The effectiveness of vestibular rehabilitation in Ménière's disease patients with chronic imbalance
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摘要: 目的 观察前庭康复在梅尼埃病慢性失衡患者中的疗效。方法 入组2020年12月—2021年12月在复旦大学附属眼耳鼻喉科医院眩晕专科门诊就诊的45例梅尼埃病慢性失衡患者，采用随机数表的方法将患者分为试验组(23例)和对照组(22例)。对照组接受门诊常规治疗，试验组在常规治疗的基础上接受为期8周的前庭康复训练。在基线和治疗8周时使用眩晕残障量表(DHI)对所有患者进行评估，计算两组患者的跌倒发生率并记录研究窗口期内的不良事件。结果 两组患者基线资料差异无统计学意义(P>0.05)。研究过程中，有2例患者退出研究，1例患者失访，共42例患者完成试验。对失访患者进行意向性分析。经过8周治疗，两组患者的DHI和DHI-F得分差值的差异有统计学意义(d1=-30.22±3.78，d2=-13.09±4.85，t=-2.799，P < 0.05；d1=-12.43±1.46，d2=-4.55±2.17，t=-3.043，P < 0.05)，DHI-P和DHI-E得分差值的差异无统计学意义(P>0.05)。两组患者的跌倒发生率差异无统计学意义(P>0.05)，但治疗后试验组的跌倒发生率已较治疗前显著下降(4.35% vs 34.78%，χ2=4.973，P < 0.05)。两组均未报告严重不良事件。结论 前庭康复能够改善梅尼埃病慢性失衡患者的平衡功能，降低患者的跌倒风险，值得临床上推广应用。Abstract: Objective To observe the effectiveness of vestibular rehabilitation in Ménière's disease patients with chronic imbalance.Methods Forty-five Ménière's disease patients with chronic imbalance treated in vertigo specialist clinic of Eye and ENT Hospital of Fudan University from December 2020 to December 2021 were enrolled. Patients were divided randomly into two groups, 23 patients in experimental group and 22 patients in control group. Both groups received routine outpatient treatment, and the experimental group received an additional vestibular rehabilitation for 8 weeks. All patients were evaluated with dizziness handicap inventory (DHI) at baseline and 8-week follow-up, and the incidence of fall was calculated. The occurrence of adverse events during the study was also recorded.Results There was no significant difference in baseline data between the two groups (P>0.05). During the study, 1 patient were lost to follow-up and 2 patients dropped out. A total of 42 patients completed the study. Intentionality analysis was performed on lost follow-up patients. After 8 weeks of the treatment, there were significant statistically differences in difference values of DHI and DHI-F scores(d1=-30.22±3.78, d2=-13.09±4.85, t=-2.799, P < 0.05; d1=-12.43±1.46, d2=-4.55±2.17, t=-3.043, P < 0.05), while no significant difference was showed in the difference values of DHI-P and DHI-E scores(P>0.05). There was no significant difference in incidence of fall between two groups(P>0.05), but the incidence of experimental group decreased significantly compared with that before treatment(4.35% vs 34.78%, χ2=4.973, P < 0.05). No serious adverse event was reported in the two groups.Conclusion Vestibular rehabilitation can improve the balance function and reduce risk of fall in Ménière's disease patients with chronic imbalance. Therefore, it is worthy of clinical application.
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Key words:
- vestibular rehabilitation /
- Ménière's disease /
- imbalance /
- vertigo
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表 1 两组患者的人口学特征比较
项目 试验组 对照组 统计量 P值 年龄/岁 57.04±2.23 59.73±2.54 Z=-1.091 0.275 性别 χ2=0.538 0.554 男 14(60.87) 11(50.00) 女 9(39.13) 11(50.00) 病程/月 80.74±21.39 54.68±11.86 Z=-0.924 0.355 病侧 χ2=0.044 0.833 左侧 15(65.22) 15(68.18) 右侧 8(34.78) 7(31.82) 合并疾病 χ2=1.138 0.286 有 11(47.83) 14(63.64) 无 12(52.17) 8(36.36) 
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表 2 治疗前后DHI评分比较
X±S 试验组(n=23) 对照组(n=22) 统计量 P值 DHI 基线 45.57±3.11 45.64±1.98 t=-0.019 0.985 8周 15.35±2.82 35.22±4.82 Z=-2.676 0.007 差值 -30.22±3.78 -13.09±4.85 t=-2.799 0.008 DHI-P 基线 15.35±1.08 18.09±1.11 t=-1.769 0.084 8周 3.91±0.95 10.00±1.65 Z=-2.751 0.006 差值 -11.43±1.42 -8.09±2.13 t=-1.319 0.194 DHI-E 基线 11.04±1.89 9.09±1.20 Z=-0.275 0.783 8周 5.83±1.26 9.00±1.73 Z=-1.460 0.144 差值 -5.22±2.10 -0.09±1.55 t=-1.954 0.057 DHI-F 基线 18.43±1.34 18.27±1.17 t=0.091 0.928 8周 6.00±1.03 13.73±1.83 Z=-3.047 0.002 差值 -12.43±1.46 -4.55±2.17 t=-3.043 0.004
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