复发性良性阵发性位置性眩晕的中西医研究概况
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摘要
良性阵发性位置性眩晕(BPPV)治疗后,仍有一定比例患者症状无好转,或数天后再次发作,复发性BPPV是临床上难以解决的问题。从中西医两个角度探讨这个问题,对复发性BPPV的诊断、可能的发病机制、复发的危险因素和防治方法,以及中医病因病机、分型论治和特色治疗等方面,予以系统论述,旨在探索更加有效的思路和方法,降低BPPV的复发率。认为通过综合分析患者体质、临床表现,依据和运用中医理论,对患者进行分型论治,作为手法复位后的辅助手段,采用个体化中西医结合治疗方案进行防治,在减轻眩晕症状,减少复发方面具有独特优势,中医药联合手法复位治疗BPPV有着广泛的应用前景。
After the treatment of benign paroxysmal positional vertigo(BPPV), there is still a certain proportion of patients with no improvement in symptoms, or a few days after the onset of positional vertigo, recurrent BPPV is a clinically difficult problem to solve. This issue is explored from two perspectives of Chinese and western medicine. The diagnosis, possible pathogenesis, risk factors and drug prevention and treatment of recurrent BPPV were discussed. The etiology and pathogenesis, classification and argumentation, systematically discuss, thus to explore more effective ideas and methods, reduce the recurrence rate of BPPV. It is considered that through comprehensive analysis of the patient's physical condition, clinical manifestations, and the use of TCM theory, the patient is classified and treated as an auxiliary means after manual reduction, using individualized integrated Chinese and Western medicine treatment plan for prevention and treatment, reducing dizziness symptoms and reducing recurrence. The aspect has unique advantages, and Chinese medicine combined with manual reduction and treatment of BPPV has broad application prospects.
After the treatment of benign paroxysmal positional vertigo(BPPV), there is still a certain proportion of patients with no improvement in symptoms, or a few days after the onset of positional vertigo, recurrent BPPV is a clinically difficult problem to solve. This issue is explored from two perspectives of Chinese and western medicine. The diagnosis, possible pathogenesis, risk factors and drug prevention and treatment of recurrent BPPV were discussed. The etiology and pathogenesis, classification and argumentation, systematically discuss, thus to explore more effective ideas and methods, reduce the recurrence rate of BPPV. It is considered that through comprehensive analysis of the patient's physical condition, clinical manifestations, and the use of TCM theory, the patient is classified and treated as an auxiliary means after manual reduction, using individualized integrated Chinese and Western medicine treatment plan for prevention and treatment, reducing dizziness symptoms and reducing recurrence. The aspect has unique advantages, and Chinese medicine combined with manual reduction and treatment of BPPV has broad application prospects.
引文
[1] 中华耳鼻咽喉头颈外科杂志编辑委员会,中华医学会耳鼻咽喉头颈外科学分会.良性阵发性位置性眩晕诊断和治疗指南(2017)[J].中华耳鼻咽喉头颈外科杂志,2017,52(3):173-177.
[2] DE STEFANO A,DISPENZA F,SUAREZ H,et al. A multicenter observational study on the role ofcomorbidities in the recurrent episodes of benign paroxysmal positional vertigo[J]. Auris Nasus Larynx,2014,41(1):31-36.
[3] BRANDT T,HUPPERT D,HECHT J,et al. Benign paroxysmal positioning vertigo:a long-term follow-up (6-17 years) of 125 patients[J].Acta Otolaryngol,2006,126(2): 160-163.
[4] 田永胜,王淑珍,刘颖,等.特发性良性阵发性位置性眩晕复发特点分析[J].临床耳鼻咽喉头颈外科杂志,2018,32(2):118-121
[5] SU P,LIU Y C,LIN H C.Risk factors for the recurrence of post-semicircular canal benign paroxysmal positional vertigo after canalith repositioning[J]. Journal of neurology,2016,263(1):45-51.
[6] 金雪红.良性阵发性位置性眩晕复发的影响因素分析[J].实用心脑肺血管病杂志,2015,23(9):68-70.
[7] 刘姣,王斌全.复发和非复发良性阵发性位置性眩晕患者温度试验结果比较[J].中国耳鼻咽喉头颈外科,2015,22(4):177-179.
