高龄老年良性阵发性位置性眩晕的特点及手法复位治疗的注意事项

夏菲; 王彦君; 王宁宇

doi:10.13201/j.issn.1001-1781.2015.01.004

高龄老年良性阵发性位置性眩晕的特点及手法复位治疗的注意事项

- 北京朝阳医院耳鼻咽喉头颈外科(北京, 100020)
基金项目:
国家自然科学基金资助项目(优先效应中对下丘抑制性调控机制的研究,No:81271090)

详细信息

通讯作者: 王宁宇,E-mail:wny@sohu.com

中图分类号: R764.3

收稿日期: 2014-12-01

Analysis of clinical features with benign paroxysmal positional vertigo in elderly patients and precautions for canalith repositioning procedure treatment

- Department of Otolaryngology-Head and Neck Surgery, Chaoyang Hospital of Beijing, Beijing, 100020, China

More Information

Corresponding author: WANG Ningyu, E-mail: wny@sohu.com

Received Date: 01 December 2014

摘要

摘要: 目的:探讨高龄老年人良性阵发性位置性眩晕(BPPV)的特点及手法复位治疗的注意事项。方法:回顾性分析76例80岁以上高龄老年BPPV患者(高龄组)的资料,并与同期诊治的76例60~65岁老年BPPV患者(老年组)的临床特点进行分析比较。结果:①受累半规管状况:高龄组后半规管受累72例,水平半规管受累4例;老年组后半规管受累70例,水平半规管受累5例,多半规管受累1例;②起病诱因:高龄组起病诱因多样,与情感因素、感染、季节交替、手术、外伤等关系密切,而老年组多与劳累、手术有关,组间差异有统计学意义(P<0.05);③治疗后症状:高龄组复位治疗成功后头沉、头昏症状持续时间与老年组相比,组间差异有统计学意义(P<0.05),平衡障碍持续时间、恶心大汗等植物神经症状持续时间长(均P<0.05);④疗效:首次、二次耳石复位治疗的治愈率、改善率高龄组分别为34.2%、81.6%,老年组分别为76.3%、93.4%;组间疗效比较差异有统计学意义(P<0.05);二次、多次复位2组患者疗效差异无统计学意义(均P>0.05);⑤与伴随疾病的关系:高龄组患者伴发疾病多,存在脑血管病危险,伴发疾病与疗效无显著相关性(P>0.05);⑥手法复位的注意事项:治疗前消除焦虑、恐惧情绪,复位时手法要轻柔,速度可稍缓,用力得当,避免出现副损伤,治疗后加强心理支持;⑦治疗后随访2年,老年组11例(14.5%)复发,高龄组29例(38.2%)复发,复发率组间差异有统计学意义(P<0.05)。结论:高龄老年BPPV患者起病诱因多样,常见诱发因素为精神心理因素、过度疲劳;BPPV初次发作时症状易被已有疾病掩盖,但伴随疾病对BPPV手法复位的疗效无影响;首次复位治疗的疗效差,多次手法复位治疗安全有效;治疗后患者头沉、头昏、平衡障碍持续时间长。
- 良性阵发性位置性眩晕 /
- 高龄 /
- 老年人
Abstract: Objective: To analyze clinical features with benign paroxysmal positional vertigo (BPPV) and discuss the attentions in the canalith repositioning procedures.Method: A total of 76 male and female patients aged 80 and over with BPPV (elderly group) and 76 patients aged 60-65 years old with BPPV (older group) was retrospectively analyzed. Result: ①Semicircular canal condition: in elderly group, posterior semicircular canal was involved in 72 cases, whereas the horizontal semicircular 4 cases. In older group, posterior semicircular canal was involved in 70 cases, whereas the horizontal semicircular and multiple canals in 5 cases and 1 case respectively. ②Precipitating factors: precipitating factors of elderly were variety. It's closely related with emotion, infection, seasonal alternation surgery, and trauma. There were significant differences between the two groups (P<0.05). ③The symptoms of undergoing treatment and post-treatment: the duration of dizziness and carebaria were significant difference after canalith repositioning procedure t reatment between two groups (P<0.05), the duration of balance disturbance and symptoms of vegetative nerve functional disturbance like nausea and sweating were significant difference (P<0.05). ④Treatment and outcomes: the remission, partial remission rate were 34.2 %, 81.6% respectively, after the first or second time of repositioning treatment. The efficacy of repositioning treating at the first time was significantly different between two groups (P<0.05). It was poor efficacy in elderly group. There is no difference in efficacy for repositioning treatment at the second or third time (P>0.05). ⑤The elderly always accompanied with other medical condition and had risk factors of cerebrovascular disease. The efficacy was not associated with the complication(P>0.05). However, it was most likely to overtreatment caused by emphasizing other medical conditions treatment. BPPV was easy to ignore and misdiagnose, meanwhile, delayed the diagnosis and increased the medical costs. ⑥Many elderly were accompanied cervical spondylosis, lumbar spondylosis body stiffness and fear of vertigo which increased the difficulty of repositioning treatment. ⑦Recurrence:we followed up 2 years after treatment. In older group, 11 patients (14.5%)were relapsed. In elderly group,29 patients (38.2%)relapsed. There were significant differences between the two groups (P<0.05).Conclusion: There are various precipitating factors in elderly patients with BPPV, the most frequent precipitating factors were related to psychological factor and overfatigue. The symptoms of the patients attack BPPV was always mask with other diseases, but do not impact on the efficacy of Canalith repositioning at the first time; Even the efficacy of repositioning is poor at the first time, it's effective and safety after multiple treatments of repositioning; It prolonged the symptoms including carenaria, dizziness and nausea after treatment.
- benign paroxysmal positional vertigo /
- misdiagnosis /
- elderly

