管石复位法治疗良性发作性位置性眩晕的短期和长期效果  

Short-term and long-term efficacy of canalith repositioning procedures for the treatment of benign paroxysmal positional vertigo

作　　者：周永[1] 李胜利[1] 郭啸鸣[1] 朱向阳[1] 董政协[1] 黄怀宇[1] 

机构地区：[1]南通市第一人民医院神经内科,江苏南通226001

出　　处：《中风与神经疾病杂志》2013年第9期827-830,共4页Journal of Apoplexy and Nervous Diseases

摘　　要：目的分析良性发作性位置性眩晕(BPPV)的临床特点,观察管石复位法(CRP)治疗BPPV的短期和长期疗效。方法 232例神经内科门诊连续就诊的BPPV患者,年龄20~89岁,平均55.4±14.7岁,女性占66.4%(154/232),病程2h^8m,平均11.8±26.6d。BPPV的诊断依据临床表现结合变位试验。根据受累半规管的类型选择合适的CRP,包括改良Epley法、Barbecue翻滚法和Gufoni法。评估了疗效和安全性,长期随访观察了复发率及影响因素。结果 232例BPPV患者中,受累部位在后半规管(PC-BPPV)、外半规管(HC-BPPV)、前半规管和多个半规管分别为68.5%、26.7%、0.9%和3.9%,主观性BPPV占5.2%。首次就诊治愈率83.2%,1w治愈率93.5%。PC-BPPV、HC-BPPV和多个半规管BPPV分别平均接受了1.5±1.0、2.4±1.4和5.4±1.5次CRP(F=62.242,P<0.001)。26.3%的患者治疗成功后仍有头昏。长期随访20.6%的患者复发,13.1%发生于6m内,年龄、病程和外伤史可能是影响复发的因素。CRP过程中未见严重不良反应,但有5.2%的患者发生了耳石部位转换。结论 BPPV多累及后半规管,但HC-BPPV的发病率可能被低估;CRP是安全有效的治疗方法,但外半规管和多个半规管受累时需更多的CRP次数;长期随访BPPV有较高的复发率。Objective To analyze the clinical features of benign paroxysmal positional vertigo （BPPV） and to deter- mine the short-term and long-term therapeutic efficacies of canalith repositioning procedures （CRP） on BPPV. Methods A total of 232 patients （ mean age 55.4 ＋ 14.7years,66.4% female） with BPPV were recruited from June 2009 to Decem- ber 2012. The average duration of symptoms was 11.8 -＋ 26.6 days. The diagnosis was based on clinical manifestation and positional testing. CRP for treatment included modified Epley, Barbecue and Gufoni maneuvers. Efficacy and safety of CRP were assessed. Long-term recurrence rate and influencing factors were also evaluated. Results Posterior semicircular ca- nal（PC-BPPV） was involved in 68.5% of the patients, horizontal canal （HC-BPPV） in 26.7%, anterior canal in 0.9%, and mixed canals in 3.9%. There were 12（5.2% ） patients with subjective BPPV. At the 1 and 7 day follow-up,83.2 and 93.5% ,respectively,of patients recovered from vertigo. An average of 1.5,2.4 and 5.4 therapeutic sessions per patient was performed in patients with PC-BPPV, HC-BPPV and mixed canals BPPV respectively. Residual dizziness occurred in 26.3% patients after treatment. Follow-up was performed at average of 15.4 ＋ 9.8 months after the initial phase. Recur- rence occurred in 36 of the 160 patients （20.6%） and within 6 months in 21 patients （ 13.1% ）. Older age,a longer dura- tion of symptoms and history of head trauma were more frequent in patients who developed recurrence. No serious complica- tions occurred during the treatment, but canal switch took place in 5.2% patients. Conclusion PC-BPPV is the most com- mon type of BPPV, but the incidence of HC-BPPV may be underestimated. CRP is an effective and safe treatment, but HC- BPPV and mixed canals BPPV need more therapeutic sessions. Long-term recurrence rate of BPPV is higher.

关 键 词：良性发作性位置性眩晕 管石复位法 治疗 预后 

分 类 号：R742[医药卫生—神经病学与精神病学]