摘要
目的探讨短期内多次手法复位疗效不佳的良性阵发性位置性眩晕（benign paroxysmal positional vertigo,BPPV）的影响因素。方法回顾性分析2014年1月-2015年6月39例在本院耳鼻喉门诊首诊，2周以内经反复（3次以上）手法复位疗效不佳的BPPV患者其2周后的临床表现、治疗及随诊结果，探讨其影响因素。结果此类患者占同期全部BPPV患者的9.8%（39/396），其中，男15例，女24例，年龄26岁～81岁，平均63.0±14.5岁，60岁以上的28例，占71.8%。单侧后半规管BPPV 5例，单侧后半规管嵴顶BPPV 7例，单侧水平半规管BPPV 7例，单侧水平嵴顶BPPV 10例，上半规管BPPV 3例，混合型BPPV 7例。其中特发性的25例，继发性的14例（头部外伤7例，梅尼埃病2例，前庭神经炎1例，突发性耳聋1例，中耳炎1例，偏头痛2例）。所有患者均经过超过2周3次以上的手法复位，后半规管及后半规管壶腹嵴受累者采用Epley+Semont法，水平半规管及水平壶腹嵴顶受累者多采用Barbecue+Gufoni或Casani+强迫健侧卧位法，上半规管受累者采用Yacovino法进行复位，39例中28例结合Brandt-daroff体位训练及其药物辅助治疗。2周后-1个月内眩晕和变位性眼震能够完全缓解的19例，1个月后能够完全缓解的26例，2个月后和3个月后能够完全缓解的分别为31例和34例，随诊1年手法复位完全无效的5例，完全缓解的34例中1年内复发的21例（占61.8%）。结论2周内经历多次手法复位疗效欠佳的BPPV患者多为60岁以上的老年患者，嵴顶结石、多管受累、头部外伤、梅尼埃病等内耳疾病是可能是其复位效果不佳的影响因素。此类患者一次手法复位难以成功，多数需要联合多种复位方法，结合体位训练和药物辅助治疗；个别患者手法复位完全无效；复位有效者，部分容易复发。
Objective To investigate factors that may be associated with poor short-term outcomes following positionalmaneuvers in patients with BPPV. Methods From Jan, 2014 to Jun, 2015, 39 patients experiencing poor short-term outcomesfollowing multiple positional maneuvers within two weeks were inquired and their clinical data were analyzed retrospectively.Results The rate of poor outcomes among all treated patients in the period was 9.8% (39/396), including 15(38.5%) men and 24 (61.5%) women, age ranging from 26 to 81 (mean 63.0±14.5) years. Among them, 28 (71.8%) wereolder than 60 years. The lesion involved unilateral posterior semicircular canal in 5 cases, unilateral posterior semicircularcupular in 7 cases, horizontal semicircular canal in 7 cases, horizontal semicircular cupular in 10 cases, superior semicircularcanal in 3 cases, and combined multiple semicircular canals in 7 cases. Twenty five patients (64.1%) presented with idiopathicBPPV and secondary BPPV was diagnosed in 14 patients (head trauma in 7 cases, Meniere’s disease in 2 cases,vestibular neuritis in 1 case, sudden deafness in 1 case, 1 case of otitis media and 2 cases of migraine). All patients receivedmore than 3 sessions of repositioning maneuver treatment within two weeks to three months after diagnosis. BPPV patients with lesions in the posterior semicircular canal and cupula were treated by Epley + Semont maneuver, horizontalsemicircular canal and cupular lesions by Barbecue + Gufoni or Casani + force health side-lying position method, and superiorsemicircular canal lesions by YACOVINO method. Twenty eight patients received both positional training and drugtreatment. Complete remission of vertigo and nystagmus were recorded in 26 cases after 1 month, 31 cases after 2 months,34 cases after 3 months, respectively. The repositioning maneuver was completely ineffective in 5 cases. Recurrence wasseen in 21 (61.8%) out of 34 cases. Conclusions Short-term ineffective outcomes following more than 3 sessions of positionalmaneuvers during the first two weeks were more prevalent in patients older than 60 years of age. Cupulolithiasis,multiple-canal involvement, head trauma and inner ear ischemia may be factors that can lead to poor curative effect. It isdifficult for these patients to recover through single repositioning maneuver. Most of them need several repositioning maneuverapproaches, combined with postural training and drugs. Repositioning maneuver may not be effective in a smallnumber of these patients. Even for some of these patients to whom repositioning maneuvers are effective, it is easy for BPPVto reoccur.
作者
熊彬彬
赵晓明
刘劲
林春梅
伍慧卿
梁勇
Zhao Xiaoming;Liu Jin;Lin Chunmei;Wu Huiqing;Xiong Binbin;Liang Yong(Department of Otolaryngology Head and Surgery, First People’s Hospital of Zhuhai, Zhuhai, 519000;Department of Otolaryngology Head and Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515)
出处
《中华耳科学杂志》
CSCD
北大核心
2016年第4期473-477,共5页
Chinese Journal of Otology
关键词
短期疗效
良性阵发性位置性眩晕
临床特征
ineffective short-term outcomes
benign paroxysmal positional vertigo
diagnosis and treatment strategy
