水平半规管良性阵发性位置性眩晕患者82例诊治分析

摘要

目的:探讨水平半规管良性阵发性位置性眩晕(HC-BPPV)患者的临床特征、诊断和治疗.方法:收集HC-BPPV患者82例,登记临床基线资料,分析HC-BPPV临床特征、诊断和治疗.结果:①本组患者以位置性眩晕就诊者62例(75.6%),以位置性头晕就诊者12例(14.6%),以走路不稳就诊者8例(9.8%).②发病至就诊时间间隔:3 d内39例(47.6%),4~7 d 14例(17.1%),7~14 d 9例(11.0%),>14 d 20例(24.4%).③诱因:劳累43例(52.4%),睡眠障碍31例(37.8%),情绪波动10例(12.2%),头外伤6例(7.3%),前驱感染3例(3.7%).④发作持续时间:持续数秒钟16例(19.5%),持续数10 sec~1 min钟35例(42.7%),持续1~2 min 19例(23.2%),持续2~5 min 2例(2.4%),持续时间>5 min 10例(12.2%).⑤前庭双温检查:28例患者存在一侧前庭功能减低,其中22例(78.6%)与受累半规管侧别一致.⑥行Roll试验出现短暂向地性位置性眼震(DCPN)46例(56.1%),持续背地性DCPN 30例(36.6%),持续向地性DCPN 6例(7.3%),其中右侧受累50例(61.0%),左侧受累32例(39.0%).⑦短暂向地性DCPN、持续向地性DCPN与持续背地性DCPN患者手法复位即时痊愈率分别为86.5%(45/52)、0%、73.3%(18/30),1周痊愈率分别为92.3%(48/52)、33.3%(2/6)、80.0%(24/30).结论:HC-BPPV患者手法复位治疗有效,其中短暂向地性和持续背地性HC-BPPV患者手法复位有效率较高,持续向地性DCPN可能存在非耳石机制.%Objectives: To explore the clinical features, diagnosis and treatment of horizontal canal benign paroxysmal positional vertigo (HC-BPPV). Methods: A total of 82 consecutive HC-BPPV patients were enrolled.The clinical baseline data of the patients were registered to analyze the clinical features,diagnosis and treatment of HC-BPPV patients.Results:①Of the 82 HC-BPPV patients,62(75.6%)were positional vertigo, 12(14.6%)were positional dizziness,and 8(9.8%)were walking unsteady.②Onset-to-visit intervals:39 cases (47.6%)within 3 days,14 cases(17.1%)in 4~7 days,9 cases(11.0%)in 7~14 days,20 cases over 14 days (24.4%).③Inducements:43 cases(52.4%)had fatigue,31 cases(37.8%)had sleep disorders,10 cases(12.2%) had emotional agitation,6 cases(7.3%)had head injuries,and 3 cases(3.7%)had precursor infection.④Attack duration:16 patients(19.5%)lasted for several seconds,35 patients(42.7%)lasted for 10 seconds to 1 minute, and 19 patients(23.2%)lasted for 1 to 2 minutes,2 patients lasted for 2 to 5 minutes and 10 patients(12.2%) lasted for more than 5 minutes. ⑤Vestibular function examination: 28 cases (35.0%) had unilateral peripheral vestibular dysfunction,22(78.6%)were consistent with the side of the affected semicircular canal.⑥In the Roll test, there were 46 cases (56.1%) had transient geotropic direction-changing positional nystagmus (DCPN), 6 cases (7.3%) had persistent geotropic DCPN, and 30 cases (36.6%) had persistent apogeotropic DCPN. Fifty cases (61.0%) were affected on the right side and 32 cases (39.0%) on the left side. ⑦The instantaneous cure rates for patients with transient DCPN, continuous DCPN, and persistent DCPN was 86.5% (45/52), 0%, and 73.3%(18/30),respectively.The recovery rate was 92.3%(48/52),33.3%(2/6),and 80.0%(24/30)respectively after 1 week. Conclusion: Repositioning maneuver is an effective way to treat patients with HC-BPPV, especially for the transient geotropic HC-BPPV and persistent apogeotropic HC-BPPV. Non-otolith mechanism may exist in persistent geotropic DCPN.