山东大学耳鼻喉眼学报 ›› 2018, Vol. 32 ›› Issue (5): 53-57.doi: 10.6040/j.issn.1673-3770.0.2018.036

• ·论著· • 上一篇    下一篇

眼震方向可转换型外侧半规管良性阵发性位置性眩晕35例临床分析

朱梓建,刘强   

  1. 山东中医药大学第二附属医院耳鼻咽喉头颈外科, 山东 济南 250001
  • 收稿日期:2018-01-11 出版日期:2018-09-20 发布日期:2018-09-20
  • 通讯作者: 朱梓建. E-mail:782759857@qq.com

Clinical analysis of 35 cases of lateral semicircular canal benign paroxysmal positional vertigo with transformable-direction eye shock

ZHU Zijian, LIU Qiang   

  1. Department of Otolaryngology Head and Neck Surgery, Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan 250001, Shandong, China
  • Received:2018-01-11 Online:2018-09-20 Published:2018-09-20

HTML

PDF (PC)

311

摘要： 目的 探讨眼震方向可转换型外侧半规管良性阵发性位置性眩晕(LSC- BPPV)患者的临床特点和治疗效果。 方法 回顾性分析2016年1月至2017年6月诊治的35例眼震方向可转换型LSC- BPPV患者(可转换型组)的临床资料并观察手法复位的疗效,与同期治疗的38例眼震方向不变型LSC- BPPV患者(不变型组)进行对比,并追踪随访6个月。患者根据眼震方向及持续时间分别采用Barbecue 翻滚法、Gufoni 法或强迫持续卧位法复位治疗。采用SPSS 19.0对数据进行统计分析。 结果 35例眼震方向可转换型患者中可自动转换型7例,主动可转换型28例,眼震由离地型转为向地型31例,眼震由向地型转为离地型2例,眼震方向反复多次转换型2例,眼震持续时间>1 min者6例、<1 min者29例。38例眼震方向不变型均为向地型,眼震持续时间全部<1 min。可转换型组首次复位有效率为62.86%(22/35),不变型组为86.84%(33/38),两组比较差异有统计学意义(χ2=5.642, P=0.018)。多次复位后有效率分别为91.43%(32/35)和97.37%(37/38),组间比较差异无统计学意义(χ2=1.241, P=0.265 )。可转换型组、不变型组复位成功时所需平均循环次数分别为(2.81±1.21)、(1.56±0.69)次,两组比较差异有统计学意义(t=4.053, P<0.001)。随访6个月后可转换型组与不变型组复发率分别为17.14%和23.68%,两组比较差异无统计学意义(χ2=0.478, P=0.490)。 结论 准确判断受累半规管侧别及耳石类型是诊治眼震方向可转换型LSC- BPPV患者的关键,手法复位治疗可取得较为满意的疗效,但首次复位有效率较眼震方向不变患者低,且复位成功需较多循环次数。

关键词: 眼震, 耳石, 手法复位, 外侧半规管, 眩晕

Abstract: Objective To investigate clinical features of transformable-direction eye shock and to evaluate the efficacy of manual reduction in its treatment in patients with lateral semicircular canal benign paroxysmal positional vertigo(LSC-BPPV). Methods A retrospective analysis was performed on thirty-five transformable-direction eye shock patients with LSC-BPPV(the transformable group)and thirty-eight invariant-direction eye shock patients with LSC-BPPV(the invariant group)from Jan. 2016 to Jul. 2017 in our hospital. The results were compared between these two groups. All patients were followed up for 6 months. Statistical analysis was performed using SPSS 19.0 software. Results The transformable group included 7 cases of spontaneous eye shock and 28 cases of intentional eye shock. Apogeotropic eye shock was changed to geotropic eye shock in 31 patients, and geotropic eye shock was changed to apogeotropic eye shock in 2 patients. Other 2 patients showed transformable-direction eye shock, which was repeated many times. The eye shock duration was more than 1 min in 6 patients,but it was less than 1 min in 29 patients. All patients were administered manual reduction treatment according to the eye shock direction and duration with the Barbecue maneuver, Gufoni maneuver, and forced prolonged position maneuver. The efficacy after the first manual reduction treatment was 62.86%(22/35)in the transformable group and 86.84%(33/38)in the invariant group, and the difference in the treatment efficacy was significant between these two groups(χ2=5.642, P=0.018). Total efficacy was 91.43%(32/35)in the transformable group and 97.37%(37/38)in the invariant group after manual reduction treatment for more than once, and no significant differences in total efficacy were observed between these two groups(χ2=1.241, P=0.265). The number of circulation of first success was 2.81±1.21 in the transformable group and 1.56±0.69 in the invariant group after manual reduction management, and a significant difference was found between these two groups(t=4.053, P=0.000). The recurrence rate was 17.14% in the transformable group and 23.68% in the invariant group at the 6-month follow-up visit, but no significant differences were observed between these two groups(χ2=0.478, P=0.490). Conclusion The key step for successful treatment is to determine which otolith and canal types are accurately affected. The efficacy after the first manual reduction treatment was lower in the transformable group than in the invariant group. More circulation of first success was needed in the manual reduction management. The total efficacy and recurrence rate did not show significant differences between these two groups. Therefore, manual reduction is an effective treatment for transformable-direction eye shock patients with LSC-BPPV.

