摘要
目的:探索前庭康复效果及其影响因素。方法:对2018年12月至2020年10月在复旦大学附属眼耳鼻喉科医院接受前庭康复的患者进行前瞻性随访,康复前后完成一系列前庭功能检查和精神心理状态量表评估。共171例患者纳入研究,其中男性72例,女性99例;年龄10~89岁,中位年龄55岁。主要结局指标采用视觉模拟量表(Visual Analogue Scale,VAS)评估眩晕/头晕和不稳感的严重程度,次要结局指标采用前庭活动与参与量表(Vestibular Activities and Participation measure,VAP)测量患者日常活动与社会参与功能。康复前后的效果比较采用配对t检验,康复结局影响因素分析采用二元Logistic回归。结果:171例患者临床资料完整,规律随访,中位随访时间为11个月。6个月的随访数据显示,康复前后眩晕/头晕VAS评分的差值为(1.79±1.80)分,不稳感VAS评分差值为(1.56±1.76)分,VAP量表活动维度评分的差值为(2.51±4.13)分,VAP量表参与维度评分的差值为(1.27±3.75)分,上述4项指标康复前后比较,差异均有统计学意义(P值均<0.01)。回归分析示:长病程是平衡恢复不佳的显著预测因素(OR=6.52;95%CI:2.10~20.27),视觉依赖(OR=5.44;95%CI:1.38~21.47)和可疑焦虑(OR=6.45;95%CI:1.49~28.30)是导致眩晕/头晕恢复不佳的危险因素。结论:前庭康复可有效减轻晕感,促进平衡,改善日常活动功能;长病程、视觉依赖和可疑焦虑症状是阻碍康复进程的主要因素。
Objective To explore the effect of vestibular rehabilitation and to identify factors that can affect rehabilitation outcomes.Methods From December 2018 to October 2020,patients who underwent vestibular rehabilitation in the Eye,Ear,Nose and Throat Hospital of Fudan University were prospectively followed up.A battery of vestibular function examinations and psychological status evaluations were applied before and after rehabilitation initiation.The main outcomes were vertigo/dizziness and unsteadiness,measured by visual analogue scale(VAS);Secondary outcomes were daily activities and participation,assessed by vestibular activities and participation measure(VAP).Paired t-test was used to compare the effects before and after rehabilitation.Binary logistic regressions were applied to analyze the influencing factors of rehabilitation outcomes.Results A total sample of 171 patients was followed up regularly with a median time of 11 months.Of the 171 patients evaluated,72 were males and 99 were females;age ranged from 10 to 89 years old with a median age of 55 years old.At 6-month follow-up,the difference of VAS score of vertigo/dizziness and unsteadiness pre-post rehabilitation was 1.79±1.80 and 1.56±1.76,respectively;The difference of activity and participation domain of VAP score was 2.51±13 and 1.27±3.75,respectively.All differences pre-post rehabilitation exhibited statistically significant with P values<0.01.Regression analysis demonstrated that the length of symptom onset was a significant predictor of poor balance recovery(OR=6.52;95%CI:2.10,20.27).Visual dependence(OR=5.44;95%CI:1.38,21.47)and suspectable anxiety(OR=6.45;95%CI:1.49,28.30)were identified as risk factors for poor recovery of vertigo/dizziness.Conclusions Vestibular rehabilitation effectively reduces dizziness,promotes balance,and improves the function of daily activities.Time from the onset,visual dependence and suspectable anxiety are the main factors hindering a desirable rehabilitation outcome.
作者
李文妍
吴沛霞
李华伟
Li Wenyan;Wu Peixia;Li Huawei(Center for Vertigo and Balance Disorders,Department of Otorhinolaryngology,ENT Institute,Eye&ENT Hospital of Fudan University,NHC Key Laboratory of Hearing Medicine(Fudan University),Shanghai 200031,China)
出处
《中华耳鼻咽喉头颈外科杂志》
CSCD
北大核心
2022年第3期263-269,共7页
Chinese Journal of Otorhinolaryngology Head and Neck Surgery
基金
国家重大疾病多学科合作诊疗能力建设项目(耳源性眩晕)
上海市科委2018年度“科技创新行动计划”(18411951900)
上海市科委生物医药项目(20S31902400)
上海市卫生健康委员会卫生行业临床研究专项面上项目(201940061)
上海市临床重点专科(shslczdzk00801)。
关键词
前庭康复
眩晕
平衡
前庭功能
风险因素
Vestibular rehabilitation
Vertigo
Balance
Vestibular function
Risk factor
