难治性眩晕患者个性化前庭康复的疗效及方案制定策略  

The efficacy and strategy of individualized vestibular rehabilitation in patients with intractable vertigo

作　　者：余菁 黄一波 王璟 Yu Jing;Huang Yibo;Wang Jing(ENT Institute and Department of Otorhinolaryngology,Eye&ENT Hospital,Fudan University/NHC Key Laboratory of Hearing Medicine(Fudan University),Shanghai 200031,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

出　　处：《中华医学杂志》2021年第26期2044-2049,共6页National Medical Journal of China

基　　金：国家自然科学基金(81870724)。

摘　　要：目的探讨难治性眩晕患者在进行个性化前庭康复训练后起效的节点和治疗后的转归,并归纳个性化前庭康复方案的有效制定策略。方法选取2017年9月至2019年12月在复旦大学附属眼耳鼻喉科医院就诊的难治性眩晕患者35例,男15例,女20例,年龄24-71岁。制定个性化前庭康复方案并在治疗后2、4周进行随访,比较患者治疗前后的主观量表[焦虑自评量表(SAS)、眩晕障碍量表(DHI)、特异性活动平衡信心量表(ABC)]得分,以及前庭功能动静态姿势图(CDP)及眼震电图(VNG)的结果。结果与治疗前比较,治疗后2、4周SAS[(41±8)、(37±8)、(36±8)分,P=0.020]、DHI[56(40,78)、46(22,74)、16(6,76)分,均P<0.01]、ABC[(80±17)、(87±11)、(91±9)分,P=0.002]量表的得分均有逐渐好转趋势。年龄与性别不影响各量表的得分(均P>0.05),年龄分层、性别与时间之间无交互效应(均P>0.05)。治疗后2、4周动静态平衡台中前庭觉维持平衡的功能与治疗前相比提高(均P<0.001),眼震电图中优势偏向(DP)值在治疗后2周改善不明显(P=0.593),治疗后4周出现明显改善(P=0.007);单侧减弱值从治疗后2周即出现明显改善(P=0.001);性别和年龄不影响平衡台和眼震电图结果的恢复(均P>0.05)。结论通过对难治性眩晕患者进行规范的个性化前庭康复,不但可以改善患者的焦虑状态,控制眩晕症状,提高日常活动能力;客观上也能提高前庭-脊髓反射通路及前庭-眼动反射通路的功能。Objective To explore the prognosis of individualized vestibular rehabilitation(VR)in patients with intractable vertigo and work out an effective and normative rehabilitation program.Methods A total of 35 patients diagnosed with intractable vertigo who visited Eye&ENT Hospital of Fudan University from September 2017 to December 2019 were enrolled.All the participants consisted of 15 males and 20 females,aged from 24 to 71 years old,and underwent an individualized VR.Follow-ups were conducted at 2 and 4 weeks post-rehabilitation.Assessments consisted of self-rating anxiety scale(SAS),dizziness handicap inventory scale(DHI),activities-specific balance confidence sacle(ABC),computerized dynamic posturography(CDP),and video-electronystagmograph(VNG)were performed.Results SAS,DHI,ABC scores gradually improved after VR.The scores of SAS scale of pre-VR,2 and 4 weeks post-VR were 41±8,37±8 and 36±8,respectively.The scores of DHI were 56(40,78),46(22,74),16(6,76),respectively.Meanwhile,the scores of ABC were 80±17,87±11 and 91±9,respectively.There were significant statistical differences of aforementioned three scale scores at different time points(P=0.020,P<0.01,P=0.002),which was not influenced by age and gender(all P>0.05).No interactive effects were revealed among age,gender and time(all P>0.05).The improvement of vestibular function to control balance was statistically significant after 2-and 4-week rehabilitation(both P<0.001).The value of directional preponderance was significantly improved after 4-week VR(P=0.007),while no obvious improvement was found after 2 weeks treatment(P=0.593).There was a statistically significant difference in the value of unilateral weakness(UW)between pre-VR and post-VR since 2 weeks(P=0.001).Conclusion Individualized VR in patients with intractable vertigo can not only eliminate anxiety,control dizziness,increase activities of daily life,but also improve the function of vestibulo-spinal and vestibulo-ocular reflex pathways.

关 键 词：前庭疾病 难治性眩晕 前庭康复 主观量表 动态姿势图 眼震电图 

分 类 号：R764[医药卫生—耳鼻咽喉科] R493[医药卫生—临床医学]