Key words: Lateral semicircular canal, Manual reduction, Vertigo, Eye shock, Otolith

中图分类号: 

  • R441.2
[1] Bhattacharyya N, Gubbels SP, Schwarts SR, et al. Clinical practice guideline:benign paroxysmal positional vertigo(update)[J]. Otolaryngol Head Neck Surg, 2017, 156(3S):S1-S47.
[2] Parnes LS, Agrawal SK, Atlas J. Diagnosis and management of benign paroxysmal positional vertigo[J]. CMAJ, 2003, 169:681-693.
[3] Moon SY, Kim JS, Kim BK, et al. Clinical characteristics of benign paroxysmal positional vertigo in Korea: a multicenter study[J]. J Korean Med Sci, 2006, 21(3):539-543.
[4] 中华耳鼻咽喉头颈外科杂志编辑委员会,中华医学会耳鼻咽喉头颈外科学分会.良性阵发性位置性眩晕诊断和治疗指南(2017)[J].中华耳鼻咽喉头颈外科杂志, 2017, 52(3):173-177. Editorial Board of Chinese Journal of Otorhinolaryngology Head and Neck Surgery; Society of Otorhinolaryngology Head and Neck Surgery Chinese Medical Association. Guideline of diagnosis and treatment of benign paroxysmal positional vertigo(2017)[J]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi, 2017, 52(3):173-177. doi: 10.3760/cma.j.issn.1673-0860.2017.03.003.
[5] Lempert T. Horizontal benign positional vertigo[J]. Neurology, 1994, 44(11):2213-2214.
[6] Gufoni M, Mastrosimone L, Di Nasso F. Repositioning maneuver in benign paroxysmal vertigo of horizontal semicircular canal[J]. Acta Otorhinolaryngol Ital, 1998, 18(6):363-367.
[7] Asprella LG. Diagnostic and treatment strategy of lateral semicircular canal canalolithiasis[J]. Acta Otorhinolaryngol Ital, 2005, 25(5):277-283.
[8] Schuknecht HF. Cupulolithiasis[J]. Arch Oto-laryngol, 1969, 90:765-778.
[9] Hall SF, Ruby RR, McClure JA. The mechanics of benign paroxysmal vertigo[J]. J Otolaryngol, 1979, 8(2):15l-158.
[10] McClure JA. Horizontal canal BPV[J]. Otolaryngol, 1985,14(1):30-35.
[11] Baloh RW, Yue Q, Jacobson KM, et al. Persistent direction-changing positional nystagmus: another variant of benign positionalnystagmus[J]. Neurology, 1995, 45(7):1297-1301.
[12] Ogawa Y, Ichimura A, Otsuka K, et al. Spontaneous inversion of nystagmus witllout a positional change in the horizontal canal variant of benign paroxysmal positional vertigo[J]. J Vestib Res, 2015, 25(3-4):169-175.
[13] Kim CH. A new method for evaluating lateral semicircular canal cupulopathy[J]. Laryngoscopel, 2015, 125(8):1921-1925.
[14] Oh SY, Kim JS, Jeong SH, et al. Treatment of apogeotropic benign positional vertigo: comparison of therapeutic head-shaking and modified Semont maneuver[J]. J Neurol, 2009, 256(8):1330-1336.
