中医药治疗颈性眩晕的研究进展

颈性眩晕是常见的骨科疾病,主要以老年人为主,已严重影响了人们的生活与工作。近年来中医通过多种特色疗法取得了很好疗效。但目前没有统一的辨证分型和理法方药,还需进一步研究。     

Acetazolamide: A New Treatment for Visual Vertigo

Visual vertigo is a disorder characterised by symptoms of dizziness, vertigo, unsteadiness, disorientation, and general discomfort induced by visual triggers. It is currently treated with vestibular rehabilitation therapy, with no effective pharmacotherapy available for treatment-resistant cases. The objective of this study was to evaluate the efficacy of oral acetazolamide in improving symptoms of visual vertigo. A comparative case series of adult patients clinically diagnosed with visual vertigo was conducted from January 1992 to May 2015. Patients without a full neurologic or otorhinolaryngologic work-up, negative magnetic resonance imaging (MRI), and an organic cause for their symptoms were excluded. The identified patients were then contacted by phone to complete a voluntary symptom survey. Main outcome was the subjective reported percentage in symptom improvement. Secondary outcomes were subjective improvement by symptom triggers. The participants were retrospectively divided into three groups based on their treatment with acetazolamide: currently on acetazolamide, terminated acetazolamide, or never initiated acetazolamide. Fifty-seven patients met the inclusion criteria and were willing to complete the phone survey (19 currently on acetazolamide, 27 terminated acetazolamide, and 11 never initiated therapy). Overall symptomatic improvement was reported by 18 (94.7%) patients currently on acetazolamide, 18 (66.7 %) who terminated acetazolamide, and 5 (45.5%) who never initiated therapy, varying significantly by group (p = 0.0061). Greatest improvement was reported in symptoms triggered by being a passenger in a car. These results show that acetazolamide has a positive association with improvement of symptoms of visual vertigo.     

学龄前和学龄期BPV患儿临床特征比较

目的 探讨学龄前和学龄期良性阵发性眩晕(BPV)患儿临床特征差异性。 方法 选取BPV患儿48例,通过眩晕问卷调查、听力学检查、前庭功能检查,对比分析学龄前和学龄期BPV患儿在临床表现、前庭功能的特点。 结果 48例BPV患儿中男22例、女26例,年龄3~12岁,中位年龄7.0岁;学龄前患儿25例,学龄期患儿23例。学龄前及学龄期患儿临床表现为恶心、呕吐率分别为35.7%(10/28)和64.3%(18/28),平衡功能障碍率分别为85.7%(12/14)和14.3%(2/14),伴发头痛率分别为18.2%(2/11)和81.8%(9/11),学龄前和学龄期患儿恶心、呕吐率、平衡功能障碍率、伴发头痛率比较,差异有统计学意义(P均<0.05);辅助检查中纯音测听、声导抗、高刺激率ABR、前庭冷热气检查方面,学龄前和学龄期患儿比较,差异无统计学意义。 结论 学龄前和学龄期BPV患儿在临床表现、平衡障碍、伴发头痛方面有所不同。     

Qualitative analysis of the Dix-Hallpike maneuver in multi-canal BPPV using a biomechanical model: Introduction of an expanded Dix-Hallpike maneuver for enhanced diagnosis of multi-canal BPPV

Introduction/ObjectiveMultiple canal BPPV can be a diagnostic challenge to the clinician. This is due in part to the complex anatomy of the labyrinth but also to complex and often simultaneous ocular responses that result from stimulation of multiple canals during traditional diagnostic testing. Our objective was to analyze the Dix-Hallpike maneuver used in the diagnosis of BPPV to look for patterns of simultaneous canal response and to develop a diagnostic maneuver that will allow separation of canal responses in multiple canal BPPV.MethodsA previously created and published 3D biomechanical model of the human labyrinths for the study of BPPV was used to analyze and compare the position and movement of otoliths in the Dix-Hallpike maneuver as well as in a proposed expanded version of the traditional Dix-Hallpike maneuver.ResultsThe traditional Dix-Hallpike maneuver with the head hanging may promote movement of otoliths in 5 of the six semicircular canals. The Dix-Hallpike maneuver with the head lowered only to the horizontal position allows for otoconia in only the lowermost posterior canal to fall to the most gravity dependent position. This position allows for minimal or no movement of otoconia in the contralateral posterior canal, or in either superior canal. Turning the head ninety degrees to the opposite side while still in the horizontal position will provoke otolith movement in only the contralateral posterior canal. The superior canals can then be examined for free otolith debris by extending the neck to a head-hanging position. These positions may be assumed directly from one to the next in the lying position. There seems to be no advantage to sitting up between positions.ConclusionThe Dix–Hallpike maneuver may cause simultaneous movement of otoliths present in multiple canals and create an obstacle to accurate diagnosis in multi-canal BPPV. An expanded Dix-Hallpike maneuver is described which adds intermediate steps with the head positioned to the right and left in the horizontal position before head-hanging. This expanded maneuver has helped to isolate affected semi-circular canals for individual assessment in multiple canal BPPV.     

