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摘要: 目的:分析继发性良性阵发性位置性眩晕(BPPV)的临床特征,为其精准诊治提供依据。方法:与BPPV相关的眩晕患者942例,其中原发性BPPV 204例,前庭性偏头痛(VM)592例、梅尼埃病(MD)83例、前庭神经炎(VN)48例、突发性聋(SSNHL)伴眩晕15例。继发于MD、VN、VM、SSNHL伴眩晕的BPPV患者127例。所有患者均在详细询问病史的基础上经手法或仪器进行BPPV诊断及复位治疗,继发性BPPV患者同时按原发疾病的诊治原则进行处置。统计各相关疾病继发BPPV的发生率,比较其与原发性BPPV在性别、年龄、受累半规管、复位次数、眩晕控制率上的差异。结果:①MD、VN、SSNHL伴眩晕、VM继发BPPV的发生率分别为36.1%(30/83)、35.4%(17/48)、33.3%(5/15)和12.7%(75/592)。②继发于MD的BPPV,多半规管受累占比高于原发性BPPV,差异有统计学意义(P<0.05),其余疾病之间受累半规管分布无明显差异。③继发于MD、VM的BPPV眩晕控制率低于原发性BPPV,差异有统计学意义(P<0.05)。④继发于VM (2.88±2.32)和MD (2.53±1.14)的BPPV平均复位次数大于原发性BPPV (2.37±1.77),差异有统计学意义(P<0.05),其他继发性BPPV与原发性BPPV相比平均复位次数无显著性差异。结论:继发性BPPV的常见原因有MD、VN、SSNHL伴眩晕、VM;与原发性BPPV一样,女性多见、后半规管发病率最高;继发于MD的BPPV较原发性BPPV更易发生多半规管受累。详询病史结合针对性的检查有利于BPPV的精准诊断;继发性BPPV也可通过手法或仪器诊疗,但疗效较原发性BPPV差;继发性BPPV除了复位治疗外还需按原发病的治疗原则处置。Abstract: Objective:To analyze the clinical features of secondary benign paroxysmal positional vertigo (BPPV) and provide evidence for its precise diagnosis and treatment.Method:There were 942 patients with vertigo related to BPPV, including 204 patients with primary BPPV, 592 patients with vestibular migraine (VM), 83 patients with Meniere's disease (MD), 48 patients with vestibular neuronitis (VN), and 15 patients with sudden sensorineural hearing loss (SSNHL) accompanied by vertigo.There were 127 patients with BPPV secondary to vertigo in MD, VN, VM, and SSNHL.All patients received otolith repositioning treatment by hand or instrument based on detailed medical history.Secondary BPPV patients are treated according to the principle of diagnosis and treatment of primary BPPV.The incidence of secondary BPPV in each related disease was counted, and the difference between primary and secondary BPPV in gender, age, affected semicircular canal, number of reductions, and vertigo control rate was compared.Result:①The incidence of MD, VN, sudden vertigo, and VM secondary BPPV were 36.1% (30/83), 35.4% (17/48), 33.3% (5/15), and 12.7% (75/592).②In patients with BPPV secondary to MD, the proportion of multi-semicircular canals involved was higher than that of primary BPPV, the difference was statistically significant (P<0.05), and there was no significant difference in the distribution of semicircular canals involved among the remaining diseases.③The vertigo control rate of BPPV secondary to MD and VM was lower than that of primary BPPV, and the difference was statistically significant (P<0.05).④The repositioning time of BPPV secondary to VM (2.88±2.32) and MD (2.53±1.14) was higher than that of primary BPPV (2.37±1.77).The difference was statistically significant (P<0.05).There was no significant difference in the repositioning time between other secondary BPPV and primary BPPV.Conclusion:Common causes of secondary BPPV include MD, VN, SSNHL, and VM.Same as primary BPPV, the secondary BPPV was more common in women and the posterior semicircular canal was most affected.BPPV secondary to MD is more susceptible to multi-semicircular canals involvement than primary BPPV.Detailed medical history combined with targeted examination is conducive to the accurate diagnosis of BPPV.Secondary BPPV can also be treated by manipulation or instrument, however, the effect is worse than primary BPPV.Secondary BPPV should be treated according to the treatment principle of primary disease besides otolith repositioning.
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Key words:
- vertigo /
- Meniere's disease /
- vestibular neuronitis /
- deafness /
- sudden /
- vestibular migraine
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