异丙嗪治疗25例小脑出血性眩晕疗效观察

目的探讨异丙嗪治疗小脑出血所致眩晕的临床疗效。方法将25例小脑出血患者随机分为两组,对照组为常规营养神经、抑酸以及甲氧氯普胺镇吐等治疗,治疗组在对照组治疗方案的基础上加用异丙嗪肌肉注射。结果两组比较总有效率治疗组明显高于对照组。结论异丙嗪治疗小脑出血导致的眩晕起效快,效果显著,值得临床推广应用。     

良性阵发性位置性眩晕的复发影响因素分析

目的 探讨良性阵发性位置性眩晕（BPPV）复发的相关影响因素。 方法 搜集300例BPPV患者的相关资料,给予手法复位治疗后电话随访一年,将完成随访228例患者按照是否复发分为复发组60例和未复发组168例,并对2组患者的年龄、性别、发病部位、伴发基础疾病和生活相关因素情况进行比较,采用Logistic回归模型对BPPV复发的影响因素进行多因素分析。 结果 经单因素统计分析发现,过度劳累（P<0.01）,年龄≥45岁（P<0.01）、经常出差（P<0.01）、长期使用电脑（P=0.003）、有睡眠障碍（P=0.002）、口服钙片（P=0.002）及伴发后循环缺血（P=0.025）和高脂血症（P=0.004）与BPPV复发相关;二元Logistic回归分析发现年龄≥45岁（OR=10.20,P<0.01）、过度劳累（OR=2.612,P=0.006）、经常出差（OR=5.257,P=0.006）、长期使用电脑（OR=3.870,P=0.003）、有睡眠障碍（OR=2.612,P=0.039）、伴发后循环缺血（OR=3.411,P=0.043）或伴发高脂血症（OR=2.299,P=0.047）是BPPV复发的危险因素,而年龄≥45岁对患者复发的影响最大。 结论 年龄是BPPV患者复发的最大危险因素;而后循环缺血、高脂血症、过度劳累、睡眠障碍、长期使用电脑以及经常出差也是BPPV复发的危险因素。     

Migraine vestibulaire : critères diagnostiques. Document consensuel de la Société Bárány et de la Société internationale des céphalées

This paper presents diagnostic criteria for vestibular migraine, jointly formulated by the Committee for Classification of Vestibular Disorders of the Bárány Society and the Migraine Classification Subcommittee of the International Headache Society (IHS). The classification includes vestibular migraine and probable vestibular migraine. Vestibular migraine will appear in an appendix of the third edition of the International Classification of Headache Disorders (ICHD) as a first step for new entities, in accordance with the usual IHS procedures. Probable vestibular migraine may be included in a later version of the ICHD, when further evidence has been accumulated. The diagnosis of vestibular migraine is based on recurrent vestibular symptoms, a history of migraine, a temporal association between vestibular symptoms and migraine symptoms and exclusion of other causes of vestibular symptoms. Symptoms that qualify for a diagnosis of vestibular migraine include various types of vertigo as well as head motion-induced dizziness with nausea. Symptoms must be of moderate or severe intensity. Duration of acute episodes is limited to a window of between 5 minutes and 72 hours.     

椎动脉起始部迂曲对血管性眩晕的影响及其临床危险因素

目的 探讨椎动脉起始部迂曲对血管性眩晕的影响及其临床危险因素. 方法 连续入选神经内科病房住院的老年眩晕患者206例,记录脑血管病相关的临床危险因素、眩晕分级、治疗缓解天数,检测血清总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、同型半胱氨酸(Hcy)、超敏C-反应蛋白(hsCRP),进行颈部CT血管成像(CTA)或对比增强磁共振血管成像(CEMRA)检查.将眩晕患者分为椎动脉起始部迂曲组(137例)与非迂曲组(69例),采用Logistic回归分析探讨椎动脉起始部迂曲的临床危险因素. 结果 椎动脉起始部迂曲组合并椎动脉优势者多于非迂曲组,差异有统计学意义(75例比26例,x2 =2.496,P＜0.01).椎动脉起始部迂曲患者眩晕级别:1级17例,2级36例,3级79例,4级4例,5级1例;治疗缓解天数为1～1o d.非迂曲组眩晕级别:1级18例,2级35例,3级10例,4级3例,5级1例,治疗缓解天数1～6 d,两组比较差异均有统计学意义(t=2.014,2.849,均P＜0.01).单因素分析结果表明,年龄、高血压病、高LDL-C、糖尿病、吸烟、脑卒中史、椎动脉优势及颈椎病等两组之间差异有统计学意义(x2=7.498、5.182、3.724、10.461、6.883、2.748、4.496、8.265,均P＜0.05).Logistic回归分析表明,年龄＞65岁(95％CI:5.36～18.23,OR=4.84)、高血压病(95％CI:2.79～16.45,OR=3.21)、椎动脉优势(95％CI:3.25～13.49,OR=5.48)和颈椎病(95％ CI:4.38～21.28,OR=3.57)为椎动脉起始部迂曲的临床高危因素. 结论 椎动脉起始部迂曲者眩晕级别高、治疗缓解天数延长;年龄＞65岁、高血压病、椎动脉优势和颈椎病为椎动脉起始部迂曲的临床高危因素.     

