督导下短时程个性化前庭康复训练与固式化前庭康复训练对复发性外周性眩晕的疗效比较  

Comparison of efficacy between short-term personalized vestibular rehabilitation supervised by special personnel and fixed vestibular rehabilitation on recurrent peripheral vertigo

作　　者：汪毅 赵昊 田亮 黄一波 吴珏菁 王璟 Wang Yi;Zhao Hao;Tian Liang;Huang Yibo;Wu Juejing;Wang Jing(ENT Institute and Department of Otorhinolaryngology,Eye&ENT Hospital,Fudan University/NHC Key Laboratory of Hearing Medicine(Fudan University),Shanghai 200031,China;Department of Nuclear Medicine,the Affiliated Taian City Central Hospital of Qingdao University,Taian 100160,China)

机构地区：[1]复旦大学附属眼耳鼻喉科医院耳鼻喉科,上海听觉医学中心,国家卫生健康委员会听觉医学重点实验室,上海200031 [2]青岛大学附属泰安市中心医院(泰山医养中心)核医学科,泰安100160

出　　处：《中华医学杂志》2024年第14期1132-1137,共6页National Medical Journal of China

基　　金：上海市科学技术委员会项目(23DZ2202900)

摘　　要：目的比较督导下短时程个性化前庭康复训练(ST-PVR)与固式化前庭康复训练(FVR)对于失代偿复发性外周性眩晕的疗效差异。方法随机对照研究。2018年1至12月于复旦大学附属眼耳鼻喉科医院诊断为失代偿复发性外周性眩晕的患者被计算机随机分配至FVR组和ST-PVR组。FVR组患者采用固式化前庭康复方案,包括注视稳定性训练、习服训练、平衡和步态训练;ST-PVR组患者则根据其症状与前庭功能检查结果制定个性化训练方案,并根据恢复情况调整方案。在治疗2、4和8周后,使用眩晕残障量表(DHI)、特异性活动平衡信心(ABC)量表、焦虑自评量表(SAS)、温度试验和感觉统合测试(SOT)评估患者症状和前庭功能的改善情况。结果共纳入44例患者,男16例,女28例,年龄(50.6±13.5)岁。FVR组21例,ST-PVR组23例。ST-PVR组治疗2周后DHI评分[(49.5±26.8)分比(61.3±21.4)分,P=0.046]和SAS评分[(39.1±7.8)分比(44.3±6.6)分,P=0.021]较治疗前改善,而FVR组治疗8周后才出现改善[DHI:(28.1±15.9)分比(53.1±18.5)分,P=0.001;SAS:(35.3±6.7)分比(43.1±8.4)分,P=0.010]。FVR组患者治疗8周后ABC评分无明显变化[(86.5±12.9)分比(83.4±18.1)分,P=0.373],而ST-PVR组患者ABC评分在治疗4周后即升高[(83.6±15.2)分比(78.4±15.1)分,P=0.015]。温度试验结果显示,治疗8周后,两组单侧半规管功能减弱<25%的患者比例均增加[FVR组:57.1%(12/21)比9.5%(2/21),P=0.001;ST-PVR组:52.2%(12/23)比17.4%(4/23),P=0.014];ST-PVR组中优势偏向≤25%的患者比例增加[91.3%(21/23)比60.9%(14/23),P=0.016],而FVR组无明显变化[61.9(13/21)%比57.1%(12/21),P=0.500]。ST-PVR组SOT评分≥70分的患者比例在治疗2周后即增加[69.6%(16/23)比30.4%(7/23),P=0.009],而FVR组治疗8周后增加[81.0%(17/21)比42.9%(9/21),P=0.012]。结论FVR与ST-PVR均能改善失代偿复发性外周性眩晕患者前庭功能,缓解其眩晕与焦虑症状,促进前庭代偿进程,但ST-PVR可加快前庭代偿速度,增�Objective To explore the efficacy of short-term personalized vestibular rehabilitation supervised by special personnel(ST-PVR)versus fixed vestibular rehabilitation(FVR)on decompensated recurrent peripheral vertigo.Methods A randomized controlled trial was carried out.Patients diagnosed with decompensated recurrent vertigo in the clinic of Eye&ENT Hospital,Fudan University from January to December 2018 were randomly allocated into FVR and ST-PVR groups via computer-generated randomization.The FVR group received fixed scheme involving gaze stabilization exercises,habituation exercises,balance and gait training,while the ST-PVR group received individualized training programs based on symptoms and vestibular function examination results,with adjustments made according to the progress of recovery.Patient symptoms and vestibular function improvement were assessed using the dizziness handicap inventory(DHI),activities-specific balance confidence(ABC),self-rating anxiety scale(SAS),caloric test,and sensory organization test(SOT)at 2,4,and 8 weeks of treatment.Results A total of 44 patients were included,including 16 males and 28 females,with an average age of(50.6±13.5)years.There were 21 cases in the FVR group and 23 cases in the ST-PVR group.In the ST-PVR group,DHI score(49.5±26.8 vs 61.3±21.4,P=0.046)and SAS score(39.1±7.8 vs 44.3±6.6,P=0.021)significantly improved after 2 weeks of treatment,while significant improvement occurred only after 8 weeks of treatment in the FVR group(DHI score:28.1±15.9 vs 53.1±18.5,P=0.001;SAS score:35.3±6.7 vs 43.1±8.4,P=0.010).There was no significant change of ABC score in the FVR group after 8 weeks of treatment(86.5±12.9 vs 83.4±18.1,P=0.373),while a significant improvement was observed in the ST-PVR group after 4 weeks of treatment(83.6±15.2 vs 78.4±15.1,P=0.015).The caloric test results showed that after 8 weeks of treatment,the proportion of patients with unilateral weakness<25%increased in both groups[FVR group:57.1%(12/21)vs 9.5%(2/21),P=0.001;ST-PVR group:52.2%(12/

关 键 词：眩晕 前庭康复 前庭功能 短时程个性化治疗 固式化 

分 类 号：R764[医药卫生—耳鼻咽喉科]