[8] 陈请国,王兴龙,毛忠瑶,等.良性阵发性位置性眩晕的复发影响因素分析[J].中华物理医学与康复杂志,2015,37(9):683-685.
[9] 李潇潇,区永康,唐小武,等.良性阵发性位置性眩晕复发的临床特征分析[J].临床耳鼻咽喉头颈外科杂志,2018,32(11):823-826.
[10] 戚志强.良性阵发性位置性眩晕复发的相关因素分析[J].江苏医药,2012,38(2):236-237
[11] DO Y K,KIM J,PARK C Y,et al.The effect of early canalith repositioning on benign paroxysmal positional vertigo on recurrence[J]. Clinical and experimental otorhinolaryngology, 2011,4(3):113.
[12] 杨燕珍,龚树生,余青松,等.高血压大鼠耳蜗血管显微及超微结构的研究[J].中华耳鼻咽喉头颈外科杂志,2007,42(8):620-622.
[13] 王静,方永山.甲磺酸倍他司汀片联合手法复位治疗良性阵发性位置性眩晕效果观察[J].中国当代医药,2016,23(25):123-125.
[14] 张桂娟,顾能荣,何平,等.氟桂利嗪联合手法复位治疗后半规管原发性良性阵发性位置性眩晕的临床疗效观察[J].中华耳科学杂志,2011,9(3):312-314.
[15] TALAAT H S,KABEL A M H,KHALIEL L H,et al.Reduction of recurrence rate of benign paroxysmal positional vertigo by treatment of severe vitamin D deficiency[J]. Auris Nasus Larynx, 2016,43(3):237-241
[16] 朱祖福,徐静泓,张慧萍,等.Brandt-Daroff习服训练联合手法复位治疗良性阵发性位置性眩晕疗效观察[J].海南医学,2016,27(2):297-298
[17] 张爱兰.前庭康复训练在良性阵发性位置性眩晕残余症状治疗中的应用分析[J].中外医疗,2016,35(35):57-59.
[18] ZHU Q, LIU C, LIN C, et al. Efficacy and safety of semicircular canal occlusion for intractable horizontal semicircular benign paroxysmal positional vertigo[J]. Annals of Otology, Rhinology & Laryngology, 2015, 124(4):257-260.
[19] 王卫胜.实施心理干预治疗对良性阵发性位置性眩晕管石复位疗效的影响效果分析[J].心理医生,2017,23(15):11-12.
[20] 田亮.复发性良性阵发性位置性眩晕的治疗和预防策略[D].上海:复旦大学,2013.
[21] 巫遥,徐成成,崔春丽.吴明华教授寒热并用治疗反复发作性眩晕[J].环球中医药,2018,11(11):1723-1724.
[22] 李莎莎,钟利群,夏梦幻.泽泻汤的相关研究概况[J].现代中医临床,2017,24(4):56-60.
[23] 谢小晓.泽泻汤联合手法复位治疗良性阵发性位置性眩晕137例[J].医学理论与实践,2016,29(7):885-886.
[24] 朱文宗,郑国庆,黄建平,等.豁痰健脾法治疗后半规管良性阵发性位置性眩晕临床研究[J].新中医,2013,45(2):83-85.
[25] 罗俊.半夏白术天麻汤配合耳石复位法对良性阵发性位置性眩晕的疗效分析[J].中国医药指南,2018,16(16):199-200.
[26] 李平,提桂香,高荣林.路志正教授调理脾胃法在内科临床运用经验[J].北京中医药大学学报(中医临床版),2003,10(1):23-28.
[27] 黄小容,周绍华,司维,等.益气聪明汤合四物汤治疗良性阵发性位置性眩晕28例[J].上海中医药杂志,2012,46(11):45-46.
[28] 郝大慰.中医辨证联合手法复位治疗良性阵发性位置性眩晕20例[J].河南中医,2014,34(9):1781-1782.
[29] 周炜,王丽平,张其慧.许彭龄主任医师治疗肝阳上亢型眩晕经验[J].北京中医药大学学报(中医临床版),2011,18(1):35-36.
