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良性阵发性位置性眩晕成功手法复位后短期残余头晕的影响因素分析 |
姜春燕1,2, 赵颖1, 王璐1,2, 舒良1, 吴菁1, 孙旭红1, 潘辉1, 董幼镕1, 陈伟1, 刘建仁1
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1.上海交通大学医学院附属第九人民医院神经内科, 上海 200011;2.上海交通大学医学院附属第九人民医院黄浦分院神经内科, 上海 200011
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摘要: |
目的: 探讨良性阵发性位置性眩晕(benign paroxysmal positional vertigo,BPPV)患者成功手法复位后1周残余头晕(residual dizziness,RD)的发生情况及相关危险因素。方法: 对2018年6月至2019年6月在上海交通大学医学院附属第九人民医院首次就诊成功手法复位的223例BPPV患者进行为期1周的随访,在首诊(W0)及手法复位后1周(W1)时进行眩晕/头晕视觉模拟量表(VAS)、头晕残障量表(DHI)评估,并在W0行GAD-7、PHQ-9、HAMA及HAMD-17等神经心理学量表评估。W1时头晕VAS评分大于1分判定为存在RD。比较伴有及不伴有RD组之间人口学及临床指标的差异,调查成功手法复位后患者短期生活质量的影响因素。结果: 成功手法复位的BPPV患者1周时RD的发生率为50.67%(113/223)。伴有RD组首诊时头晕残障量表(DHI)评分明显高于不伴有RD组(P=0.009),差异主要体现在功能性分值(DHI-F)[(17.38±8.67)vs(14.91±9.39),P=0.044]和情绪性分值(DHI-E)[4(2,11.5)vs 4(0,8),P=0.013],而年龄、性别、眩晕持续时间,焦虑抑郁评分在2组间差异无统计学意义。多因素logistic回归分析发现,首诊时DHI评分>30分(OR=2.149,95% CI 1.257~3.673,P=0.005)是RD的独立预测因素。线性回归发现,RD是BPPV患者成功手法复位后1周时生活质量的主要影响因素(95% CI 10.346~16.661,P<0.001)。结论: 近一半的BPPV患者成功手法复位后1周存在RD,首诊时DHI总分大于30分可作为手法复位后短期RD的预测因子。 |
关键词: 良性阵发性位置性眩晕 残余头晕 头晕残障量表 |
DOI:10.12025/j.issn.1008-6358.2020.20200182 |
分类号:R441.2 |
基金项目:国家自然科学基金(81401039),上海市科学技术委员会医学引导类科技支撑项目(17411964000),上海市浦江人才计划(18PJD023). |
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Analysis of influence factors of short-term residual dizziness after successful repositioning treatment in patients with benign paroxysmal positional vertigo |
JIANG Chun-yan1,2, ZHAO Ying1, WANG Lu1,2, SHU Liang1, WU Jing1, SUN Xu-hong1, PAN Hui1, DONG You-rong1, CHEN Wei1, LIU Jian-ren1
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1.Department of Neurology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China;2.Department of Neurology, Huangpu Branch, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
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Abstract: |
Objective: To investigate the occurrence and risk factors of residual dizziness (RD) in patients with benign paroxysmal positional vertigo (BPPV) 1 week after successful canalith repositioning procedure (CRP).Methods: Totally, 223 patients with BPPV who received successful CRP in the first visit in Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine from June 2018 to June 2019 were followed up for 1 week. At the first diagnosis (W0) and one week (W1), vertigo/dizziness visual analogue scale (VAS) and dizziness handicap inventory (DHI) were evaluated, and GAD-7, PHQ-9, HAMA, and HAMD-17 were evaluated at W0. RD was defined as the dizziness VAS score >1 at W1. The baseline (W0) demographic and related clinical differences between patients with and without RD groups were compared, and the influencing factors of patients' short-term quality of life were investigated.Results: The incidence of RD was 50.67% (113/223) in BPPV patients one week (W1) after successful CRP. Compared with RD negative group, patients with RD positive group had a higher dizziness handicap inventory (DHI) score at W0 (P=0.009), among which functional score (DHI-F)([17.38±8.67] vs[14.91±9.39], P=0.044) and emotional score (DHI-E)(4[2,11.5] vs 4[0,8], P=0.013) were significantly increased. There was no significant difference in age, gender, vertigo duration, involved semicircular canal, anxiety and depression scores between the two groups. Binary logistic regression analysis found that the DHI score >30 (OR=2.149, 95%CI 1.257-3.673, P=0.005) at W0 was an independent predictor of RD in patients with BPPV at 1 week. Stepwise linear regression showed that RD was the main factor influencing the quality of life in patients with BPPV 1 week after successful CRP (95% CI 10.346-16.661, P<0.001).Conclusions: Nearly half of BPPV patients has RD 1 week after successful CRP. The DHI score >30 at the first diagnosis might increase the risk of short-term RD. |
Key words: benign paroxysmal positional vertigo residual dizziness dizziness handicap inventory |