【摘要】：目的:通過(guò)對(duì)神經(jīng)內(nèi)科門(mén)診就診的良性陣發(fā)性位置性眩暈(BPPV)的患者進(jìn)行臨床分析,對(duì)其臨床特點(diǎn)進(jìn)行歸納總結(jié),以減少BPPV的漏診以及誤診。方法:收集2016年1月~2016年6月就診于吉林大學(xué)白求恩第一醫(yī)院神經(jīng)內(nèi)科門(mén)診的471例良性陣發(fā)性位置性眩暈的患者,采集患者的相關(guān)信息,如性別、年齡、每次頭暈持續(xù)時(shí)間、發(fā)作頻率、誘因及緩解方式、眩暈發(fā)作距本次就診的時(shí)間、伴隨癥狀、神經(jīng)系統(tǒng)查體、輔助檢查、診斷、復(fù)位治療、治療效果情況等指標(biāo),對(duì)采集的患者資料進(jìn)行臨床分析,并將數(shù)據(jù)資料進(jìn)行統(tǒng)計(jì)學(xué)處理。結(jié)果:(1)就診于吉林大學(xué)第一醫(yī)院門(mén)診并行眩暈檢查的患者1289例,其中診斷為BPPV的患者471例(36.54%)。(2)在BPPV患者中,男女比例為1:2。(3)BPPV患者中年齡最小15歲,最大年齡82歲,平均發(fā)病年齡為53.95歲,發(fā)病人群主要分布在40~69歲,在良性陣發(fā)性位置性眩暈患者中年齡差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。(4)頭暈家族史、高血壓、高血脂、中耳炎病史及頭部外傷史與良性陣發(fā)性位置性眩暈具有相對(duì)獨(dú)立性,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),糖尿病病史對(duì)BPPV的發(fā)病具有統(tǒng)計(jì)學(xué)意義(P0.05)。(5)后半規(guī)管BPPV共348例(73.89%);前半規(guī)管BPPV共10例(2.12%);水平半規(guī)管BPPV共92例(19.53%);混合型BPPV共21例(4.46%)。(6)PC-BPPV患者中抬頭、低頭、起床、躺下體位可誘發(fā)及加重眩暈的患者310例(89.08%);HC-BPPV患者中左側(cè)翻身和(或)右側(cè)翻身時(shí)可誘發(fā)及加重眩暈的患者71例(77.17%);SC-BPPV患者中抬頭、低頭、起床、躺下體位時(shí)眩暈誘發(fā)及加重的患者5例(50.00%)。(7)伴視物旋轉(zhuǎn)416例(88.32%);頭昏脹感,無(wú)視物旋轉(zhuǎn)31例(6.58%);自己晃動(dòng)感8例(1.70%);伴惡心和(或)嘔吐、大汗274例(58.17%)。伴隨癥狀的不同在良性陣發(fā)性位置性眩暈中具有統(tǒng)計(jì)學(xué)意義(P0.05)。(8)眩暈持續(xù)時(shí)間幾秒鐘至1分鐘的患者423例(89.81%);持續(xù)1分鐘至10分鐘的患者31例(6.58%);持續(xù)10分鐘至1小時(shí)的患者7例(1.49%);持續(xù)1小時(shí)以上的患者10例(2.12%)。眩暈持續(xù)時(shí)間的不同在良性陣發(fā)性位置性眩暈中具有統(tǒng)計(jì)學(xué)意義(P0.05)。(9)在本組研究中,給予眩暈藥物治療(包括口服藥物及靜脈點(diǎn)滴藥物)的患者診斷為BPPV的233例(33.72%),未給予藥物治療的眩暈患者診斷為BPPV的238例(39.80%),眩暈藥物的治療對(duì)良性陣發(fā)性位置性眩暈診斷的影響有統(tǒng)計(jì)學(xué)意義(P0.05)。(10)BPPV患者給予復(fù)位治療,總有效率(包括痊愈與好轉(zhuǎn))為94.06%。(11)治療時(shí)距此次發(fā)病時(shí)間的長(zhǎng)短對(duì)復(fù)位治療效果有統(tǒng)計(jì)學(xué)意義。其中治療時(shí)距此次發(fā)病時(shí)間小于1天的患者復(fù)位治療有效的患者占總有效率最高(56.21%)。結(jié)論:在良性陣發(fā)性位置性眩暈(BPPV)患者中男性患者少,女性患者多;40~69歲年齡段患者為BPPV的高發(fā)人群。BPPV的患者中各種類(lèi)型所占的比例由高到低依次為:PC-BPPV、HC-BPPV、混合半規(guī)管型BPPV、SC-BPPV。BPPV患者臨床表現(xiàn)主要為與體位有關(guān)的視物旋轉(zhuǎn),時(shí)間多小于一分鐘,多數(shù)伴有惡心、嘔吐、大汗等。眩暈藥物治療可降低BPPV的檢出率。BPPV患者復(fù)位治療效果較好,且患者越早進(jìn)行診斷與治療效果越好。
[Abstract]:Objective: To summarize the clinical characteristics of benign paroxysmal positional vertigo (BPPV) patients in neurology outpatient clinic in order to reduce the misdiagnosis and missed diagnosis of BPPV. Methods: 471 cases of BPPV patients in neurology outpatient clinic of Bethune First Hospital of Jilin University from January 2016 to June 2016 were collected. Patients with positional vertigo were collected for relevant information, such as gender, age, duration of each dizziness, frequency of attack, inducement and remission, time from the onset of vertigo to this visit, accompanying symptoms, nervous system examination, auxiliary examination, diagnosis, reduction treatment, treatment effect and other indicators. The collected data of patients were clinically scored. Results: (1) Among the 1289 patients who were