周圍性眩暈患者心身狀況分析及偏頭痛性眩暈的預(yù)防性治療研究
發(fā)布時(shí)間：2018-10-26 18:18
【摘要】：目的:1)觀察偏頭痛患者的神經(jīng)耳科學(xué)改變,探討偏頭痛與眩暈、耳鳴、聽力下降的關(guān)系;2)量化了解常見周圍性眩暈患者焦慮及抑郁情緒障礙狀況;3)探討鹽酸氟桂利嗪在偏頭痛性眩暈(migrainous vertigo MV)預(yù)防性治療中的有效性及安全性。方法:1)回顧性總結(jié)321例偏頭痛患者的神經(jīng)耳科學(xué)表現(xiàn),并將其按有無眩暈分成伴眩暈組和不伴眩暈組。所有存在與偏頭痛相關(guān)的耳部癥狀的患者進(jìn)行純音測聽、聽性腦干反應(yīng)及耳鳴匹配檢查,所有存在與偏頭痛相關(guān)的眩暈患者行前庭功能檢查。2)收集四種常見的周圍性眩暈疾病患者129人,其中良性陣發(fā)性位置性眩暈(benign paroxysmal positional vertigo(BPPV)患者49人,偏頭痛性眩暈(migrainous vertigo MV)患者37人,梅尼埃病(Menière’s disease MD)患者28人,前庭神經(jīng)炎(vestibular neuritis VN)患者15人,所有患者均進(jìn)行細(xì)致的耳科查體及神經(jīng)耳科學(xué)檢查及焦慮/抑郁自評(píng)量表的心理評(píng)估測試;3)篩選需要進(jìn)行預(yù)防性治療的MV患者,將同意參與試驗(yàn)的患者隨機(jī)分為甲、乙兩組,建議所有患者進(jìn)行生活方式的改變,甲組給予鹽酸氟桂利嗪10毫克每日睡前口服+在眩暈發(fā)作時(shí)口服甲磺酸倍他司汀片12毫克一日三次,持續(xù)用藥48小時(shí);乙組僅在眩暈發(fā)作時(shí)口服甲磺酸倍他司汀片12毫克一日三次,持續(xù)用藥48小時(shí)。治療開始及治療3個(gè)月后分別記錄患者3個(gè)月眩暈發(fā)作次數(shù)、累計(jì)發(fā)作天數(shù)、眩暈發(fā)作強(qiáng)度,并對(duì)比兩組不同方案對(duì)患者上述三項(xiàng)指標(biāo)的影響,并紀(jì)錄不良事件發(fā)生情況。結(jié)果:1)25.5%(82/321)的偏頭痛患者伴有眩暈,7.5%(24/321)的患者有耳鳴癥狀,2.8%(9/321)的患者自覺聽力下降,8.4%(27/321)的患者純音測聽異常,9.0%(29/321)的患者聽性腦干反應(yīng)異常(表現(xiàn)為各波絕對(duì)潛伏期延長和或波間期延長)。對(duì)比兩組耳鳴發(fā)生率、純音測聽、聽性腦干異常率,有顯著性差異。2)根據(jù)前庭功能檢查結(jié)果將所有患者分為前庭功能正常組和前庭功能異常組,兩組之間焦慮/抑郁狀態(tài)的發(fā)生概率差異無統(tǒng)計(jì)學(xué)意義(P0.05)。在四組患者中,MV和MD組患者伴發(fā)焦慮(MV=45.9%,MD=50%)和抑郁(MV=27%MD=28.6%)狀態(tài)的發(fā)生率明顯高于BPPV和VN組患者;3)23名MV患者經(jīng)治療3個(gè)月后,兩組患者的累計(jì)眩暈發(fā)作次數(shù)均減少(P0.05),累計(jì)眩暈天數(shù)均減少(P0.05),眩暈發(fā)作強(qiáng)度均減輕(P0.05);與乙組相比,使用氟桂利嗪的甲組能更有效減少患者眩暈發(fā)作次數(shù)(P=0.0100.05),但在減少累計(jì)發(fā)作天數(shù)、眩暈發(fā)作強(qiáng)度的影響與乙組相近(P0.05)。未發(fā)現(xiàn)嚴(yán)重不良事件。結(jié)論:1)伴隨眩暈的偏頭痛患者更易出現(xiàn)前庭耳蝸癥狀,本文旨在加深耳鼻喉科醫(yī)生對(duì)偏頭痛在耳蝸及前庭器官上所產(chǎn)生的影響的認(rèn)識(shí),從而對(duì)其在接診偏頭痛患者時(shí)做出更加精準(zhǔn)的評(píng)估、診斷提供幫助。2)焦慮/抑郁評(píng)分的高低與前庭功能正常與否無關(guān)。在常見的周圍性眩暈疾病中,MV和MD患者最易伴發(fā)焦慮/抑郁狀態(tài),分析其可能的原因?yàn)椴煌膊∑浒Y狀發(fā)生的機(jī)制不同及患者對(duì)眩暈發(fā)作的預(yù)防和控制能力不同�？傊�,對(duì)于復(fù)雜的難治性的眩暈患者尤其MV和MD患者給予心理測試,及時(shí)發(fā)現(xiàn)心理問題,跨學(xué)科聯(lián)合心理干預(yù)治療是非常必要的。3)氟桂利嗪是一種安全有效的MV預(yù)防性治療藥物。
[Abstract]:Objective: 1) To observe the changes of nerve ear science in patients with migraine, to explore the relationship between migraine and vertigo, tinnitus and hearing loss. 3) To study the efficacy and safety of fluorethyl hydrochloride in prophylactic treatment of migraine vertigo (MV). Methods: 1) 321 patients with migraine were retrospectively reviewed, and their vertigo was divided into vertigo group and vertigo group without vertigo. all patients with ear symptoms associated with migraine were examined for hearing, auditory brainstem response, and tinnitus matching examinations, all patients with vertigo associated with migraine were subjected to vestibular function tests. 