The evidence base for the evaluation and management of dizziness

Objectives  Dizziness presentations pose many clinical challenges. The objective of this study is to broadly summarize the evidence base that supports clinical decisions in dizziness presentations.
Methods  MEDLINE (1966 to September 2007), Web of Science and The Cochrane Library were searched for articles with clinical relevance on topics concerning dizziness. Additional sources were also searched for clinical practice guidelines. The following information was abstracted from each article: year of publication, journal type, type of article and the topics of the article.
Results  Of nearly 3000 articles identified, 1244 articles met the inclusion criteria. The most common article type was a case report or case series, followed by expert opinion or review articles, studies of medical tests and clinical trials. Meta-analyses and systematic reviews were found on benign paroxysmal positional vertigo and Meniere's disease, but only a few other topics. No clinical practice guidelines were found that focus specifically on dizziness.
Conclusions  The evidence base for the evaluation and management of dizziness seems to be weak. Future work to establish or summarize evidence in clinically meaningful ways could contribute to efforts to optimize patient care and health care utilization for one of the most common presenting symptoms.     

电针配合推拿治疗血流缓慢型颈性眩晕病

目的：探讨电针配合推拿治疗血流缓慢型颈性眩晕病的临床疗效。方法采用TCD对针灸组、推拿组、电针推拿组治疗前后椎动脉、基底动脉血流速度的观察比较三组疗效。结果电针组、推拿组、电针推拿组椎动脉、基底动脉血流速度治疗前后相比均明显增加（ P＜0.01）,推拿组疗效好于电针组（ P＜0.01）,电针推拿组疗效好于推拿组（ P＜0.01）。结论电针、推拿治疗血流缓慢型颈性眩晕疗效确切,两者联合,效果更好。     

推拿治疗寰枢关节半脱位源性椎动脉型颈椎病

目的 探讨定向仰正法推拿治疗寰枢关节半脱位源性椎动脉型颈椎病(椎动脉型颈椎病)的临床疗效.方法 随机将57例患者分为治疗组28例与对照组29例.治疗组采用放松类手法加定向仰正法治疗,对照组只采用放松类手法治疗,6次为1个疗程,2个疗程后观察疗效.结果 治疗组总有效率96.43％,对照组总有效率72.42％,治疗组优于对照组(P＜0.05).结论 定向仰正法治疗寰枢关节半脱位源性椎动脉型颈椎病,能濡筋骨利关节,纠正错位,促进机体产生一系列生物物理变化,达到治疗疾病的目的.     

自拟中药汤剂对痰浊型眩晕患者生活功能及躯体功能的影响

目的 观察平肝熄风、化痰止痉类中药配伍对痰浊型眩晕患者生活功能和躯体功能的影响.方法 将60例患者随机分为治疗组和对照组,各30例,治疗组采用半夏白术天麻汤加减治疗,对照组用盐酸倍他司汀片治疗.观察2组治疗前后眩晕单项症状评分、眩晕残障程度评定量表(DHI)及生存质量评定表(SF-36表)改善情况.结果 治疗组在改善眩晕程度、降低眩晕发作频率方面均优于对照组(P＜0.05);2组DHI、SF-36评分均优于治疗前(P＜0.05),且治疗组优于对照组(P＜0.05).结论 半夏白术天麻汤治疗痰浊型眩晕,能显著改善患者的生活功能及躯体功能,减轻临床症状.     

Horizontal Direction‐Changing Positional Nystagmus and Vertigo: A Case of Vestibular Migraine Masquerading as Horizontal Canal BPPV

Episodic positional vertigo is typically due to benign paroxysmal positional vertigo (BPPV) but may also be a manifestation of vestibular migraine. Distinguishing vestibular migraine from BPPV is essential since the treatment of each disorder is markedly different. The 31‐month clinical course of a 41‐year‐old woman with vestibular migraine causing recurrent positional vertigo is described. During vestibular migraine attacks, she developed left‐beating nystagmus in the upright position with removal of fixation, and geotropic horizontal nystagmus during the supine roll test. Interictally, her exam demonstrated positional apogeotropic horizontal nystagmus with the supine roll test, more intense in the supine head left position. Her vestibular migraine was successfully controlled with topiramate and eletriptan.