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参考文献(23)

[1]	BATUECAS-CALETRIO A,TRINIDAD-RUIZ G,ZSCHAEZK C,et al.Benign paroxysmal positional vertigo in the elderly[J].Gerontology,2013,59:408-412.
[2]	VON BREVERN M,RADTKE A,LEZITTS F, et al.Epidemiology of benign paroxysmal positional vertigo:a population based study[J].J Neurol Neurosurg Psychiatry,2007,78:710-715.
[3]	中华医学会耳鼻咽喉-头颈外科编辑委员会,中华医学会耳鼻咽喉科学分会良性阵发性位置性眩晕的诊断依据和疗效评估(2006年,贵阳)[J].中华耳鼻咽喉头颈外科杂志,2007,42(3):163-164.
[4]	黄选兆,汪吉宝,孔维佳.实用耳鼻咽喉头颈外科学[M].北京:人民卫生出版社,2007:1046-1050.
[5]	沈悌. 21世纪我国老年医学发展方向[J].中国实用内科杂志,2011,31(1):6-7.
[6]	张祎,刘博,左丽静,等.良性阵发性位置性眩晕的临床特点[J].中国耳鼻咽喉头颈外科杂志,2010,17(12):646-649.
[7]	黄魏宁,徐进,高波,等.118例老年人眩晕和平衡障碍的病因及其影响因素分析[J].中华流行病学杂志,2005,26(9):720-722.
[8]	张素珍.良性阵发性位置性眩晕的发病机理、临床诊断与治疗[J].继续医学教育,2006,20(1):16-22.
[9]	JANG Y S, HWANG C H, SHIN J Y, et al. Age-related changes on the morphology of the otoconia[J]. Laryngoscope, 2006,116:996-1001.
[10]	DI GIROLAMO S, OTTAVIANI F, SCARANO E, et al. Postural control in horizontal benign paroxysmal positional vertigo[J]. Eur Arch Otorhinolaryngol, 2000, 257:372-375.
[11]	SEOK J I, LEE H M, YOO J H, et al.Residual dizziness after successful repositioning treatment in patients with benign paroxysmal positional vertigo[J].J Clin Neurol,2008, 4:107-110.
[12]	VON BREVERN M, SCHMIDT T, SCHÖNFELD U, et al.Utricular dysfunction in patients with benign paroxysmal positional vertigo[J]. Otol Neurotol, 2006,27:92-96.
[13]	GALL R M, IRELAND D J, ROBERTSON D D. Subjective visual vertical in patients with benign paroxysmal positional vertigo[J]. J Otolaryngol, 1999,28:162-165.
[14]	GODEMANN F, SCHABOWSKA A, NAETEBUSCH B, et al.The impact of cognitions on the development of panic and somatoform disorders:aprospective study in patients with vestibular neuritis[J]. Psychol Med,2006,36:99-108.
[15]	HEINRICHS N, EDLER C, ESKENS S, et al. Predicting continued dizziness after an acute peripheral vestibular disorder[J]. Psychosom Med, 2007,69:700-707.
[16]	DORIGUETO R S,MAZZETTI K R, GABILAN Y P, et al.Benign paroxysmal positional vertigo recurrence and persistence[J].Braz J Otorhinolaryngol,2009, 75:565-572.
[17]	STEENERSON R L, CRONIN G W, MARBACH P M. Effectiveness of treatment techniques in 923 cases of benign paroxysmal positional vertigo[J]. Laryngoscope, 2005, 115:226-231.
[18]	RICHARD W, BRUINTJES T D, OOSTENBRINK P, et al. Efficacy of the Epley maneuver for posterior canal BPPV:a long-term, controlled study of 81 patients[J]. Ear Nose Throat,2005,84:22-25.
[19]	POLLAK L,KUSHNIR M,GOLDBERG H S.Physical inactivity as a contributing factor for onset of idiopathic benign paroxysmal positional vertigo[J].Acta Otolaryngol,2011,131:624-627.
[20]	LEE S H,KIM J S.Benign paroxysmal positional vertigo[J].J Clin Neurol,2010,6:51-63.
[21]	HUGHES C A, PROCTOR L. Benign paroxysmal positional vertigo[J]. Laryngoscope,1997,107:607-613.
[22]	YAKINTHOU A,MAURER J,MANN W.Benign paroxysmal positioning vertigo:diagnosis and therapy using video-oculographic control[J].ORL J Otorhinolaryngol Relat Spec,2003,65:290-294.
[23]	王淑琴,刘德义,高兴斌.高血压病患者血压的季节性变化与气象因素相关性的前瞻性研究[J].中华临床医师杂志(电子版),2011,5(6):1570-1574.