周围性眩晕患者心身状况分析及偏头痛性眩晕的预防性治疗研究

发布时间：2018-10-26 18:18

【摘要】：目的:1)观察偏头痛患者的神经耳科学改变,探讨偏头痛与眩晕、耳鸣、听力下降的关系;2)量化了解常见周围性眩晕患者焦虑及抑郁情绪障碍状况;3)探讨盐酸氟桂利嗪在偏头痛性眩晕(migrainous vertigo MV)预防性治疗中的有效性及安全性。方法:1)回顾性总结321例偏头痛患者的神经耳科学表现,并将其按有无眩晕分成伴眩晕组和不伴眩晕组。所有存在与偏头痛相关的耳部症状的患者进行纯音测听、听性脑干反应及耳鸣匹配检查,所有存在与偏头痛相关的眩晕患者行前庭功能检查。2)收集四种常见的周围性眩晕疾病患者129人,其中良性阵发性位置性眩晕(benign paroxysmal positional vertigo(BPPV)患者49人,偏头痛性眩晕(migrainous vertigo MV)患者37人,梅尼埃病(Menière’s disease MD)患者28人,前庭神经炎(vestibular neuritis VN)患者15人,所有患者均进行细致的耳科查体及神经耳科学检查及焦虑/抑郁自评量表的心理评估测试;3)筛选需要进行预防性治疗的MV患者,将同意参与试验的患者随机分为甲、乙两组,建议所有患者进行生活方式的改变,甲组给予盐酸氟桂利嗪10毫克每日睡前口服+在眩晕发作时口服甲磺酸倍他司汀片12毫克一日三次,持续用药48小时;乙组仅在眩晕发作时口服甲磺酸倍他司汀片12毫克一日三次,持续用药48小时。治疗开始及治疗3个月后分别记录患者3个月眩晕发作次数、累计发作天数、眩晕发作强度,并对比两组不同方案对患者上述三项指标的影响,并纪录不良事件发生情况。结果:1)25.5%(82/321)的偏头痛患者伴有眩晕,7.5%(24/321)的患者有耳鸣症状,2.8%(9/321)的患者自觉听力下降,8.4%(27/321)的患者纯音测听异常,9.0%(29/321)的患者听性脑干反应异常(表现为各波绝对潜伏期延长和或波间期延长)。对比两组耳鸣发生率、纯音测听、听性脑干异常率,有显著性差异。2)根据前庭功能检查结果将所有患者分为前庭功能正常组和前庭功能异常组,两组之间焦虑/抑郁状态的发生概率差异无统计学意义(P0.05)。在四组患者中,MV和MD组患者伴发焦虑(MV=45.9%,MD=50%)和抑郁(MV=27%MD=28.6%)状态的发生率明显高于BPPV和VN组患者;3)23名MV患者经治疗3个月后,两组患者的累计眩晕发作次数均减少(P0.05),累计眩晕天数均减少(P0.05),眩晕发作强度均减轻(P0.05);与乙组相比,使用氟桂利嗪的甲组能更有效减少患者眩晕发作次数(P=0.0100.05),但在减少累计发作天数、眩晕发作强度的影响与乙组相近(P0.05)。未发现严重不良事件。结论:1)伴随眩晕的偏头痛患者更易出现前庭耳蜗症状,本文旨在加深耳鼻喉科医生对偏头痛在耳蜗及前庭器官上所产生的影响的认识,从而对其在接诊偏头痛患者时做出更加精准的评估、诊断提供帮助。2)焦虑/抑郁评分的高低与前庭功能正常与否无关。在常见的周围性眩晕疾病中,MV和MD患者最易伴发焦虑/抑郁状态,分析其可能的原因为不同疾病其症状发生的机制不同及患者对眩晕发作的预防和控制能力不同。总之,对于复杂的难治性的眩晕患者尤其MV和MD患者给予心理测试,及时发现心理问题,跨学科联合心理干预治疗是非常必要的。3)氟桂利嗪是一种安全有效的MV预防性治疗药物。
[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.
【学位授予单位】：新疆医科大学
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R747.2

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