摘要
目的：探讨高龄老年人良性阵发性位置性眩晕（BPPV）的特点及手法复位治疗的注意事项。方法：回顾性分析76例80岁以上高龄老年BPPV患者（高龄组）的资料,并与同期诊治的76例60~65岁老年BPPV患者（老年组）的临床特点进行分析比较。结果：1受累半规管状况：高龄组后半规管受累72例,水平半规管受累4例;老年组后半规管受累70例,水平半规管受累5例,多半规管受累1例;2起病诱因：高龄组起病诱因多样,与情感因素、感染、季节交替、手术、外伤等关系密切,而老年组多与劳累、手术有关,组间差异有统计学意义（P〈0.05）;3治疗后症状：高龄组复位治疗成功后头沉、头昏症状持续时间与老年组相比,组间差异有统计学意义（P〈0.05）,平衡障碍持续时间、恶心大汗等植物神经症状持续时间长（均P〈0.05）;4疗效：首次、二次耳石复位治疗的治愈率、改善率高龄组分别为34.2%、81.6%,老年组分别为76.3%、93.4%;组间疗效比较差异有统计学意义（P〈0.05）;二次、多次复位2组患者疗效差异无统计学意义（均P〉0.05）;5与伴随疾病的关系：高龄组患者伴发疾病多,存在脑血管病危险,伴发疾病与疗效无显著相关性（P〉0.05）;6手法复位的注意事项：治疗前消除焦虑、恐惧情绪,复位时手法要轻柔,速度可稍缓,用力得当,避免出现副损伤,治疗后加强心理支持;7治疗后随访2年,老年组11例（14.5%）复发,高龄组29例（38.2%）复发,复发率组间差异有统计学意义（P〈0.05）。结论：高龄老年BPPV患者起病诱因多样,常见诱发因素为精神心理因素、过度疲劳;BPPV初次发作时症状易被已有疾病掩盖,但伴随疾病对BPPV手法复位的疗效无影响;首次复位治疗的疗效差,多次手法复位治疗安全有效;治疗后患者头沉、头昏、平衡障碍持续时间长。
Objective：To analyze clinical features with benign paroxysmal positional vertigo （BPPV） and discuss the attentions in the canalith repositioning procedures. Method：A total of 76 male and female patients aged 80 and over with BPPV （elderly group） and 76 patients aged 60--65 years old with BPPV （older group） was retro spectively analyzed. Result： @Semicircular canal condition： in elderly group, posterior semicircular canal was in- volved in 72 cases, whereas the horizontal semicircular 4 cases. In older group, posterior semicircular canal was involved in 70 cases, whereas the horizontal semicircular and multiple canals in 5 cases and 1 case respectively. （1） Precipitating factors： precipitating factors of elderly were variety. It＇s closely related with emotion, infection, seasonal alternation surgery, and trauma. There were significant differences between the two groups （P〈0.05）. （2） The symptoms of undergoing treatment and post treatment： the duration of dizziness and carebaria were significant difference after canalith repositioning procedure treatment between two groups （P〈0.05）, the duration of bal- ance disturbance and symptoms of vegetative nerve functional disturbance like nausea and sweating were significant difference （P〈0.05）. @Treatment and outcomes： the remission, partial remission rate were 34.2 %, 81.6% respectively, after the first or second time of repositioning treatment. The efficacy of repositioning treating at the first time was significantly different between two groups （P〈0.05）. It was poor efficacy in elderly group. There is no difference in efficacy for repositioning treatment at the second or third time （P〈0.05）. @The elderly always accompanied with other medical condition and had risk factors of cerebrovascular disease. The efficacy was not associated with the complication（P〈0.05）. However, it was most likely to overtreatment caused by emphasizing other medical conditions treatment. BPPV was easy to ignore and misdiagn
出处
《临床耳鼻咽喉头颈外科杂志》
CAS
北大核心
2015年第1期12-16,共5页
Journal of Clinical Otorhinolaryngology Head And Neck Surgery
基金
国家自然科学基金资助项目(优先效应中对下丘抑制性调控机制的研究
No:81271090)
关键词
良性阵发性位置性眩晕
高龄
老年人
benign paroxysmal positional vertigo
misdiagnosis
elderly
