良性阵发性位置性眩晕的临床特征及心理因素对复位后残余症状的影响研究  

Clinical Characteristics of Benign Paroxysmal Positional Vertigo and the Influence of Psychological Factors on Residual Symptoms after Reduction

作　　者：周昕阳 于书剑 王倩[1] 于红[1] ZHOU Xinyang;YU Shujian;WANG Qian;YU Hong(Department of Otorhinolaryngology Head and Neck Surgery,First Hospital of Jilin University,Changchun 130000,China)

机构地区：[1]吉林大学第一医院耳鼻咽喉头颈外科,吉林省长春市130000

出　　处：《中国全科医学》2024年第14期1685-1691,共7页Chinese General Practice

基　　金：吉林省自然科学基金资助项目(20210101435JC);吉林省卫健委基金(2020J055)。

摘　　要：背景良性阵发性位置性眩晕(BPPV)是以具有自限性、易反复发作为特点的临床常见病,手法复位治疗可以取得较好疗效,复位后部分患者会出现残余症状。近年来对BPPV治疗效果影响因素的研究较多,但对具体病因间的治疗效果比较及残余症状发生的影响因素仍有待探讨。目的分析继发性BPPV的临床特征,探讨BPPV的病因分类对疾病复发率的影响及BPPV复位后发生残余症状的影响因素。方法选取2019年4月—2021年4月就诊于吉林大学第一医院耳鼻咽喉头颈外科眩晕门诊及耳内科住院患者中确诊为BPPV的患者共340例,患者均同意行手法复位治疗。按是否存在原发病将患者分为原发性BPPV(原发组)、继发性BPPV(继发组)。继发组再按病因的不同分为5个亚组,主要病因包括突发性聋(SSNHL)、前庭性偏头痛(VM)、梅尼埃病(MD)、前庭神经炎(VN)、其他(如颅脑及耳部手术、Hunt综合征、颞骨骨折等)。比较原发组、继发组之间的临床特征及预后情况。随访至首次复位后3个月,再按患者随访期内有无残余症状发生将患者分为出现残余症状组、未出现残余症状组。比较两组间临床特征及不同时段(诊断时、治疗后4周、治疗后3个月)焦虑自评量表(SAS)、抑郁自评量表(SDS)评分的差异,分析BPPV复位后发生残余症状的独立影响因素。结果340例患者中,原发组184例(54.1%)、继发组156例(45.9%)。继发组较原发组患者发病年龄小,经2次以上复位治疗所占比例高,一次复位成功率低,3个月内复发率、残余症状发生率、诊断时SAS评分、诊断时SDS评分高(P<0.05)。继发性BPPV患者中不同病因患者年龄比较,差异有统计学意义(P<0.05);其中其他(如颅脑及耳部手术、Hunt综合征、颞骨骨折等)病因患者年龄小于SSNHL、VM、MD、VN患者(P<0.05)。继发性BPPV患者中不同病因患者性别、受累半规管、复位次数、一次复位成功率、3个Background Benign paroxysmal positional vertigo(BPPV)is a common clinical disease characterized by self-limiting and easy recurrence.Manual reduction is effective but residual symptoms may occur in some patients after reduction.In recent years,there have been many studies focus on the influencing factors of therapeutic efficiency of BPPV,while the comparison among specific causes and factors influencing residual symptoms remain to be further investigated.Objective To analyze the clinical features of secondary BPPV,investigate the effect of etiological classification of BPPV on the recurrence rate,and clarify the risk factors of residual symptoms after BPPV reduction.Methods A total of 340 patients diagnosed with BPPV were enrolled in the vertigo clinic of the Department of Otorhinolaryngology Head and Neck Surgery and Otology Department of the First Hospital of Jilin University from April 2019 to April 2021,and all of them agreed to manual reduction.The included patients were divided into the primary BPPV(the primary group)and secondary BPPV(the secondary group)groups according to the presence or absence of primary disease.The secondary group was further divided into five subgroups according to different etiologies,including sudden sensorineural hearing loss(SSNHL),vestibular migraine(VM),Meniere disease(MD),vestibular neuritis(VN),and others(such as cranial and ear surgery,Hunt syndrome,temporal bone fracture,etc.).The clinical features and prognosis were compared between the primary group and the secondary group.Follow-up to 3 months after the first reduction,the patients were divided into the residual symptom group and non-residual symptom group according to the occurrence of residual symptoms.The differences were compared in clinical characteristics and scores of Self-rating Anxiety Scale(SAS)and Self-rating Depression Scale(SDS)at different periods(at diagnosis,4 weeks after treatment,and 3 months after treatment)between the two groups,and the independent risk factors of residual symptoms after BPPV reductio

关 键 词：良性阵发性位置性眩晕 前庭疾病 残余症状 心理因素 影响因素分析 

分 类 号：R764.33[医药卫生—耳鼻咽喉科]