Effect of triple therapy combined with betahistine in treating residual dizziness of patients with benign paroxysmal positional vertigo after repositioning
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摘要:目的
评价三联疗法联合倍他司汀对耳石症复位后残余头晕患者大脑血液循环、皮肤交感反应(SSR)的影响。
方法将196例耳石症复位后残余头晕患者随机分为2组，每组98例。对照组采取倍他司汀治疗，实验组接受倍他司汀联合三联疗法(复合手法、经颅磁刺激及特定体位)，以7 d为1个疗程，治疗2个疗程。比较2组疗效，残余头晕持续时间，治疗前及疗程结束后眩晕障碍量表(DHI)、视觉模拟评分法(VAS)、活动平衡信心量表(ABC)、汉密尔顿焦虑量表(HAMA)、前庭症状指数(VSI)评分，以及SSR与大脑椎动脉(VA)、基底动脉(BA)的血液平均流速(Vm)值。
结果实验组残余头晕持续时间为(10.25±3.74) d, 短于对照组的(15.26±2.98) d, 差异有统计学意义(P < 0.001); 实验组治疗总有效率为93.88%, 高于对照组的79.59%, 差异有统计学意义(P < 0.05)。实验组疗程结束后DHI的3个维度评分均低于对照组，差异有统计学意义(P < 0.05)。实验组疗程结束后VAS、HAMA、VSI评分低于对照组, ABC评分高于对照组，差异有统计学意义(P < 0.05)。实验组疗程结束后SSR波幅值低于对照组, SSR潜伏期值高于对照组，差异有统计学意义(P < 0.05)。实验组疗程结束后VA、BA的Vm值高于对照组，差异有统计学意义(P < 0.05)。
结论三联疗法联合倍他司汀对耳石症复位后残余头晕疗效确切，可减轻眩晕、前庭症状，提高患者活动平衡信心，降低焦虑程度，改善SSR与大脑血流循环。
Abstract:ObjectiveTo evaluate the effects of triple therapy combined with betahistine on cerebral blood circulation and cutaneous sympathetic response (SSR) in patients with residual dizziness after reposition of benign paroxysmal positional vertigo.
MethodsA total of 196 patients with residual dizziness after reposition of benign paroxysmal positional vertigo were randomly divided into two groups, with 98 cases in each group. Control group was treated with betahistine, while experimental group was treated with betahistine and triple therapy (compound manipulation, transcranial magnetic stimulation and specific body position), and both groups were treated for 2 courses of treatment, with 7 days as a course of treatment. Efficacy, duration of residual dizziness, the scores of the Dizziness Handicap Inventory (DHI), the Visual Analogue Scale (VAS), the Activity Balance Confidence (ABC), the Hamilton Anxiety Scale (HAMA) and the Vestibular Symptom Index (VSI) before treatment and after the course of the treatment, SSR, and values of mean blood flow velocity (Vm) of cerebral vertebral artery (VA) and basilar artery (BA) were compared between the two groups.
ResultsThe duration of residual dizziness in the experimental group was (10.25±3.74) days, which was significantly shorter than (15.26±2.98) days in the control group (P < 0.001); the total treatment effective rate of the experimental group was 93.88%, which was significantly higher than 79.59% of the control group (P < 0.05). At the end of the course, the scores of the three dimensions of the DHI in the experimental group were significantly lower than those in the control group (P < 0.05). At the end of the course, the VAS, the HAMA and the VSI scores in the experimental group were significantly lower than those in the control group, while the ABC score was significantly higher than that in the control group (P < 0.05). At the end of the course, the SSR amplitude value in the experimental group was significantly lower than that in the control group, while the SSR latency value was significantly higher than that in the control group (P < 0.05). At the end of the course, the values of Vm of VA and BA in the experimental group were significantly higher than those in the control group (P < 0.05).
ConclusionThe combination of triple therapy and betahistine has a definite therapeutic effect on residual dizziness after reposition of benign paroxysmal positional vertigo, which can alleviate dizziness and vestibular symptoms, enhance activity balance confidence, relieve anxiety degree, and improve SSR and cerebral blood circulation.
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表 1 2组一般资料比较($\mathop x\limits^ - $±s)
一般资料 分类 对照组(n=98) 实验组(n=98) 性别 男 54 50 女 44 48 年龄/岁 44.72±4.16 43.85±4.35 体质量指数/(kg/m2) 23.16±2.48 22.81±2.34 病程/d 3.35±0.84 3.29±0.74 病变侧别 左侧 50 54 右侧 48 44 受累半规管 后半规管 70 66 水平半规管 26 22 前半规管 2 10 
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表 2 2组临床疗效比较[n(%)]
组别 n 临床缓解 显效 进步 无效 总有效 对照组 98 6(6.12) 26(26.53) 46(46.94) 20(20.41) 78(79.59) 实验组 98 16(16.33) 28(28.57) 48(48.98) 6(6.12) 92(93.88)* 与对照组比较, *P<0.05。
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表 3 2组DHI评分比较($\mathop x\limits^ - $±s)
分 组别 n 情感评分 躯体评分 功能评分 治疗前 疗程结束后 治疗前 疗程结束后 治疗前 疗程结束后 对照组 98 23.26±3.84 15.35±2.65* 21.05±2.65 16.11±2.85* 20.35±3.58 15.56±2.02* 实验组 98 23.16±4.11 10.46±2.38*# 20.74±2.46 10.32±2.41*# 20.42±4.28 10.49±3.32*# DHI: 眩晕障碍量表。与治疗前比较, *P < 0.05; 与对照组比较, #P < 0.05。
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表 4 2组VAS、ABC、HAMA及VSI评分比较($\mathop x\limits^ - $±s)
分 组别 VAS评分 ABC评分 HAMA评分 VSI评分 治疗前 疗程结束后 治疗前 疗程结束后 治疗前 疗程结束后 治疗前 疗程结束后 对照组(n=98) 6.43±1.52 3.58±1.06* 40.56±7.98 70.25±8.45* 22.56±4.25 14.35±3.65* 30.15±3.59 17.46±4.26* 实验组(n=98) 6.33±1.45 1.78±0.89*# 41.28±7.98 87.46±10.05*# 22.74±4.03 8.46±1.64*# 30.58±4.25 12.03±3.58*# VAS: 视觉模拟评分法; ABC: 活动平衡信心量表; HAMA: 汉密尔顿焦虑量表; VSI: 前庭症状指数量表。
与治疗前比较, *P < 0.05; 与对照组比较, #P < 0.05。
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表 5 2组SSR检测结果比较($\mathop x\limits^ - $±s)
组别 n SSR波幅值/mV SSR潜伏期值/ms 治疗前 疗程结束后 治疗前 疗程结束后 对照组 98 2.11±0.24 1.67±0.22* 1.49±0.15 1.64±0.27* 实验组 98 2.05±0.26 1.37±0.28*# 1.47±0.17 1.99±0.31*# SSR: 皮肤交感反应。与治疗前比较, *P < 0.05; 与对照组比较, #P < 0.05。
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表 6 2组VA、BA的Vm值比较($\mathop x\limits^ - $±s)
cm/s 组别 n VA BA 治疗前 疗程结束后 治疗前 疗程结束后 对照组 98 17.46±3.65 29.65±5.52* 21.46±4.98 28.46±5.63* 实验组 98 18.21±3.94 35.48±5.85*# 20.48±4.86 34.98±5.74*# VA: 大脑椎动脉; BA: 基底动脉; Vm: 血液平均流速。与治疗前比较, *P < 0.05; 与对照组比较, #P < 0.05。
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