药物联合前庭康复训练及认知行为疗法治疗慢性主观性头晕伴发焦虑的临床疗效
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摘要
目的观察药物联合前庭康复训练及认知行为疗法治疗慢性主观性头晕(CSD)伴发焦虑的临床疗效。方法选取2014年8月—2017年1月首都医科大学附属北京友谊医院收治的CSD伴发焦虑患者120例,根据随机抽签原则分为对照组与观察组,每组60例。对照组患者给予常规药物治疗,观察组患者在对照组治疗的基础上给予前庭康复训练及认知行为疗法治疗。比较两组患者临床疗效、治疗前后医院焦虑/抑郁量表的焦虑评分、治疗后简明健康状况调查问卷(SF-36)评分,并观察两组患者治疗期间不良反应发生情况。结果观察组患者临床疗效优于对照组(P<0.05)。治疗前两组患者焦虑评分比较,差异无统计学意义(P>0.05);治疗后观察组患者焦虑评分低于对照组(P<0.05)。治疗后观察组患者生理维度、环境维度、心理维度、社会关系维度评分高于对照组(P<0.05)。两组患者治疗期间均未发生严重不良反应。结论药物联合前庭康复训练及认知行为疗法可有效提高CSD伴发焦虑患者临床疗效,改善患者焦虑情绪,提高患者生活质量,且安全性较高。
Objective To observe the clinical effect of drug therapy combined with vestibular rehabilitation exercise and cognitive behavior therapy in treating chronic subjective dizziness(CSD)patients complicated with anxiety. Methods A total of 120 CSD patients complicated with anxiety were selected in Beijing Friendship Hospital Affiliated to Capital Medical University from August 2014 to January 2017,and they were divided into control group and observation group according to random draw principle,each of 60 cases. Patients in control group received conventional medical treatment,while patients in observation group received vestibular rehabilitation exercise and cognitive behavior therapy based on conventional medical treatment. Clinical effect,anxiety score of HAD before and after treatment,and SF-36 score after treatment were compared between the two groups,and incidence of adverse reactions during treatment was observed. Results Clinical effect in observation group was statistically significantly better than that in control group(P<0.05). No statistically significant differences of HAD-a score was found between the two groups before treatment(P>0.05),while anxiety score in observation group was statistically significantly lower than that in control group after treatment(P<0.05). Physiological dimension score,environmental dimension score,psychological dimension score and social relation dimension score in observation group were statistically significantly higher than those in control group after treatment(P<0.05). No one in the two groups occurred any serious adverse reactions during treatment. Conclusion In CSD patients complicated with anxiety,drug therapy combined with vestibular rehabilitation exercise and cognitive behavior therapy can effectively improve the clinical effect and quality of life,relieve the anxiety emotion,with relatively high safety.
Objective To observe the clinical effect of drug therapy combined with vestibular rehabilitation exercise and cognitive behavior therapy in treating chronic subjective dizziness(CSD)patients complicated with anxiety. Methods A total of 120 CSD patients complicated with anxiety were selected in Beijing Friendship Hospital Affiliated to Capital Medical University from August 2014 to January 2017,and they were divided into control group and observation group according to random draw principle,each of 60 cases. Patients in control group received conventional medical treatment,while patients in observation group received vestibular rehabilitation exercise and cognitive behavior therapy based on conventional medical treatment. Clinical effect,anxiety score of HAD before and after treatment,and SF-36 score after treatment were compared between the two groups,and incidence of adverse reactions during treatment was observed. Results Clinical effect in observation group was statistically significantly better than that in control group(P<0.05). No statistically significant differences of HAD-a score was found between the two groups before treatment(P>0.05),while anxiety score in observation group was statistically significantly lower than that in control group after treatment(P<0.05). Physiological dimension score,environmental dimension score,psychological dimension score and social relation dimension score in observation group were statistically significantly higher than those in control group after treatment(P<0.05). No one in the two groups occurred any serious adverse reactions during treatment. Conclusion In CSD patients complicated with anxiety,drug therapy combined with vestibular rehabilitation exercise and cognitive behavior therapy can effectively improve the clinical effect and quality of life,relieve the anxiety emotion,with relatively high safety.