diagnosed with BPPV, 471 (36.54%) were diagnosed with vertigo. (2) Among the BPPV patients, the male-female ratio was 1:2. (3) The youngest age was 15 years, the oldest age was 82 years, the average age of onset was 53.95 years. The age of patients with benign paroxysmal positional vertigo was significantly different (P 0.05). (4) Family history of dizziness, hypertension, hyperlipidemia, history of otitis media and head trauma were relatively independent of benign paroxysmal positional vertigo, and there was no significant difference (P 0.05). The incidence of BPPV was statistically significant (P 0.05). (5) Posterior semicircular canal BPPV in 348 cases (73.89%), anterior semicircular canal BPPV in 10 cases (2.12%), horizontal semicircular canal BPPV in 92 cases (19.53%) and mixed BPPV in 21 cases (4.46%). (6) PC-BPPV patients in 310 cases (89.08%) PC-BPPV patients, low head, get up, lying down position can induce and aggravate vertigo. And (or) 71 patients (77.17%) with vertigo induced and aggravated by right turn-over; 5 patients (50.00%) with vertigo induced and aggravated by raising head, bowing head, getting up and lying down position in SC-BPPV; (7) 416 patients (88.32%) with visual rotation; 31 patients (6.58%) with dizziness and disorientation rotation; 8 patients (1.70%) with self-shaking feeling; 274 patients (1.70%) with nausea and (or) vomiting and perspiration (8) 423 patients (89.81%) had vertigo lasting from seconds to 1 minute; 31 patients (6.58%) had vertigo lasting from 1 minute to 10 minutes; 7 patients (1.49%) had vertigo lasting from 10 minutes to 1 hour; and 10 patients (2.12%) had vertigo lasting more than 1 hour. The difference of dizziness duration was statistically significant in benign paroxysmal positional vertigo (P The effect of treatment on the diagnosis of benign paroxysmal positional vertigo was statistically significant (P 0.05). (10) The total effective rate (including recovery and improvement) of BPPV patients was 94.06%. (11) The duration of treatment from the onset of the disease had statistical significance on the reduction effect. Among them, the time of treatment was less than one day after the onset of BPPV patients recovered. Conclusion: There are fewer males and more females in BPPV patients, and the 40-69 age group is the high risk group of BPPV. The proportion of BPPV patients is PC-BPPV, HC-BPPV, mixed semicircular BPPV, SC-BPPV. The main clinical manifestations of BPPV patients were posture-related visual rotation, which lasted less than one minute, most of them were accompanied by nausea, vomiting, sweating and so on. Vertigo medication could reduce the detection rate of BPPV. BPPV patients had better reposition effect, and the earlier the patients were diagnosed and treated, the better the effect was.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R741.041

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