【作者】 郭海峰；

【导师】 陈嘉峰；

【作者基本信息】 吉林大学 ， 临床医学硕士（专业学位）， 2018， 硕士

【摘要】 目的:通过对神经内科门诊就诊的非典型良性阵发性位置性眩晕(benign paroxysmal positional vertigo,BPPV)的患者进行数据收集,对其临床特征进行分析,提高对非典型BPPV的认识,降低误诊率。材料和方法:收集2017年6月~12月就诊于吉林大学第一医院神经内科门诊诊断为非典型BPPV患者47例,收集性别、年龄、药物使用、眩晕发作持续时间、发病距离就诊时间、伴随症状、既往史、家族史、治疗效果等。结果:1、就诊患者中诊断为BPPV的共568例,非典型BPPV患者共47例,占8.3%。2、非典型BPPV患者中,男性患者共12例,女性患者共35例,男女比例接近1:3。3、从年龄组成来看,最小年龄27岁,最大年龄78岁,平均年龄55.2岁。年龄在60~69岁的患者所占比例最大。在非典型BPPV患者中,与典型BPPV组比较,各年龄组无统计学意义(p>0.05)。4、本研究发现糖尿病病史、耳部疾病及外伤史对非典型BPPV有统计学意义(p<0.05)。家族史、高血压病史无统计学意义(p>0.05)。5、在典型BPPV患者中,持续几秒钟到1分钟的患者占480例;1分钟到10分钟的患者41例。在非典型BPPV患者中,持续几秒钟到1分钟的患者占39例,1分钟到10分钟的患者8例。眩晕持续时间对非典型BPPV的诊断具有统计学意义(p<0.05)。6、诊断为BPPV的患者中,共有292例患者使用药物(包括口服、静脉输液药物)治疗,未给与药物治疗的患者276例。其中典型BPPV患者中给予药物治疗的患者275例,未给予药物治疗的患者246例,非典型BPPV患者中给予药物治疗的患者17例,未给与药物治疗的患者30例。药物治疗(如甲磺酸倍他司汀)对非典型BPPV的诊断具有统计学意义(p<0.05)。7、在统计到47例非典型BPPV患者中,主诉症状典型、不伴有眼震的非典型BPPV共有17例,主诉症状不典型、伴有位置性眼震的患者共有6例,主诉症状典型、伴有位置性眼震的患者24例,其中4例考虑水平嵴帽耳石症;4例患者考虑多管耳石症;16例患者发病时主诉症状可能半规管与实际发病半规管不一致,其中11例患者根据首发体位考虑为后半规管耳石,实际发病为水平半规管,5例患者根据首发体位考虑水平半规管耳石,实际发病半规管位于后半规管。8、在47例非典型BPPV患者中,复位治疗好转或痊愈的患者共计33例,复位治疗有效率70.2%,较典型BPPV患者低。各类型非典型BPPV患者的不同对复位治疗有统计学意义(p<0.05),其中主诉症状不典型、伴有位置性眼震复位治疗有效占比最大,不伴有位置性眼震的BPPV患者复位治疗无效比例最大。9、发病距离就诊时间的长短对非典型BPPV复位治疗无统计学意义(p>0.05)。结论:1、非典型BPPV患者女性多于男性,女性发病率较典型BPPV高。各年龄组对其发病率无影响。2、非典型BPPV临床表现主要为变位相关的短暂性眩晕(部分患者可能仅有头晕昏沉感),伴或不伴有眼震。常伴有恶心呕吐、大汗等自主神经症状。3、非典型BPPV患者复位效果较典型BPPV差,可能需要多次复位。更多还原

【Abstract】 Objective:Through data collection of patients with atypical paroxysmal positional vertigo(BPPV)in the outpatient department of Neurology,the clinical features were analyzed to improve the understanding of atypical BPPV and reduce the rate of misdiagnosis.Materials and methods:From June 2017 to December,we collected 47 atypical BPPV patients diagnosed as atypical BPPV patients in the neurology department of the First Hospital of Jilin University,and collected sex,age,drug use,duration of vertigo attack,time of hospitalization,accompanying symptoms,history,family history,treatment effect,and so on.Result:1.Among the 568 patients diagnosed as BPPV,47 cases were atypical BPPV,accounting for 8.3%.2.Among the atypical BPPV patients,there were 12 male and 35 female patients,with a male to female ratio close to 1:3.3.From the perspective of age composition,the minimum age was 27,the maximum age was 78,and the average age was 55.2years.The proportion of patients aged 60~69 years is the largest.In atypical BPPV patients,there was no statistical significance in all age groups(p>0.05).4.We found that diabetes history,ear diseases and trauma history had statistical significance for atypical BPPV(p<0.05).Family history and history of hypertension were not statistically significant(p>0.05).5.In typical BPPV patients,480 patients continued for a few seconds to 1 minutes,and 41 patients in 1 minutes to 10 minutes.In atypical BPPV patients,39 patients lasted for a few seconds to 1 minutes,and 8 patients were 1 minutes to 10 minutes.The duration of vertigo was statistically significant in atypical BPPV(p<0.05).6.In the patients diagnosed with BPPV,292 patients were treated with anti vertigo drugs(including oral and intravenous infusion),and 276 patients were not treated with anti vertigo drugs.Among the typical BPPV patients,275 were given drug treatment,246 were not given drug treatment,17 were given medications in atypical BPPV patients and 30 patients were not given medication.The diagnostic value of anti vertigo drugs for atypical BPPV was statistically significant(p<0.05).7.Among 47 atypical BPPV patients,there were 17 cases of atypical BPPV with typical complaints and no nystagmus.There were 6 cases of atypical complaints and positional nystagmus.24 cases with typical complaints with positional nystagmus,4 of which considered Horizontal canal canalolithiasis;4 patients considered multiple canal otolithiasis;In other 16 cases,the main complaint was that the semicircular canals were not consistent with the actual semicircular canals,of which 11 cases were considered to be posterior semicircular otolith according to the first body position.The actual incidence was horizontal semicircular canals.5 patients considered the horizontal semicircular otolith according to the first body position,and the actual semicircular canals were located in the posterior semicircular canal.8.In 47 cases of atypical BPPV patients,33 patients were cured or improved after treatment,and the effective rate of reduction was 70.2%,which was lower than that of typical BPPV patients.The different types of atypical BPPV patients were statistically significant(p<0.05),of which the main complaint was not typical,and the position associated nystagmus treatment was the most effective,and the BPPV patients without positional nystagmus were the most invalid.9.There was no statistically significant difference in the time length of disease for atypical BPPV patients(p>0.05).Conclusion:1.Female patients with atypical BPPV are more than men,and the incidence of female patients in atypical BPPV is higher than that of typical BPPV patients.The age group has no effect on the incidence of the disease.2.The clinical manifestations of atypical BPPV are mainly transient related vertigo(some patients may only have dizziness),with or without nystagmus.Often accompanied by nausea and vomiting,sweating and other autonomic symptoms.3.The reduction effect of atypical BPPV patients is worse than that of typical BPPV patients.Multiple reduction can relieve symptoms.更多还原