引文
[1]褚彦君,张爱月,王素蛟,等.慢性脑供血不足头晕患者的护理干预[J].现代中西医结合杂志,2013,22(21):2375-2378.
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[9]SAMAN Y,MCLELLAN L,MCKENNA L,et al.State Anxiety Subjective Imbalance and Handicap in Vestibular Schwannoma[J].Front Neurol,2016,13(7):101.DOI:10.3389/fneur.2016.00101.
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[11]袁天懿,秦玲,唐建良,等.前庭康复训练联合认知行为疗法治疗慢性主观性头晕伴发焦虑的疗效观察[J].中华物理医学与康复杂志,2016,38(12):938-941.DOI:10.3760/cma.j.issn.0254-1424.2016.12.016.
[12]STABB J P,RUCKENSTEIN M J.Expanding the differential diagnosis of chronic dizziness[J].Arch Otolaryngol Head Neck Surg,2007,133(2):170-176.DOI:10.1001/archotol.133.2.170.
[13]STABB J P,RUCKENSTEIN M J.Chronic dizziness and anxiety:effect of course of illness on treatment out come[J].Arch Otolaryngol Head Neck Surg,2005,131(8):675-679.DOI:10.1001/archotol.131.8.675.
[14]WARE J E Jr,SHEBOURNE C D.The MOS 36-item short-form health survey(SF-36).Ⅰ.Conceptual framework and item selecion[J].Med Care,1992,30(6):473-483.
[15]INDOVINA I,RICCELLI R,CHIARELLA G,et al.Role of the Insula and Vestibular System in Patients with Chronic Subjective Dizziness:An f MRI Study Using Sound-Evoked Vestibular Stimulation[J].Front Behav Neurosci,2015,9(9):334.DOI:10.3389/fnbeh.2015.00334.
[16]DIETERICH M,STAAB J P.Functional dizziness:from phobic postural vertigo and chronic subjective dizziness to persistent postural-perceptual dizziness[J].Curr Opin Neurol,2017,30(1):107-113.DOI:10.1097/WCO.0000000000000417.
[17]姚珍珍,张培莉,单希征,等.慢性主观性头晕(CSD)的人格特征[J].中国健康心理学杂志,2016,24(8):1144-1147.DOI:10.13342/j.cnki.cjhp.2016.08.008.
[18]HALL C D,HERDMAN S J,WHITNEY S L,et al.Vestibular Rehabilitation for Peripheral Vestibular Hypofunction:An Evidence-Based Clinical Practice Guideline:FROM THE AMERICAN PHYSICAL THERAPY ASSOCIATION NEUROLOGY SECTION[J].J Neurol Phys Ther,2016,40(2):124-155.DOI:10.1097/NPT.0000000000000120.
[19]ROSNER M S,FEINBERG D L,DOBLE J E,et al.Treatment of vertical heterophoria ameliorates persistent post-concussive symptoms:A retrospective analysis utilizing a multi-faceted assessment battery[J].Brain Inj,2016,30(3):311-317.DOI:10.3109/02699052.2015.1113564.
[20]PALAZZO P,RUFF M,LYERLY M J,et al.Basilar artery thrombus vs.fenestration:a differential diagnostic challenge in acute ischemic stroke[J].J Neuroimaging,2014,24(6):607-609.DOI:10.1111/jon.12069.
[21]刘叶,刘红巾.生物反馈-认知行为联合前庭康复训练治疗慢性主观性头晕的疗效研究[J].中华行为医学与脑科学杂志,2017,26(2):139-142.DOI:10.3760/cma.j.issn.1674-6554.2017.02.009.
[22]THOMPSON K J,GOETTING J C,STAAB J P,et al.Retrospective review and telephone follow-up to evaluate a physical therapy protocol for treating persistent postural-perceptual dizziness:A pilot study[J].J Vestib Res,2015,25(2):97-103.DOI:10.3233/VES-150551.
