【作者】 王娟；

【导师】 陈嘉峰；

【作者基本信息】 吉林大学 ， 临床医学硕士（神经病学）（专业学位）， 2020， 硕士

【摘要】 背景和目的:持续性姿势-感知性头晕(persistent postural-perceptual dizziness,PPPD)是近年定义的慢性功能性疾病,作为主要诊断及共病诊断影响着近半数慢性头晕患者,同时近四分之一急性或阵发性前庭疾病患者在患病后的1年内可能出现PPPD样症状。前庭康复治疗可作为有效干预手段用于治疗PPPD。SRM-Ⅳ前庭功能诊疗系统可通过体位改变来刺激各半规管进行功能锻炼,可作为一种被动前庭康复手段。本研究旨在通过SRM-Ⅳ诊疗系统联合药物治疗对PPPD患者进行前庭康复,评估其对PPPD的治疗效果。对象与方法:(1)研究对象:选择2019年3月至2020年2月在吉林大学第一医院院神经内科门诊就诊的PPPD患者40例。纳入标准为符合2017年巴拉尼协会制订的PPPD诊断标准的18-65岁间患者,排除活动性神经耳科学及其他神经系统疾病、神经影像学检查及前庭功能检查明显异常或药物导致的持续头晕症状患者。(2)研究方法:按照治疗方法不同将患者分为康复组和对照组。康复组采用药物治疗联合SRM-Ⅳ系统辅助治疗,对照组仅采用抗焦虑药物治疗。治疗前及治疗1个月后对患者进行量表评估,评估结果采用SPSS 23.0进行统计学分析:1)通过DHI量表对患者头晕和平衡障碍严重程度及其对生活的影响程度做出评估;2)通过HAMA量表及HADM量表对患者焦虑抑郁程度做出评估;3)应用Berg平衡量表评估患者重心主动转移和姿势控制能力;4)应用主观疗效评价量表评价患者自身对治疗效果的满意程度;比较两组疗效差别。结果:(1)研究共纳入患者40例,康复组20例,对照组20例。两组患者一般资料比较无统计学差异(p>0.05),表明两组患者基线资料均衡可比。(2)治疗前,康复组与对照组患者进行DHI量表评估,两组患者治疗前DHI量表总分与各分项得分比较无统计学差异(p>0.05);治疗4周后分别对康复组与对照组患者治疗前后DHI量表评分情况进行比较,结果显示治疗后两组患者DHI量表评分均较治疗前降低,差异具有显著性(p<0.05);康复组患者治疗后DHI量表评分较对照组降低,差异具有显著性(P<0.05)。(3)治疗前,康复组与对照组患者进行HAMA量表评估,两组患者HAMA量表得分比较无统计学差异(p>0.05);治疗4周后分别对康复组与对照组患者治疗前后HAMA量表评分情况进行比较,结果显示治疗后两组患者HAMA量表评分均较治疗前降低,差异具有显著性(p<0.05);康复组患者治疗后HAMA量表评分较对照组低,差异具有显著性(P<0.05)。(4)治疗前,康复组与对照组患者进行HAMD量表评估,两组患者HAMD量表得分比较无统计学差异(p>0.05);治疗4周后分别对康复组与对照组患者治疗前后HAMD量表评分情况进行比较,结果显示治疗后两组患者HAMD量表评分均较治疗前降低,差异具有显著性(p<0.05);两组患者间治疗后HAMD量表评分无统计学差异(p>0.05)。(5)治疗前,康复组与对照组患者进行Berg量表评估,两组患者Berg量表得分比较无统计学差异(p>0.05);治疗4周后分别对康复组与对照组患者治疗前后Berg量表评分情况进行比较,结果显示治疗后两组患者Berg量表评分较治疗前均无统计学差异(p>0.05)。结论:(1)SRM-Ⅳ系统联合抗焦虑药物辅助治疗及单纯抗焦虑药物治疗在对于改善PPPD患者头晕导致的躯体症状、情绪及功能障碍均有效。SRM-Ⅳ系统联合抗焦虑药物辅助治疗在改善患者头晕症状的效果优于单纯应用抗焦虑药物。(2)SRM-Ⅳ系统联合抗焦虑药物辅助治疗及单纯抗焦虑药物治疗均可改善患者焦虑症状。SRM-Ⅳ系统联合抗焦虑药物辅助治疗在改善焦虑效果优于单纯应用抗焦虑药物。(3)SRM-Ⅳ系统联合抗焦虑药物辅助治疗及单纯抗焦虑药物治疗均可改善患者抑郁症状。SRM-Ⅳ系统联合抗焦虑药物辅助治疗在改善患者抑郁效果对比单纯应用抗焦虑药物,两者无差异。(4)PPPD患者对于坐、站位下的动、静态平衡、重心主动转移等运动时无明显障碍,跌倒风险较低。SRM-Ⅳ系统联合抗焦虑药物辅助治疗及单纯抗焦虑药物治疗对于这方面的治疗均无明显改善。更多还原