[30] 殷春萍,蓝青,王钊,等.中医辨证联合SRM-Ⅳ前庭功能诊疗系统治疗良性阵发性位置性眩晕[J].中国研究型医院,2017,4(1):31-34.
[31] 郑伟,胡刚.基于《伤寒论》少阳证论治耳眩晕[J].世界最新医学信息文摘,2018,18(83):168.
[32] 钟明,何兰英.舒肝解郁胶囊联合手法复位治疗复发的良性阵发性位置性眩晕的临床疗效观察[J].四川医学,2012,33(7):1196-1198.
[33] 仓志兰,陆海芬,汤粉英.止眩饮治疗良性阵发性位置性眩晕复位后残余症状疗效观察[J].中国中医急症,2016,25(10):2005-2008.
[34] 任成龙,单希征,王恩彤,等.针灸联合复位治疗良性阵发性位置性眩晕的系统评价与Meta分析[J].北京医学,2018,40(2):137-140.
[35] 冯亮,秦美影.温针灸完骨穴、风池穴治疗良性阵发性位置性眩晕手法复位后残留头晕症状[J].按摩与康复医学,2018,9(3):31-33.
[36] 倪斐琳,张丽萍,胡珊珊,等.隔姜灸联合手法复位治疗良性阵发性位置性眩晕临床观察[J].针灸推拿医学(英文版),2016,14(1):31-35.
[37] 邢瀚,张春红,张妍,等.针刺与交感神经的关系探讨[J].江苏中医药,2010,42(9):45-47.
[2] DE STEFANO A,DISPENZA F,SUAREZ H,et al. A multicenter observational study on the role ofcomorbidities in the recurrent episodes of benign paroxysmal positional vertigo[J]. Auris Nasus Larynx,2014,41(1):31-36.
[3] BRANDT T,HUPPERT D,HECHT J,et al. Benign paroxysmal positioning vertigo:a long-term follow-up (6-17 years) of 125 patients[J].Acta Otolaryngol,2006,126(2): 160-163.
[4] 田永胜,王淑珍,刘颖,等.特发性良性阵发性位置性眩晕复发特点分析[J].临床耳鼻咽喉头颈外科杂志,2018,32(2):118-121
[5] SU P,LIU Y C,LIN H C.Risk factors for the recurrence of post-semicircular canal benign paroxysmal positional vertigo after canalith repositioning[J]. Journal of neurology,2016,263(1):45-51.
[6] 金雪红.良性阵发性位置性眩晕复发的影响因素分析[J].实用心脑肺血管病杂志,2015,23(9):68-70.
[7] 刘姣,王斌全.复发和非复发良性阵发性位置性眩晕患者温度试验结果比较[J].中国耳鼻咽喉头颈外科,2015,22(4):177-179.
[8] 陈请国,王兴龙,毛忠瑶,等.良性阵发性位置性眩晕的复发影响因素分析[J].中华物理医学与康复杂志,2015,37(9):683-685.
[9] 李潇潇,区永康,唐小武,等.良性阵发性位置性眩晕复发的临床特征分析[J].临床耳鼻咽喉头颈外科杂志,2018,32(11):823-826.
[10] 戚志强.良性阵发性位置性眩晕复发的相关因素分析[J].江苏医药,2012,38(2):236-237
[11] DO Y K,KIM J,PARK C Y,et al.The effect of early canalith repositioning on benign paroxysmal positional vertigo on recurrence[J]. Clinical and experimental otorhinolaryngology, 2011,4(3):113.
[12] 杨燕珍,龚树生,余青松,等.高血压大鼠耳蜗血管显微及超微结构的研究[J].中华耳鼻咽喉头颈外科杂志,2007,42(8):620-622.
[13] 王静,方永山.甲磺酸倍他司汀片联合手法复位治疗良性阵发性位置性眩晕效果观察[J].中国当代医药,2016,23(25):123-125.
[14] 张桂娟,顾能荣,何平,等.氟桂利嗪联合手法复位治疗后半规管原发性良性阵发性位置性眩晕的临床疗效观察[J].中华耳科学杂志,2011,9(3):312-314.
