神经内科门诊良性阵发性位置性眩晕患者471例临床分析

发布时间：2018-09-06 10:25

【摘要】：目的:通过对神经内科门诊就诊的良性阵发性位置性眩晕(BPPV)的患者进行临床分析,对其临床特点进行归纳总结,以减少BPPV的漏诊以及误诊。方法:收集2016年1月~2016年6月就诊于吉林大学白求恩第一医院神经内科门诊的471例良性阵发性位置性眩晕的患者,采集患者的相关信息,如性别、年龄、每次头晕持续时间、发作频率、诱因及缓解方式、眩晕发作距本次就诊的时间、伴随症状、神经系统查体、辅助检查、诊断、复位治疗、治疗效果情况等指标,对采集的患者资料进行临床分析,并将数据资料进行统计学处理。结果:(1)就诊于吉林大学第一医院门诊并行眩晕检查的患者1289例,其中诊断为BPPV的患者471例(36.54%)。(2)在BPPV患者中,男女比例为1:2。(3)BPPV患者中年龄最小15岁,最大年龄82岁,平均发病年龄为53.95岁,发病人群主要分布在40~69岁,在良性阵发性位置性眩晕患者中年龄差异具有统计学意义(P0.05)。(4)头晕家族史、高血压、高血脂、中耳炎病史及头部外伤史与良性阵发性位置性眩晕具有相对独立性,差异无统计学意义(P0.05),糖尿病病史对BPPV的发病具有统计学意义(P0.05)。(5)后半规管BPPV共348例(73.89%);前半规管BPPV共10例(2.12%);水平半规管BPPV共92例(19.53%);混合型BPPV共21例(4.46%)。(6)PC-BPPV患者中抬头、低头、起床、躺下体位可诱发及加重眩晕的患者310例(89.08%);HC-BPPV患者中左侧翻身和(或)右侧翻身时可诱发及加重眩晕的患者71例(77.17%);SC-BPPV患者中抬头、低头、起床、躺下体位时眩晕诱发及加重的患者5例(50.00%)。(7)伴视物旋转416例(88.32%);头昏胀感,无视物旋转31例(6.58%);自己晃动感8例(1.70%);伴恶心和(或)呕吐、大汗274例(58.17%)。伴随症状的不同在良性阵发性位置性眩晕中具有统计学意义(P0.05)。(8)眩晕持续时间几秒钟至1分钟的患者423例(89.81%);持续1分钟至10分钟的患者31例(6.58%);持续10分钟至1小时的患者7例(1.49%);持续1小时以上的患者10例(2.12%)。眩晕持续时间的不同在良性阵发性位置性眩晕中具有统计学意义(P0.05)。(9)在本组研究中,给予眩晕药物治疗(包括口服药物及静脉点滴药物)的患者诊断为BPPV的233例(33.72%),未给予药物治疗的眩晕患者诊断为BPPV的238例(39.80%),眩晕药物的治疗对良性阵发性位置性眩晕诊断的影响有统计学意义(P0.05)。(10)BPPV患者给予复位治疗,总有效率(包括痊愈与好转)为94.06%。(11)治疗时距此次发病时间的长短对复位治疗效果有统计学意义。其中治疗时距此次发病时间小于1天的患者复位治疗有效的患者占总有效率最高(56.21%)。结论:在良性阵发性位置性眩晕(BPPV)患者中男性患者少,女性患者多;40~69岁年龄段患者为BPPV的高发人群。BPPV的患者中各种类型所占的比例由高到低依次为:PC-BPPV、HC-BPPV、混合半规管型BPPV、SC-BPPV。BPPV患者临床表现主要为与体位有关的视物旋转,时间多小于一分钟,多数伴有恶心、呕吐、大汗等。眩晕药物治疗可降低BPPV的检出率。BPPV患者复位治疗效果较好,且患者越早进行诊断与治疗效果越好。
[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.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R741.041

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