良性阵发性位置性眩晕的治疗进展及心理评估

良性阵发性位置性眩晕（BPPV）是在头位改变时出现的以短暂眩晕发作为主要特征的外周前庭性疾患,耳石复位治疗具有独特的疗效。体位限制对耳石复位后的治疗及预后是否有效尚未明确。前庭康复对反复发作的BBPV及其预后有一定疗效。BPPV引起的眩晕／头晕、姿势不稳等不适症状明显影响患者心理状态,更多表现为焦虑状态,因此心理评估及心理干预在BPPV的康复治疗中愈显重要。现对良性阵发性位置性眩晕的复位手法、体位限常】、前庭康复及心理评估作一综述。     

养血清脑颗粒联合纳洛酮治疗眩晕症的效果观察

目的探讨养血清脑颗粒联合纳洛酮治疗眩晕症的的临床效果及安全性。方法 2009年10月～2013年1月入选眩晕症患者100例,按治疗方法分为治疗组和对照组。治疗组予以口服养血清脑颗粒,同时联用纳洛酮静脉滴注;对照组采用维生素C＋维生素B6＋三磷酸腺苷（ATP）＋地塞米松5 mg加入5%葡萄糖250 ml中静脉滴注。两组的治疗周期均为5 d。结果治疗组中显效51例,有效6例,无效5例,总有效率为95%,对照组中显效10例,有效10例,无效20例,总有效率为50%,两组的总有效率比较,差异有统计学意义（P=0.0004）。结论养血清脑颗粒联合纳洛酮治疗眩晕症具有很好的临床应用意义。     

Diagnostic assessment of patients with Meniere's disease through caloric testing and the video-head-impulse test

IntroductionMeniere's disease is a labyrinth disease that usually presents with episodes of spontaneous vertigo associated with sensorineural hearing loss, tinnitus and ipsi- and unilateral aural fullness in most cases. Vestibular function tests, video-head-impulse test and the caloric test, are not specific for diagnosis of the disease, but may show alterations that help to evaluate the functional impairment.ObjectiveTo describe the results obtained at the caloric test and video-head-impulse test in patients with definite Meniere's disease and compare them between symptomatic, asymptomatic ears and those of the control group.MethodsCross-sectional and observational study including patients with definite Meniere's disease diagnosed according to the Bárány Society criteria (2015) and healthy individuals (control group) undergoing caloric test and video-head-impulse test. All subjects were assessed by neurotological anamnesis and audiological evaluation (pure-tone, vocal and immittance audiometry) to characterize the sample. The findings obtained at the caloric test and video-head-impulse test were described and compared between the symptomatic and asymptomatic ears of patients with Meniere's disease and those of the control group.ResultsThirty-two patients with definite Meniere's disease were evaluated, with a mean age of 45.7 years, mostly females (68.8%) and unilateral disease. The control group consisted of 20 healthy individuals, with a mean age of 44.7 years, mostly females (70.0%). The groups were homogeneous in relation to age and gender. The patients’ main complaint was vertigo (71.9%), and most patients had more than six episodes in the last six months (71.9%). Moderate sensorineural hearing loss was present in 38.5% of patients. The prevalence of hyporeflexia at the caloric test was higher in symptomatic (56.4%) and asymptomatic (36%) ears of patients with Meniere's disease compared to the ears of control subjects (7.5%), p < 0.001 and p = 0.004, respectively. Video-head-impulse test alterations in the lateral semicircular canals were more frequent in the symptomatic ears of patients with Meniere's disease than in the ears of control subjects (p = 0.026).ConclusionMost patients with definite Meniere's disease showed hyporeflexia at the caloric test and video-head-impulse test with normal function in the symptomatic ear. Vestibular hyporeflexia at the caloric test was more frequent in the symptomatic and asymptomatic ears of patients with Meniere's disease than in the control group. The video-head-impulse test showed more alterations in the lateral semicircular canals.     

非典型眼震表现的良性阵发性位置性眩晕中西医结合治疗

目的:探讨中西医结合治疗非典型眼震表现的良性阵发性位置性眩晕(benign paroxysmal positional vertigo,BPPV)患者的临床疗效。方法:随机将36例非典型眼震表现的良性阵发性位置性眩晕患者分为对照组和治疗组,每组各18例。对照组给予手法复位及一般内科支持治疗,治疗组在对照组治疗基础上结合中医辨证治疗。治疗2周后,分别对2组患者的疗效、眩晕残障程度评定量表(DHI评分)进行比较,并在3个月内随访患者的复发情况。结果:治疗2周后治疗组、对照组的有效率分别为94.45%和61.12%,差异有统计学意义。治疗组眩晕残障程度DHI评分(11.25±2.88),对照组眩晕残障程度DHI评分(19.72±5.31),差异有统计学意义。随访3个月后治疗组复发率为16.67%,对照组复发率为38.89%,差异有统计学意义。结论:应用手法复位结合中医辨证疗法治疗非典型眼震表现的良性阵发性位置性眩晕,可以提高患者临床疗效,改善眩晕残障严重程度并减少手法复位后的复发率。     

疏血通注射液与氟桂利嗪联合治疗椎-基底动脉供血不足性眩晕60例疗效观察

目的观察疏血通注射液与氟桂利嗪联合治疗椎-基底动脉供血不足性眩晕的疗效。方法将60例椎-基底动脉供血不足性眩晕的患者分为两组，观察组患者用疏血通注射液6mL＋生理盐水250mL静脉滴注，配合氟桂利嗪5mg，1日2次，而对照组用复方丹参注射液20mL加入5％葡萄糖注射液或生理盐水250mL静脉滴注。结果治疗组总有效率为86．7％；对照组总有效率为66．7％。两组比较差异有显著性（P〈0．05）。治疗组在纠正血液流变学异常方面，治疗前后比较有统计学意义（P〈0．05）。结论疏血通注射液与氟桂利嗪片联合治疗椎-基底动脉供血不足性眩晕的疗效显著，且副作用少，值得推广使用。