[15] TALAAT H S,KABEL A M H,KHALIEL L H,et al.Reduction of recurrence rate of benign paroxysmal positional vertigo by treatment of severe vitamin D deficiency[J]. Auris Nasus Larynx, 2016,43(3):237-241
[16] 朱祖福,徐静泓,张慧萍,等.Brandt-Daroff习服训练联合手法复位治疗良性阵发性位置性眩晕疗效观察[J].海南医学,2016,27(2):297-298
[17] 张爱兰.前庭康复训练在良性阵发性位置性眩晕残余症状治疗中的应用分析[J].中外医疗,2016,35(35):57-59.
[18] ZHU Q, LIU C, LIN C, et al. Efficacy and safety of semicircular canal occlusion for intractable horizontal semicircular benign paroxysmal positional vertigo[J]. Annals of Otology, Rhinology & Laryngology, 2015, 124(4):257-260.
[19] 王卫胜.实施心理干预治疗对良性阵发性位置性眩晕管石复位疗效的影响效果分析[J].心理医生,2017,23(15):11-12.
[20] 田亮.复发性良性阵发性位置性眩晕的治疗和预防策略[D].上海:复旦大学,2013.
[21] 巫遥,徐成成,崔春丽.吴明华教授寒热并用治疗反复发作性眩晕[J].环球中医药,2018,11(11):1723-1724.
[22] 李莎莎,钟利群,夏梦幻.泽泻汤的相关研究概况[J].现代中医临床,2017,24(4):56-60.
[23] 谢小晓.泽泻汤联合手法复位治疗良性阵发性位置性眩晕137例[J].医学理论与实践,2016,29(7):885-886.
[24] 朱文宗,郑国庆,黄建平,等.豁痰健脾法治疗后半规管良性阵发性位置性眩晕临床研究[J].新中医,2013,45(2):83-85.
[25] 罗俊.半夏白术天麻汤配合耳石复位法对良性阵发性位置性眩晕的疗效分析[J].中国医药指南,2018,16(16):199-200.
[26] 李平,提桂香,高荣林.路志正教授调理脾胃法在内科临床运用经验[J].北京中医药大学学报(中医临床版),2003,10(1):23-28.
[27] 黄小容,周绍华,司维,等.益气聪明汤合四物汤治疗良性阵发性位置性眩晕28例[J].上海中医药杂志,2012,46(11):45-46.
[28] 郝大慰.中医辨证联合手法复位治疗良性阵发性位置性眩晕20例[J].河南中医,2014,34(9):1781-1782.
[29] 周炜,王丽平,张其慧.许彭龄主任医师治疗肝阳上亢型眩晕经验[J].北京中医药大学学报(中医临床版),2011,18(1):35-36.
[30] 殷春萍,蓝青,王钊,等.中医辨证联合SRM-Ⅳ前庭功能诊疗系统治疗良性阵发性位置性眩晕[J].中国研究型医院,2017,4(1):31-34.
[31] 郑伟,胡刚.基于《伤寒论》少阳证论治耳眩晕[J].世界最新医学信息文摘,2018,18(83):168.
[32] 钟明,何兰英.舒肝解郁胶囊联合手法复位治疗复发的良性阵发性位置性眩晕的临床疗效观察[J].四川医学,2012,33(7):1196-1198.
[33] 仓志兰,陆海芬,汤粉英.止眩饮治疗良性阵发性位置性眩晕复位后残余症状疗效观察[J].中国中医急症,2016,25(10):2005-2008.
[34] 任成龙,单希征,王恩彤,等.针灸联合复位治疗良性阵发性位置性眩晕的系统评价与Meta分析[J].北京医学,2018,40(2):137-140.
[35] 冯亮,秦美影.温针灸完骨穴、风池穴治疗良性阵发性位置性眩晕手法复位后残留头晕症状[J].按摩与康复医学,2018,9(3):31-33.
[36] 倪斐琳,张丽萍,胡珊珊,等.隔姜灸联合手法复位治疗良性阵发性位置性眩晕临床观察[J].针灸推拿医学(英文版),2016,14(1):31-35.
[37] 邢瀚,张春红,张妍,等.针刺与交感神经的关系探讨[J].江苏中医药,2010,42(9):45-47.
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