)的不同康复干预策略及机制。方法60例原发性BPPV复位后RD患者为研究对象,采取随机数字表法分为前庭康复组、经颅磁刺激组与对照组,各20例。对照组仅予以甲磺酸倍他司汀药物治疗;前庭康复组予以前庭康复训练;经颅磁刺激组予以经颅磁刺激仪治疗。对比三组临床疗效及干预前后眩晕障碍量表(DHI)评分。结果经颅磁刺激组和前庭康复组治疗总有效率分别为95.00%、90.00%,均高于对照组的45.00%,差异有统计学意义(P<0.05)。经颅磁刺激组和前庭康复组治疗总有效率对比,差异无统计学意义(P>0.05)。干预前,三组DHI评分对比,差异无统计学意义(P>0.05);干预后1、2、4周,经颅磁刺激组DHI评分分别为(38.62±5.33)、(15.26±4.87)、(7.22±1.08)分,前庭康复组DHI评分分别为(38.97±5.94)、(15.33±5.21)、(7.31±1.14)分,均低于对照组的(46.71±6.11)、(28.97±6.75)、(15.98±2.54)分,差异有统计学意义(P<0.05)。干预后1、2、4周,经颅磁刺激组与前庭康复组DHI评分对比,差异无统计学意义(P>0.05)。结论原发性BPPV复位后RD采用不同康复干预策略的效果有一定的差异,前庭康复训练、经颅磁刺激仪治疗均可以获得较好的预后,临床应用价值较高。

Objective To discuss the different rehabilitation intervention strategies and mechanisms of residual dizziness(RD)after manipulative reduction of primary benign paroxysmal positional vertigo(BPPV).Methods A total of 60 patients with RD after manipulative reduction of primary BPPV were divided into vestibular rehabilitation group,transcranial magnetic stimulation group and control group according to the random numerical table,with 20 cases in each group.The control group was treated with betahistine mesylate only;the vestibular rehabilitation group was given vestibular rehabilitation training;the transcranial magnetic stimulation group was treated with transcranial magnetic stimulation apparatus.The clinical efficacy and the score of dizziness handicap inventory(DHI)before and after intervention were compared.Results The total effective rate of transcranial magnetic stimulation group and vestibular rehabilitation group were 95.00%and 90.00%,which were higher than that of 45.00%of the control group,and the difference was statistically significant(P<0.05).There was no statistically significant difference in total effective rate between transcranial magnetic stimulation group and vestibular rehabilitation group(P>0.05).Before intervention,there was no statistically significant difference in DHI scores among the three groups(P>0.05).At 1,2 and 4 weeks after intervention,DHI scores in the transcranial magnetic stimulation group were(38.62±5.33),(15.26±4.87)and(7.22±1.08)points,while those in the vestibular rehabilitation group were(38.97±5.94),(15.33±5.21)and(7.31±1.14)points,which were lower than those of(46.71±6.11),(28.97±6.75)and(15.98±2.54)points in the control group,and the differences were statistically significant(P<0.05).At 1,2 and 4 weeks after intervention,there was no statistically significant difference in DHI scores between transcranial magnetic stimulation group and vestibular rehabilitation group(P>0.05).Conclusion There are certain differences in the effectiveness of different rehabilitation intervention strategies for patients with RD after manipulation reduction of primary BPPV.Both vestibular rehabilitation training and transcranial magnetic stimulation can achieve good prognosis and have high clinical application value.