作　　者： (邢娟丽）; (张婷）; (李延）;

机构地区： 西安交通大学第一附属医院耳鼻咽喉头颈外科,陕西710061

出　　处： 《北京医学》 2017年第8期790-792,共3页

摘　　要： 目的评估手法复位治疗高龄良性阵发性位置性眩晕(BPPV)患者的疗效和风险。方法回顾分析2013年1月至2015年12月我科门诊78例诊断为BPPV的高龄患者(年龄≥80岁),其中58例患者采取了个体化手法复位,后半规管和上半规管BPPV采用改良Epley法,水平半规管BPPV采用Barbecue法或联合乳突震荡法。20例拒绝手法复位的患者采取药物治疗联合前庭康复治疗。两组患者分别作为复位组和对照组,治疗1周后比较治疗效果,9个月后比较两组BPPV复发率。结果治疗1周后,复位组总有效率100%,对照组总有效率10%(P<0.05)。两组均无严重并发症发生。治疗后9个月后内,复位组出现BPPV复发10例(17.2%),对照组有19例(95.0%)其BPPV持续存在或复发。在复位组,经1次复位治愈者其BPPV复发率(9/29,15.5%)明显高于经2次复位治愈者(1/23,4.3%)或≥3次复位治愈者(0/6,0%)(χ~2=7.796,P<0.05)。结论有些高龄BPPV患者虽不适宜常规复位手法,但可采用个体化手法复位治疗,其效果优于药物联合前庭康复治疗,多次手法复位可明显降低BPPV复发率。手法复位方法简单,花费少,安全性较好。 Objective To evaluate the efficacy and risks of repositioning maneuvers in the treatment of benign paroxysmal positional vertigo （BPPV）. Methods A total of 78 patients with BPPV were included, 58 of them were treated with personalized canalith repositioning procedures （CRP group）, including Epley maneuver for posterior or anterior canal BPPV and Barbecue maneuver or mastoid oscillation for lateral canal BPPV; and 20 patients received the combined treatment of medication and vestibular rehabilitation therapy （control group）. Treatment efficacy, safety and recurrence were compared between two groups. Results One week after treatment, resolution of BPPV was obtained in 58 （100%） patients of the CRP group, but only in 2 （10%） patients of the control group, with statistically significant difference. No serious complications occurred in both groups. With 9-month follow-up after treatment, BPPV recurred in 10 （17.2%） cases of the CRP group and 19 （95.0%） cases in the control group presented with persistent or recurrent vertigo, the difference was significant （P 〈 0.05）. In the CRP group, patients treated with single maneuver showed a higher recurrent rate compared with patients treated by CRP for more than 2 maneuvers （P 〈 0.01）. Conclusion Personalized CRP is effective and safe for the treatment of BPPV in patients older than 80 years. The results of this study have shown that it has higher efficacy and lower recurrence than medication plus vestibular rehabilitation therapy.

关 键 词： 高龄老年人 手法复位 良性阵发性位置性眩晕 疗效 风险