甲磺酸倍他司汀对良性阵发性位置性眩晕位置试验眼震的影响  

Effect of betahistine mesylate on nystagmus in the position test of benign paroxysmal positional vertigo

作　　者：刘晶[1] 孙怡 张小莉[1] 佘万东[1] LIU Jing;SUN Yi;ZHANG Xiaoli;SHE Wandong(Department of Otolaryngology Head and Neak Surgery,Affiliated Drum Tower Hospital of Nanjing University Medical School,Jiangsu Provincal Key Medical Discipline(Laboratory),Research Institute of Otolaryngology,Nanjing,Jiangsu,210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院耳鼻咽喉头颈外科,江苏省医学重点学科,南京鼓楼医院耳鼻咽喉研究所,江苏南京210008

出　　处：《中国耳鼻咽喉头颈外科》2023年第9期562-566,共5页Chinese Archives of Otolaryngology-Head and Neck Surgery

基　　金：南京鼓楼医院临床研究专项资金面上项目(2022-LCYJ-NMS-01);南京市医学重点科技发展项目(zkx-21012);江苏省科教强卫工程项目(ZDXK202243)。

摘　　要：目的 探讨甲磺酸倍他司汀对良性阵发性位置性眩晕(BPPV)位置试验眼震的影响。方法 2022年1~6月就诊的头晕患者并且予BPPV位置试验检查,其中61例检查前24 h内仅口服过甲磺酸倍他司汀治疗,199例检查前24 h内口服其他药物或者多种药物联合治疗。观察其停药前、后BPPV位置试验眼震变化情况:检查前24 h内有用药史者,先予第1次BPPV位置试验,记录眼震情况;若第1次位置试验为阴性,嘱其停药24 h后再予第2次BPPV位置试验,记录眼震情况;若第1次位置试验为阳性,予手法复位治疗,1 h后复查,若复位效果欠佳,嘱其停药24 h后再予第2次BPPV位置试验,记录眼震情况。位置试验眼震均通过视频眼罩观察。结果 检查前24 h内仅口服过甲磺酸倍他司汀的患者中,第1次BPPV位置试验眼震阳性者占16.39%(10/61),停药24 h后第2次BPPV位置试验眼震阳性者占49.02%(25/51),停药前、后BPPV位置试验眼震阳性率有显著统计学差异(χ^(2)=8.89,P=0.003)。第1次位置试验眼震阳性者中,有5例(50%)在停药24 h后第2次位置试验中眼震强弱程度发生变化,导致定位患侧半规管发生变化:2例左水平半规管BPPV修正为右水平半规管BPPV;1例左水平半规管嵴帽型BPPV修正为右水平半规管嵴帽型BPPV;2例水平半规管嵴帽型BPPV,从第1次位置试验无法根据眼震强弱程度辨别患侧,到第2次位置试验可以根据眼震强弱程度明确患侧。结论 甲磺酸倍他司汀对BPPV位置试验的精确性有一定影响,主要表现为抑制患者发病时原有的眼震,建议停药24 h后再做位置试验,有助于BPPV精准诊疗。OBJECTIVE To investigate the effect of betahistine mesylate on nystagmus in the position test of benign paroxysmal positional vertigo(BPPV).METHODS Among the dizziness patients examined by position test seen from January 2022 to June 2022,61 patients were treated only with betastine mesylate within 24 h before examination,and 199 patients received other oral drugs or multiple drugs within 24h before examination.Changes in nystagmus were observed during the location test before and after drug withdrawal:Patients with a history of medication within 24 hours before the examination were all given the first BPPV position test,and their nystagmus was recorded.If the first position test is negative,the patient was told to medication for 24 hours before conducting a second location test,and the condition of nystagmus was recorded.If the first position test is positive,manual repositioning treatment will be given,and a follow-up examination will be conducted after 1 hour.If the repositioning effect is not satisfactory,the patient will be instructed to discontinue the medication for 24 hours before undergoing a second BPPV position test,and the condition of nystagmus will be recorded.The nystagmus was observed through video eye masks.RESULTS There were 10 cases(10/61,16.39%)with positive nystagmus in the first BPPV position test,and 25 cases(25/51,49.02%)with positive nystagmus in the second BPPV position test 24 hours after drug withdrawal.There was a significant statistical difference in the positive rate of nystagmus in the BPPV position test before and after drug withdrawal(χ^(2)=8.89,P=0.003).Among those with positive nystagmus in the first position test,5 cases(5/10,50%)had changes in the intensity of nystagmus in the second position test 24 hours after drug withdrawal,resulting in changes in the localization of the affected semicircular canal:2 cases of left horizontal semicircular canal BPPV were corrected to right horizontal semicircular canal BPPV;1 case of left horizontal semicircular canal crest cap type BPPV

关 键 词：良性阵发性体位性眩晕 倍他司汀 位置试验 眼震 

分 类 号：R764[医药卫生—耳鼻咽喉科]