后半规管良性阵发性位置性眩晕三种自我治疗手法的疗效比较  

Comparison of three types of self-treatments for posterior canal benign paroxysmal positional vertigo： modified Epley maneuver, modified Semont maneuver and Brandt-Daroff maneuver

作　　者：章燕幸[1] 吴承龙[1] 肖桂荣[1] 钟芳芳[1] 

机构地区：[1]浙江省绍兴市人民医院(浙江大学绍兴医院)神经内科,浙江省绍兴市312000

出　　处：《中华耳鼻咽喉头颈外科杂志》2012年第10期799-803,共5页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：浙江省医药卫生科学研究基金计划A类资助项目（2009A207）;绍兴市2009年科技计划项目（2009A33015）

摘　　要：目的 对后半规管良性阵发性位置性眩晕三种自我治疗手法（改良Epley法、改良Semont法和Brandt-Daroff法）进行临床疗效和复发率的对比研究。方法168例患者随机抽签法分为四组，改良Epley组45例，改良Semont组43例，Brandt-Daroff组40例和对照组40例，对照组仅给予药物治疗不使用复位法。比较四组治疗1周和1个月时的疗效、不良反应发生率以及6个月时的复发率，并对四组达到治愈所需的时间进行比较。结果改良Epley法治疗1周时疗效优于其他三组，差异具有统计学意义（X^2=8．55、23．23及44．00，P值均〈0．01），1个月疗效优于Brandt-Daroff法（X^2=8．42，P〈0．05）。改良Semont法1周疗效优于对照组（X^2=14．49，P〈0．01），1个月疗效与对照组比较差异无统计学意义（X^2=0．01，P〉0．05）。Brandt-Daroff法疗效较差，1周和1个月疗效与对照组比较，差异均无统计学意义（X^2=3．35及0．18，P值均〉0．05）。Kaplan-Meier生存曲线比较四组的治愈时间，经Log-rank检验分析，改良Epley组治愈时间短于其他三组，差异具有统计学意义（X^2=10．850、25．779及35．085，P值均〈0．01）。眩晕、恶心、呕吐、心悸等不良反应的发生率在三个物理治疗组间差异无统计学意义。治疗6个月时四组的复发率比较，差异无统计学意义（X^2=4．076，P=0．253）。Logistic回归分析显示，年龄和治疗前病程长短是复发的独立预测因素，而复位方法、性别、患侧、病因和发病次数等与复发无关。结论改良Epley法在快速缓解后半规管良性阵发性位置性眩晕症状方面优于改良Semont法和Brandt-Daroff法，可作为反复发作患者的一线治疗选择，但该方法并不能降低复发率。Objective To compare the efficacy and recurrence rates of modified Epley maneuver, modified Semont maneuver and Brandt-Daroff maneuver in patients with posterior canal benign paroxysmal positional vertigo（PC-BPPV）. Methods One hundred and sixty-eight patients with unilateral PC-BPPV were included in the study, which were divided into four groups randomly, 45 with modified Epley maneuver （ group 1 ） , 43 with modified Semont maneuver（ group 2）, and 40 with Brandt-Daroff maneuver（ group 3 ）. There were 40 controls without physical therapy technique （ group 4） included. The efficacy after one week and one month, the time to recovery, the frequency of side effects and recurrence rates among the four groups were evaluated. Results The efficacy of modified Epley maneuver was superior to the other three groups after one week （ X^21,2 = 8.55, P 〈 0. 05 ; X^21,2 = 23.23, P 〈 0. 01 ; X^21,4 = 44. 00, P 〈 0. 01 ） and to the Brandt-Daroff maneuver at follow-up evaluation after one month （ X^2 = 8.42, P 〈 0. 05 ）. The efficacy of modified Semont maneuver was superior to the control groups after one week （ X^2 = 14. 49, P 〈 0. 01 ） , but there was no difference between the two groups after one month （ X^2 = 0. 01 , P 〉 0. 05 ） . The efficacy of Brandt-Daroff maneuver was not different with the control group at one week and one month follow-up

关 键 词：眩晕 物理治疗技术 半规管 治疗结果 

分 类 号：R764[医药卫生—耳鼻咽喉科]