TCD评估针刺百会穴对颈性眩晕椎-基底动脉供血的影响

[目的]观察经颅多普勒(TCD)评估针刺百会穴对颈性眩晕椎-基底动脉供血的影响。[方法]设针刺百会穴治疗组与空白对照组进行对照观察,在TCD显示下,分别记录观察前后椎-基底动脉的血流速度。[结果]治疗组针刺百会穴后其椎-基底动脉血流速度有较明显的改善,而对照组未见明显改变,经统计学处理两组有显著性差异(P<0.05)。[结论]针刺百会穴对颈性眩晕椎-基底动脉供血的改善有较明显的效果。     

Quantification of hearing loss in patients with posterior semicircular canal dehiscence

Conclusion: Patients with posterior semicircular canal dehiscence (PSCD) have low frequency conductive hearing loss similar to patients with superior semicircular canal dehiscence (SSCD) secondary to a pathologic third window. Objectives: PSCD can result in conductive hearing loss, but the magnitude of this hearing loss remains to be quantified. Patients with SSCD have been shown to have low frequency conductive hearing loss. The underlying pathophysiology of hearing loss from PSCD and SSCD is similar and related to a pathologic third window. Method: A PubMed search was completed for a meta-analysis of patients with PSCD. Articles with quality audiograms were obtained. Air conduction thresholds for ears with posterior semicircular canal dehiscence were compared to the opposite ear as well as normal control data. Results: Eight articles with 21 patients with PSCD and quality audiograms were included. Two patients had bilateral PSCD and one of those was excluded because hearing thresholds were at the limit of the audiometer. Patients with posterior semicircular canal dehiscence have statistically significant lower air conduction thresholds in frequencies at and below 2000 Hz.     

半夏白术天麻汤合泽泻汤治疗眩晕痰浊上蒙证34例

目的:观察半夏白术天麻汤合泽泻汤治疗眩晕痰浊上蒙证的临床疗效。方法:将68例就诊于本院的椎-基底动脉供血不足所致痰浊上蒙证眩晕患者随机分为对照组和治疗组各34例。对照组给予西比灵5 mg·次-1,2次·d~(-1),强力定眩片1.4 g,3次·d~(-1),川芎嗪注射液100m L·d~(-1);治疗组在对照组治疗的基础上加用半夏白术天麻汤合泽泻汤治疗,连续治疗1周。结果:治疗组主要症状改善明显优于对照组,证候积分降低程度低于对照组;治疗组有效率为97.1%,对照组有效率为85.3%,两组有效率比较,差异有统计学意义(P0.05);治疗组患者的血液流变改善更为明显,差异有统计学意义(P0.05)。结论:半夏白术天麻汤合泽泻汤加味联合川芎嗪注射液治疗椎-基底动脉供血不足所致痰浊上蒙证眩晕疗效显著。     

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.     

止眩宁对椎-基底动脉供血不足性眩晕患者经颅多普勒超声检查的影响

目的:观察止眩宁胶囊对椎-基底动脉供血不足性眩晕患者经颅多普勒超声检查(简称TCD)的影响。方法:将60例椎-基底动脉供血不足性眩晕患者按随机原则分为两组,包括治疗组(止眩宁胶囊治疗组)30例与对照组(盐酸氟桂利嗪治疗组)30例。结果:治疗组基底动脉(BA)、椎动脉(VA)脑血流速度平均值(Vm)改善率分别为86.7%、90.0%;对照组基底动脉(BA)、椎动脉(VA)脑血流速度平均值(Vm)改善率分别为63.3%、40.0%。结论:止眩宁胶囊对椎-基底动脉血流速度的双向调节作用明显优于盐酸氟桂利嗪对照组。     

缬沙坦氨氯地平片对正常高值血压的疗效临床观察

[背景]观察缬沙坦氨氯地平片对伴有头晕、头痛的正常高值血压的疗效.[病例报告]选择伴有头晕、头痛症状的正常高值血压患者68例,随机分为对照组和治疗组.对照组给予非药物治疗,治疗组给予非药物治疗加缬沙坦氨氯地平片.对照组总有效率为29.4%,治疗组为85.3%,治疗组总有效率明显高于对照组(P<0.01).2组治疗后与同组治疗前比较,对照组收缩压(SBP)和舒张压(DBP)有所降低,但差异无统计学意义(P>0.05);而治疗组SBP和DBP明显降低(P<0.01).2组治疗后相比较,治疗组SBP和DBP明显降低(P<0.01).[讨论]缬沙坦氨氯地平片复方制剂治疗伴有头晕、头痛症状的正常高值血压患者有效.     

慢性主观性头晕(CSD)的人格特征

目的:探讨慢性主观性头晕(Chronic subjective dizziness,CSD)的人格特征。方法:选取48例CSD患者作为实验组,以52例有前庭症状和合并有情绪障碍的慢性头晕患者作为对照组,利用汉密顿焦虑量表(HAMA)、汉密顿抑郁量表(HAMD)、艾森克人格问卷(EPQ)和眩晕功能水平评分量表进行测评。结果:在人口统计学、焦虑和抑郁水平、眩晕功能水平相近的情况下,实验组与对照组在内外向性E存在统计学差异(t=-4.297,P0.001),在神经质N和精神质P上无统计学差异(P0.05)。结论:CSD患者较其他慢性头晕患者的性格偏内向,可能是疾病发展的危险因素。     

Implementation of nurse-delivered vestibular rehabilitation in primary care: a qualitative study of nurses' views on involvement in an innovative service

Aim: To explore practice nurses’ perceptions of vestibular rehabilitation and its place in relation to their general role development. Background: Vestibular rehabilitation has been known for a long time to be effective for chronically dizzy patients in secondary care, but its use in primary care has been limited. A recent pragmatic trial of vestibular rehabilitation delivered by practice nurses in primary care has confirmed its utility in a community setting. This type of role is increasingly common for practice nurses, but few studies explore the nurses’ perspective. Methods: A qualitative study was undertaken; 19 nurses took part in focus group sessions. Participants discussed their views on vestibular rehabilitation and its potential for integration with their existing role. A thematic analysis of the data was undertaken. Findings: Four main themes were identified: creating a unique nursing role; the therapeutic role; responsibility and role boundaries; and time. Nurses were positive about developing extended roles, but sought ways to achieve this without eroding fundamental nursing skills. Vestibular rehabilitation was seen as fulfilling both the need for a distinct nursing identity and professional development. Concerns over responsibility for patient assessment and time management constraints are potential obstacles to overcome in the wider development of this therapy in primary care. Conclusions: Understanding the perspective of nurses will be vital in future development of chronic disease management within primary care. Whilst nurses may be positive about such role expansion, the implementation of services of this type will require clarity about nurses’ responsibilities and flexibility in managing workload. Relevance to clinical practice: Vestibular rehabilitation is simple, low‐tech and appropriate for widespread development in primary care. Nurses wishing to provide vestibular rehabilitation or similar chronic disease management activities will need to work with medical colleagues to define role boundaries.