[23]RICCI N A,ARATANI M C,CAOVILLA H H,et al.Evaluation of properties of the Vestibular Disorders Activities of Daily Living Scale(Brazilian version)in an elderly population[J].Braz J Phys Ther,2014,18(2):174-182.
[24]陈丰,宋歌,程冬梅,等.神经内科门诊519例眩晕/头晕患者临床分析[J].中国医药导报,2015,12(35):52-55.
[25]LINDBLAD K,BERGKVIST L,JOHANSSON A C.Evaluation of the treatment of chronic chemotherapy-induced peripheral neuropathy using long-wave diathermy and interferential currents:a randomized controlled trial[J].Support Care Cancer,2016,24(6):2523-2531.DOI:10.1007/s00520-015-3060-7.
[26]MARTIN-SANZ E,ORTEGA CRESPO I,ESTEBANSANCHEZ J,et al.Postural stability in a population of dancers,healthy non-dancers,and vestibular neuritis patients[J].Acta Otolaryngol,2017,137(9):952-956.DOI:10.1080/00016489.2017.1322711.
[2]BRITZ G W,AGARWAL V,MIHLON F,et al.Radial Artery Bypass for Intractable Vertebrobasilar Insufficiency:Case Series and Review of the Literature[J].World Neurosurg,2016,85:106-113.DOI:10.1016/j.wneu.2015.08.004.
[3]GANDHI P U,SZYMONIFKA J,MOTIWALA SR,et al.Characterization and prediction of adverse events from intensive chronic heart failure management and effect on quality of life:results from the pro-B-type natriuretic peptide outpatient-tailored chronic heart failure therapy(PROTECT)study[J].J Card Fail,2015,21(1):9-15.
[4]戚晓昆,王志伟.走出头晕与眩晕诊断的误区[J].北京医学,2015,37(5):483-485.DOI:10.15932/j.0253-9713.2015.5.025.
[5]DIETERICH M,STAAB J P.Functional dizziness:from phobic postural vertigo and chronic subjective dizziness to persistent postural-perceptual dizziness[J].Curr Opin Neurol,2017,30(1):107-113.DOI:10.1097/WCO.0000000000000417.
[6]袁天懿,唐建良,秦玲,等.前庭康复训练联合艾司西酞普兰对慢性主观性头晕的早期疗效观察[J].浙江临床医学,2016,18(2):318-319.
[7]CHIARELLA G,PETROLO C,RICCELLI R,et al.Chronic subjective dizziness:Analysis of underlying personality factors[J].J Vestib Res,2016,26(4):403-408.DOI:10.3233/VES-160590.
[8]李文辉,王丽.早期前庭康复训练在治疗慢性主观性头晕的临床应用[J].中国现代医生,2015,53(30):7-10.
[9]SAMAN Y,MCLELLAN L,MCKENNA L,et al.State Anxiety Subjective Imbalance and Handicap in Vestibular Schwannoma[J].Front Neurol,2016,13(7):101.DOI:10.3389/fneur.2016.00101.
[10]S?HSTEN E,BITTAR R S,STAAB J P.Posturographic profile of patients with persistent postural-perceptual dizziness on the sensory organization test[J].J Vestib Res,2016,26(3):319-326.DOI:10.3233/VES-160583.
[11]袁天懿,秦玲,唐建良,等.前庭康复训练联合认知行为疗法治疗慢性主观性头晕伴发焦虑的疗效观察[J].中华物理医学与康复杂志,2016,38(12):938-941.DOI:10.3760/cma.j.issn.0254-1424.2016.12.016.
[12]STABB J P,RUCKENSTEIN M J.Expanding the differential diagnosis of chronic dizziness[J].Arch Otolaryngol Head Neck Surg,2007,133(2):170-176.DOI:10.1001/archotol.133.2.170.
