老年良性阵发性位置性眩晕中医临床特点分析

目的 :分析老年良性阵发性位置性眩晕(BPPV)的中医临床特点,为BPPV中医辨证施治及个体化防治提供证据。方法:连续采集2013年12月~2015年3月在新疆医科大学第四附属医院门诊就诊的BPPV患者92例,回顾整理患者的一般资料,比较不同病变位置、不同中医证型患者一般资料的差异,根据差异总结老年BPPV的中医临床特点。结果:收集的92例BPPV患者以后半规管病变者数量最多(65例);混合型半规管病变患者中合并冠心病与脑血管病的比例均高于后半规管病变患者,差异有统计学意义(与后半规管病变组合并冠心病人数比较P=0.008,与后半规管病变组合并脑血管病人数比较P=0.039);中医证型方面,痰湿壅盛证患者最多,阴阳两虚证患者最少;病程方面,阴阳两虚证组患者中病程大于3年者占57.14%,明显高于肝火亢盛与痰湿壅盛证组,差异有统计学意义(与肝火亢盛证组比较P=0.017,与痰湿壅盛证组比较P=0.001)。结论:老年BPPV以痰湿壅盛及阴虚阳亢证为多,并以后半规管病变为主,阴阳两虚证患者病程较长,混合型病变患者合并心脑血管病变情况更普遍,说明本病具有早期实邪为主、中期虚实夹杂、晚期脏腑阴阳俱虚、久病多虚多瘀的病机特点。

Analysis on Traditional Chinese Medicine Clinical Characteristics of Benign Paroxysmal Positional Vertigo in Elder Patients

Objective:To analyze the traditional Chinese medicine(TCM) characteristics of benign paroxysmal positional vertigo(BPPV) in elder patients,so as to provide evidence for TCM treatment based on syndrome differentiation and individual control of BPPV. Methods:A total of 92 cases of BPPV patients in outpatient of the fourth affiliated hospital of Xinjiang medical university from December 2013 to March 2015 were collected and their general medical data was retrospected and analyzed. According to the differences of the general information of patients with different lesion location and different TCM syndromes,the TCM clinical characteristics of BPPV in elderly patients were summarized. Results:In the 92 cases,65 had lesion on posterior semicircular canal. The ratio of coronary heart disease and cerebrovascular disease in patients with mixed semicircular canal lesion was higher than in those with posterior semicircular canal lesion. The difference was statistically significant(compared with patients with posterior semicircular canal lesion and coronary heart disease,P =0.008. Compared with patients with posterior semicircular canal lesion and cerebrovascular disease disease,P =0.039). For TCM syndromes,the number of patients with phlegm- dampness accumulation was the largest and the number of patients with Yin and Yang deficiency was the smallest. For course of disease,in the Yin and Yang deficiency group,patients whose course of disease was more than 3 years accounted for 57.14%,which was significantly higher than that in the liver- fire excess syndrome group and phlegm- dampness accumulation syndrome group. The difference was statistically significant(compared with the liver- fire excess syndrome group,P =0.017. Compared with the phlegm- dampness accumulation syndrome group,P =0.001). Conclusion:Most of the BBPV in elder patients are phlegm- dampness accumulation syndrome and Yin deficiency and Yang excess syndrome. Posterior semicircular canal lesion is the main lesion. Patients with deficiency of both Yin and Yang syndrome have longer course of disease.Patients with mixed lesions on semicircular canal often merge cardiovascular and cerebrovascular disease. All the above show the pathogenesis characteristics of the disease:the early stage is predominated by excessive evil,the middle stage has intermingled deficiency and excess syndrome,the Yin and Yang of viscera is deficient in the later stage and long illness results in deficiency and blood stasis.