[15] Seok JI, Lee HM, Yoo JH, et al. Residual dizziness after successful repositioning treatment in patient with benign paroxysmal positional vertigo[J]. Clin Neurol, 2008, 4(3):107-110.
[16] Kansu L, Avci S, Yilmaz I, et al. Long-term follow-up of patients with posterior canal benign paroxysmal positional vertigo[J]. Acta oto-laryngologica, 2010, 130(9):1009-1012.
[1] 刘冰,李蓓,张莉,陈敏,张杰. 学龄前和学龄期BPV患儿临床特征比较[J]. 山东大学耳鼻喉眼学报, 2018, 32(5): 58-60.
[2] 侯小兵,任同力,张毅博. 69例梅尼埃病伴耳鸣的发病特点及影响因素[J]. 山东大学耳鼻喉眼学报, 2018, 32(5): 37-40.
[3] 鄢慧琴,王豪. 难治性良性阵发性位置性眩晕的临床分析[J]. 山东大学耳鼻喉眼学报, 2018, 32(3): 86-88.
[4] 李桂芳,王春华,张淑贞. 体位限制对手法复位后良性阵发性位置性眩晕的疗效观察[J]. 山东大学耳鼻喉眼学报, 2017, 31(6): 42-45.
[5] 鞠骏,李进让,邹世桢,贾曼玉. 创伤后良性阵发性位置性眩晕的临床特点及近期疗效研究[J]. 山东大学耳鼻喉眼学报, 2017, 31(5): 57-61.
[6] 刘学升,李筱瑜,邓玮. DHM阴性的非典型PSC-BPPV诊断策略探讨[J]. 山东大学耳鼻喉眼学报, 2017, 31(1): 88-90.
[7] 刘学升,李筱瑜,邓玮. 后半规管良性阵发性位置性眩晕急性发作时的临床表现[J]. 山东大学耳鼻喉眼学报, 2016, 30(6): 11-13.
[8] 张运波,习国平,靳红芳,王彩君. 非手术序列化治疗单侧梅尼埃病48例[J]. 山东大学耳鼻喉眼学报, 2016, 30(3): 73-76.
[9] 陈世琴, 胡金旺. 儿童与成人人工耳蜗植入术并发症比较及处理[J]. 山东大学耳鼻喉眼学报, 2015, 29(5): 25-28.
[10] 尹雪玲. 阻塞性睡眠呼吸暂停低通气综合征患者前庭功能的状态表现[J]. 山东大学耳鼻喉眼学报, 2015, 29(3): 9-12.
[11] 王利一, 高波, 黄魏宁. 耳石症患者复位治疗成功后头晕观察[J]. 山东大学耳鼻喉眼学报, 2014, 28(4): 20-21.
[12] 王学海，张建新，孟昭进，刘秀玲. 上半规管良性阵发性位置性眩晕41例[J]. 山东大学耳鼻喉眼学报, 2014, 28(3): 47-50.
[13] 孙祥1，于亚峰2 . 继发性后半规管良性阵发性位置性眩晕的诊治[J]. 山东大学耳鼻喉眼学报, 2013, 27(5): 22-23.
[14] 王宁宁，李永团. 位置性眩晕的临床诊疗分析[J]. 山东大学耳鼻喉眼学报, 2013, 27(5): 24-27.
[15] 梁志成，覃冠锻，莫炼. 特发性突聋伴眩晕对患者预后的影响[J]. 山东大学耳鼻喉眼学报, 2012, 26(2): 42-43.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
[1] 袁中芳,魏增涛,王晓燕 . 重组内皮抑素抑制兔角膜新生血管的实验研究[J]. 山东大学耳鼻喉眼学报, 2006, 20(6): 552 -554 .
[2] 马翔, 郭敬丽, 王利华. 双眼外直肌后徙术治疗儿童类似分开过强型间歇性外斜视22例[J]. 山东大学耳鼻喉眼学报, 2014, 28(5): 62 -65 .
[3] 张晖萍,张鹏飞,上官翰京,兰书湛 . ABAD/HADH Ⅱ在喉鳞状细胞癌与声带息肉组织中的表达[J]. 山东大学耳鼻喉眼学报, 2006, 20(5): 444 -446 .
[4] 刘衍波，林雯，王秋瑜. 鼻内镜下鼻腔泪囊吻合术38例临床效果分析[J]. 山东大学耳鼻喉眼学报, 2013, 27(6): 61 -62 .
[5] 李东梅1，许安廷1，程想2，张寒冰1，尹海英3，纪彩丽1. 人工耳蜗植入术后听力及言语康复效果相关因素的初步研究[J]. 山东大学耳鼻喉眼学报, 2010, 24(01): 16 -20 .
[6] 张中华1，王学海2，蔡晓岚3. 鼻咽癌中p-PTEN、p-Akt、p-FoxO1的表达及意义[J]. 山东大学耳鼻喉眼学报, 2014, 28(2): 55 -57 .
[7] 刘勃1，张振华2，高爱民3. 探讨鼻腔、鼻窦解剖异常与慢性鼻窦炎的相关性[J]. 山东大学耳鼻喉眼学报, 2012, 26(6): 41 -43 .
[8] 刘俊茹,高英恺,杨杨,王俊菊,刘存军. 低温等离子刀切除舌根增生性肿物40例报告[J]. 山东大学耳鼻喉眼学报, 2017, 31(2): 83 -84 .
网站版权所有 © 2018 《山东大学耳鼻喉眼学报》编辑部　
地址：山东省济南市山大南路27号（250100）电话：+86-0531-88366912 E-mail: ebhxb@sdu.edu.cn
本系统由北京玛格泰克科技发展有限公司设计开发