[13]STABB J P,RUCKENSTEIN M J.Chronic dizziness and anxiety:effect of course of illness on treatment out come[J].Arch Otolaryngol Head Neck Surg,2005,131(8):675-679.DOI:10.1001/archotol.131.8.675.
[14]WARE J E Jr,SHEBOURNE C D.The MOS 36-item short-form health survey(SF-36).Ⅰ.Conceptual framework and item selecion[J].Med Care,1992,30(6):473-483.
[15]INDOVINA I,RICCELLI R,CHIARELLA G,et al.Role of the Insula and Vestibular System in Patients with Chronic Subjective Dizziness:An f MRI Study Using Sound-Evoked Vestibular Stimulation[J].Front Behav Neurosci,2015,9(9):334.DOI:10.3389/fnbeh.2015.00334.
[16]DIETERICH M,STAAB J P.Functional dizziness:from phobic postural vertigo and chronic subjective dizziness to persistent postural-perceptual dizziness[J].Curr Opin Neurol,2017,30(1):107-113.DOI:10.1097/WCO.0000000000000417.
[17]姚珍珍,张培莉,单希征,等.慢性主观性头晕(CSD)的人格特征[J].中国健康心理学杂志,2016,24(8):1144-1147.DOI:10.13342/j.cnki.cjhp.2016.08.008.
[18]HALL C D,HERDMAN S J,WHITNEY S L,et al.Vestibular Rehabilitation for Peripheral Vestibular Hypofunction:An Evidence-Based Clinical Practice Guideline:FROM THE AMERICAN PHYSICAL THERAPY ASSOCIATION NEUROLOGY SECTION[J].J Neurol Phys Ther,2016,40(2):124-155.DOI:10.1097/NPT.0000000000000120.
[19]ROSNER M S,FEINBERG D L,DOBLE J E,et al.Treatment of vertical heterophoria ameliorates persistent post-concussive symptoms:A retrospective analysis utilizing a multi-faceted assessment battery[J].Brain Inj,2016,30(3):311-317.DOI:10.3109/02699052.2015.1113564.
[20]PALAZZO P,RUFF M,LYERLY M J,et al.Basilar artery thrombus vs.fenestration:a differential diagnostic challenge in acute ischemic stroke[J].J Neuroimaging,2014,24(6):607-609.DOI:10.1111/jon.12069.
[21]刘叶,刘红巾.生物反馈-认知行为联合前庭康复训练治疗慢性主观性头晕的疗效研究[J].中华行为医学与脑科学杂志,2017,26(2):139-142.DOI:10.3760/cma.j.issn.1674-6554.2017.02.009.
[22]THOMPSON K J,GOETTING J C,STAAB J P,et al.Retrospective review and telephone follow-up to evaluate a physical therapy protocol for treating persistent postural-perceptual dizziness:A pilot study[J].J Vestib Res,2015,25(2):97-103.DOI:10.3233/VES-150551.
[23]RICCI N A,ARATANI M C,CAOVILLA H H,et al.Evaluation of properties of the Vestibular Disorders Activities of Daily Living Scale(Brazilian version)in an elderly population[J].Braz J Phys Ther,2014,18(2):174-182.
[24]陈丰,宋歌,程冬梅,等.神经内科门诊519例眩晕/头晕患者临床分析[J].中国医药导报,2015,12(35):52-55.
[25]LINDBLAD K,BERGKVIST L,JOHANSSON A C.Evaluation of the treatment of chronic chemotherapy-induced peripheral neuropathy using long-wave diathermy and interferential currents:a randomized controlled trial[J].Support Care Cancer,2016,24(6):2523-2531.DOI:10.1007/s00520-015-3060-7.
[26]MARTIN-SANZ E,ORTEGA CRESPO I,ESTEBANSANCHEZ J,et al.Postural stability in a population of dancers,healthy non-dancers,and vestibular neuritis patients[J].Acta Otolaryngol,2017,137(9):952-956.DOI:10.1080/00016489.2017.1322711.