2) There were 129 patients who collected four common peripheral vertigo disorders, Among them, there were 49 patients with benign paroxysmal positional vertigo (BPPV), 37 patients with migraine vertigo (MV), 28 patients in Meni Sucre's disease MD and 15 patients with vestibular neuritis (VN). All patients were subjected to the psychological assessment and testing of the meticulous ear examination body and the nerve ear science examination and the anxiety/ depression self-rating scale; 3) MV patients who needed preventive treatment were screened, and the patients who agreed to participate in the trial were randomly divided into groups A and B, It is suggested that all patients will change their way of life, and the group A will give a dose of 10 mg/ day to take orally a dose of 12 mg/ day of the statin tablets for 48 hours before the onset of vertigo. Group B orally ate twice the statin tablets 12 mg once a day for 48 hours only at the onset of vertigo. Three months after the start and treatment of treatment, the number of vertigo episodes, the number of cumulative episodes, the intensity of vertigo attack were recorded, and the effects of two groups of different regimens on the above three indexes were compared, and the occurrence of adverse events was recorded. Results: 1) 25. 5% (82/ 321) patients with migraine with vertigo, 7. 5% (24/ 321) had tinnitus symptoms, 2. 8% (9/ 321) patients had a conscious hearing loss, 8. 4% (27/ 321) had abnormal auditory brainstem response abnormality, and 94.0% (29/ 321) had abnormal auditory brainstem response (manifested as prolongation of the absolute latency of each wave and prolongation of the wave interval). Compared with the two groups, the incidence of tinnitus, hearing and auditory brainstem abnormality were significantly different. 2) All patients were divided into vestibular function normal group and vestibular function abnormality group according to the result of vestibular function examination. There was no significant difference in the probability of anxiety/ depression between the two groups (P0.05). Among the four groups, the incidence of anxiety (MV = 45. 9%, MD = 50%) and depression (MV = 27% MD = 28. 6%) in MV and MD patients was significantly higher than those of BPPV and VN group (P <0.05). The number of patients with vertigo decreased (P <0.05), and the intensity of vertigo attack was reduced (P <0.05). Compared with group B, the number of patients with vertigo (P = 0.0100. 05) could be reduced more effectively compared with group B (P = 0.0100. 05). However, the effect of vertigo attack intensity was similar to that of group B (P0.05). No serious adverse events were noted. Conclusion: 1) The symptoms of vestibular cochlea appear more easily in patients with migraine accompanied with vertigo. The aim of this paper is to deepen the understanding of the effect of otolaryngology on the cochlea and vestibular organ, so as to make a more accurate assessment of patients with migraine. Diagnostic aid. 2) The level of anxiety/ depression score is independent of the normal vestibular function. Among the common peripheral vertigo diseases, the patients with MV and MD are most likely to have anxiety/ depression status, and analyze the possible causes of different symptoms of different diseases, and the prevention and control ability of patients with vertigo is different. In summary, it is necessary for patients with complicated and refractory vertigo, especially MV and MD, to provide psychological test, find out psychological problems in time, and interdiscipline combined psychological intervention is very necessary.