【Abstract】 Background and Objective:Persistent postural-perceptual dizziness(PPPD)is a chronic functional disease defined in recent years.As the main diagnosis and comorbid diagnosis,it affects nearly half of patients with chronic dizziness,at the same time,nearly 1/4 of acute or paroxysmal patients with vestibular disease may have PPPD-like symptoms within 1 year.Vestibular rehabilitation therapy can be used as an effective intervention to treat PPPD.The SRM-Ⅳ can stimulate the full flow of endolymph in semicircular canal directions,thereby providing positional stimulation information in a specific direction to the central center of the vestibular nuclear complex,which can be used as a passive vestibular rehabilitation method.The purpose of this study is to perform vestibular rehabilitation of PPPD patients through the SRM-Ⅳ,to evaluate their therapeutic effects on PPPD.Methods:(1)Research objects: 40 patients with PPPD who were treated in the outpatient department of the Department of Neurology of the First Hospital of Jilin University from March 2019 to February 2020.Inclusion criteria are 18-65-year-old patients who meet the diagnostic criteria for PPPD in ICD-11 issued by the WHO International Classification of Diseases in 2018.Active neurootology and other neurological diseases,neuroimaging examination and vestibular function examination showed obvious abnormalities were excluded,as well as persistent dizziness caused by drugs.(2)Research method: According to different treatment methods,patients were divided into observation group and control group.The observation group was treated with drug therapy combined with SRM-Ⅳ system adjuvant therapy,while the control group was treated with conventional drugs.Before and after the 1 month of treatment,the patients were evaluated by scales.The evaluation results were statistically analyzed using SPSS 23.0: 1)The severity of dizziness and balance disorders and their impact on life were evaluated through the DHI scale;2)Evaluate the degree of anxiety and depression of patients by HAMA scale and HADM scale;3)Use Berg balance scale to evaluate the patient’s ability to actively shift the center of gravity and posture control ability;4)Evaluate the subjective treatment effect of patients through the subjective curative effect evaluation scale.compare the difference between the two groups.Result:(1)The study included 40 patients,20 in each group.There was no statistical difference between the two groups of patients in general data(p> 0.05),indicating that the baseline data of the two groups of patients were balanced and comparable.(2)Before the treatment,patients in the rehabilitation group and the control group were evaluated by the DHI scale.There was no statistical difference between two groups of patients in the scores of total and each item of the DHI scales before treatment(p> 0.05);After 4 weeks of treatment,the DHI scale scores of two groups’ patients got before and after treatment were compared.The results showed that the DHI scale scores of the two groups’ patients after treatment were lower than before treatment,the difference was significant(p <0.05);The table score is lower than the control group,and the difference is significant(P <0.05).(3)Before the treatment,patients in two groups were evaluated by the HAMA scale.There was no statistical difference in the scores of the HAMA scale between the two groups(p> 0.05);after 4 weeks of treatment,the patients in the control group and the rehabilitation group were measured before and after treatment HAMA scale scores were compared,and the results showed that the HAMA scale scores of the two groups of patients after treatment were lower than before treatment,and the difference was significant(p <0.05);the HAMA scale scores of patients in the rehabilitation group after treatment were lower than the control group,the difference Significant(P <0.05).(4)Before treatment,the patients in the control group and the rehabilitation group were evaluated by the HAMD scale.There was no statistical difference in the scores of the HAMD scale between the two groups of patients(p> 0.05);after 4 weeks of treatment,the patients in the control group and the rehabilitation group were measured before and after treatment.The results showed that the HAMD scale scores of the two groups after treatment were lower than before treatment,and the difference was significant(p <0.05);but there was no statistical difference between the two groups of patients after treatment(p> 0.05).(5)Before the treatment,patients in the control group and the rehabilitation group were evaluated by the Berg balance scale.There was no statistical difference in the scores of the Berg scale between the two groups(p> 0.05);after 4 weeks of treatment,the patients in the control group and the rehabilitation group were measured,the results showed that the Berg scale scores of the two groups of patients after treatment were not statistically different than before treatment(p> 0.05).Conclusion:(1)The SRM-Ⅳ system combined with anxiolytic drug adjuvant therapy and simple anti-anxiety drug therapy are both effective in improving the physical symptoms,mood and dysfunction caused by dizziness in PPPD patients.The SRM-Ⅳ system combined with anti-anxiety drug adjuvant therapy is better than the simple application of anti-anxiety drugs in improving patients ’dizziness symptoms.(2)SRM-Ⅳ system combined with anxiolytic drug adjuvant therapy and simple anti-anxiety drug therapy can improve patients’ anxiety symptoms.SRM-Ⅳ system combined with anti-anxiety drug adjuvant therapy is better than pure anti-anxiety drug in improving anxiety.(3)SRM-Ⅳ system combined with anxiolytic drug adjuvant therapy and simple anti-anxiety drug therapy can improve patients’ depressive symptoms.There is no significant difference between the SRM-Ⅳ system and the anxiolytic drug adjuvant therapy in improving patients’ depression compared with the use of anxiolytic drugs alone.(4)PPPD patients have no obvious obstacles to movements such as sitting and standing,static balance,active center of gravity transfer,and the risk of falling is low.SRM-Ⅳ system combined with anti-anxiety drug adjuvant therapy and simple anti-anxiety drug therapy have no significant improvement in this regard.更多还原