良性阵发性位置性眩晕误诊文献荟萃分析  

Meta-analysis of Misdiagnosis Literature of Benign Paroxysmal Positional Vertigo

作　　者：郭权来[1] 陈晓珠[1] 周岳鹏 覃小兰[2] GUO Quan-lai CHEN Xiao-zhu ZHOU Yue-peng QIN Xiao-lan(Guangzhou University of Chinese Medicine, Guang- zhou 510405, China Emergency Department, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou 510120, China)

机构地区：[1]广州中医药大学,广州510405 [2]广东省中医院急诊科,广州510120

出　　处：《临床误诊误治》2017年第3期40-44,共5页Clinical Misdiagnosis & Mistherapy

基　　金：广东省科技厅项目基金资助(2009B030801295)

摘　　要：目的探讨良性阵发性位置性眩晕(benign paroxysmal positional vertigo,BPPV)的误诊原因,提出防范策略。方法利用计算机检索1979年1月—2016年9月的CNKI、VIP、CBM及万方数据库公开发表的BPPV误诊文献,并对相关数据进行统计分析。结果本研究共纳入相关文献33篇共1525例,均为病例报道或临床回顾性分析,其中1367例有明确的误诊疾病,居前3位的分别为后循环缺血或短暂性脑缺血发作(24.58%)、颈椎病(21.80%)、脑供血不足或椎基底动脉供血不足(19.09%)。误诊原因分为16类共146条,主要包括医师经验导致对BPPV缺乏认识(21.23%)、既往史或多种并存疾病干扰(17.81%)、病史询问不详细或忽略头晕与体位的关系(10.96%)、过分依赖医技检查(9.59%)等。病程及误诊时间为2 h^20年不等,误诊医院以三甲医院为主,且所有患者均误诊但未造成不良后果。结论 BPPV常被误诊为后循环缺血等多种疾病,误诊原因涉及医务人员、患者和医院管理3个方面,医务人员对其认识不足是误诊的主要原因。Objective To investigate misdiagnosed causes of benign paroxysmal positional vertigo （BPPV） so as to provide prevention strategy. Methods Published studies about BPPV misdiagnosis were searched from CNKI, VIP, CBM and WanFang databases during January 1979 and September 2016, and related data was performing statistical analysis. Results A total of 33 studies involving 1525 patients met the inclusion criteria. The studies were either case reports or clinical reviews, among them 1367 patients were misdiagnosed clearly, and the top 3 misdiagnosed diseases were posterior circulation ischemia or transient ischemic attack （24.58%） , cervical spondylosis （21.80%） and cerebral insufficiency or vertebral basilar artery insufficiency （19.09%） in turn. Misdiagnosed causes were divided into 16 categories （146 entries） , which mainly included lack of experience or awareness of BPPV （21.23%） , interfered diagnosis by past history and multiple coexisting diseases （ 17.81% ） , without inquiring history detail fully or ignoring relation between dizzy with position （ 10.96% ） , overdependence medical examination （9.59%） and so on. The course of disease and misdiagnosed time was 2 hours-20 years. Hospital of be- ing misdiagnosis were mainly three levels of first-class hospitals. All patients were misdiagnosed, but no adverse outcome was found. Conclusion BPPV is often misdiagnosed as posterior circulation ischemia and other diseases. The misdiagnosed cau- ses involve three aspects as follow medical staff, patients and hospitals management, and lack of awareness of BPPV in medi- cal staff is the main cause.

关 键 词：良性阵发性位置性眩晕 误诊 脑缺血发作 短暂性 颈椎病 椎基底动脉供血不足 

分 类 号：R764[医药卫生—耳鼻咽喉科]