【學(xué)位授予單位】：新疆醫(yī)科大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2015
【分類號(hào)】：R747.2
本文編號(hào)：2296567
[Abstract]:Objective: 1) To observe the changes of nerve ear science in patients with migraine, to explore the relationship between migraine and vertigo, tinnitus and hearing loss. 3) To study the efficacy and safety of fluorethyl hydrochloride in prophylactic treatment of migraine vertigo (MV). Methods: 1) 321 patients with migraine were retrospectively reviewed, and their vertigo was divided into vertigo group and vertigo group without vertigo. all patients with ear symptoms associated with migraine were examined for hearing, auditory brainstem response, and tinnitus matching examinations, all patients with vertigo associated with migraine were subjected to vestibular function tests. 2) There were 129 patients who collected four common peripheral vertigo disorders, Among them, there were 49 patients with benign paroxysmal positional vertigo (BPPV), 37 patients with migraine vertigo (MV), 28 patients in Meni Sucre's disease MD and 15 patients with vestibular neuritis (VN). All patients were subjected to the psychological assessment and testing of the meticulous ear examination body and the nerve ear science examination and the anxiety/ depression self-rating scale; 3) MV patients who needed preventive treatment were screened, and the patients who agreed to participate in the trial were randomly divided into groups A and B, It is suggested that all patients will change their way of life, and the group A will give a dose of 10 mg/ day to take orally a dose of 12 mg/ day of the statin tablets for 48 hours before the onset of vertigo. Group B orally ate twice the statin tablets 12 mg once a day for 48 hours only at the onset of vertigo. Three months after the start and treatment of treatment, the number of vertigo episodes, the number of cumulative episodes, the intensity of vertigo attack were recorded, and the effects of two groups of different regimens on the above three indexes were compared, and the occurrence of adverse events was recorded. Results: 1) 25. 5% (82/ 321) patients with migraine with vertigo, 7. 5% (24/ 321) had tinnitus symptoms, 2. 8% (9/ 321) patients had a conscious hearing loss, 8. 4% (27/ 321) had abnormal auditory brainstem response abnormality, and 94.0% (29/ 321) had abnormal auditory brainstem response (manifested as prolongation of the absolute latency of each wave and prolongation of the wave interval). Compared with the two groups, the incidence of tinnitus, hearing and auditory brainstem abnormality were significantly different. 2) All patients were divided into vestibular function normal group and vestibular function abnormality group according to the result of vestibular function examination. There was no significant difference in the probability of anxiety/ depression between the two groups (P0.05). Among the four groups, the incidence of anxiety (MV = 45. 9%, MD = 50%) and depression (MV = 27% MD = 28. 6%) in MV and MD patients was significantly higher than those of BPPV and VN group (P <0.05). The number of patients with vertigo decreased (P <0.05), and the intensity of vertigo attack was reduced (P <0.05). Compared with group B, the number of patients with vertigo (P = 0.0100. 05) could be reduced more effectively compared with group B (P = 0.0100. 05). However, the effect of vertigo attack intensity was similar to that of group B (P0.05). No serious adverse events were noted. Conclusion: 1) The symptoms of vestibular cochlea appear more easily in patients with migraine accompanied with vertigo. The aim of this paper is to deepen the understanding of the effect of otolaryngology on the cochlea and vestibular organ, so as to make a more accurate assessment of patients with migraine. Diagnostic aid. 2) The level of anxiety/ depression score is independent of the normal vestibular function. Among the common peripheral vertigo diseases, the patients with MV and MD are most likely to have anxiety/ depression status, and analyze the possible causes of different symptoms of different diseases, and the prevention and control ability of patients with vertigo is different. In summary, it is necessary for patients with complicated and refractory vertigo, especially MV and MD, to provide psychological test, find out psychological problems in time, and interdiscipline combined psychological intervention is very necessary.
【學(xué)位授予單位】：新疆醫(yī)科大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2015
【分類號(hào)】：R747.2
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