眩晕疾病的个体化综合治疗

目的:综合应用药物、手术和前庭康复训练治疗眩晕疾病,探讨建立眩晕疾病的个体化综合治疗方案.方法:对158例前庭外周性眩晕患者进行两个阶段个体化综合治疗.根据疾病种类,第一阶段制定个体化治疗方案,选择药物、手术或前庭康复训练作为治疗方法;经治疗后疗效不满意的患者在第二阶段进行前庭功能代偿状态和姿势平衡中的感觉整合缺陷模式评价,据此制订治疗方案,综合应用药物、手术和前庭康复训练作为治疗方法,并根据治疗反应进一步修订综合治疗方案.疗效评价方法包括:前庭症状指数(VSI)、平衡功能(计时平衡试验及海绵垫姿势描记)、眩晕障碍量表(DHI).结果:①VSI结果表明,除头痛症状在治疗前后差异无统计学意义(P>0.05)外,其他5种症状在治疗前后差异均有统计学意义(均P<0.01);②计时平衡试验及海绵垫姿势描记结果均表明治疗前后姿势稳定性提高(均P<0.01);③DHI结果表明,治疗后总DHI平均得分提高了15.97分,治疗前后总DHI得分比较差异有统计学意义(P<0.01),且DHI 3个方面的治疗前后得分比较有统计学意义(均P<0.01);④本组所有患者整体有效率为91.14%.结论:在眩晕疾病治疗中,应针对眩晕疾病病因、前庭中枢代偿状态、感觉整合缺陷类型,制定患者的个体化综合治疗方案,综合应用药物、手术及康复训练等手段治疗眩晕患者.

Individualized integrated therapy on patients with vertigo

Objective:To explore the treatment of patients with vertigo by the integrated therapy including the drug,surgery and rehabilitation exercise and to investigate the establishment of individualized integrated therapy on patients with vertigo.Method:One hundred and fifty-eight patients with peripheral vestibular vertigo were taken the individualized integrated therapy of vertigo(IITV).In first step of IITV,according to the etiology of vertigo,the therapy protocols were personally designed including drug,surgery or rehabilitation exercise.In second step of IITV,the patients who did not achieve effective treatment were followed-up and status of vestibular compensation and model of sensory organization in stance balance were re-evaluated.Then,the adjusted therapy protocol was designed by using drug,surgery or rehabilitation exercise comprehensively.The outcome assessment methods included the vestibular symptom index(VSI),balance assessment and dizziness handicap inventory(DHI).Result:The result of VSI showed that there were significant difference(P<0.01) between the post-therapy and pre-therapy in the symptoms except the headache.Both results of timed balance test and foam posturography showed that the postural stability was improved after IITV(P<0.01).The total DHI score improved 15.97 after therapy and there were significant difference(P<0.01) of total DHI score between the post-therapy and pre-therapy.The total effective rate of IITV was 91.14% in these patients with vertigo.Conclusion:To treat patients with vertigo effectively,it was necessary to design the individualized integrated therapy protocol which applied the methods of drug,surgery and rehabilitation exercise comprehensively on the base of etiology of vertigo,status of vestibular compensation and model of sensory organization.