切换至 "中华医学电子期刊资源库"
高级检索
中华脑科疾病与康复杂志(电子版)

中华脑科疾病与康复杂志(电子版) ›› 2021, Vol. 11 ›› Issue (03) : 164 -167. doi: 10.3877/cma.j.issn.2095-123X.2021.03.007

临床研究

医联体模式下良性阵发性位置性眩晕诊疗方案优化疗效评估
王崇1,†(), 王建明1, 董海燕1   
  1. 1. 224700　江苏盐城，南通大学附属建湖医院神经内科
  • 收稿日期:2021-04-25 出版日期:2021-06-15
  • 通信作者: 王崇
  • 基金资助:
    盐城市医学科技发展计划项目(YK2019077); 南通大学临床医学专项(2019LY041)

Evaluation on the effect of optimizing diagnosis and treatment scheme of BPPV under medical integration mode

Chong Wang1,†(), Jianming Wang1, Haiyan Dong1   

  1. 1. Department of Neurology, Jianhu Hospital Affiliated to Nantong University, Yancheng 224700, China
  • Received:2021-04-25 Published:2021-06-15
  • Corresponding author: Chong Wang
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

王崇, 王建明, 董海燕. 医联体模式下良性阵发性位置性眩晕诊疗方案优化疗效评估[J]. 中华脑科疾病与康复杂志(电子版), 2021, 11(03): 164-167.

Chong Wang, Jianming Wang, Haiyan Dong. Evaluation on the effect of optimizing diagnosis and treatment scheme of BPPV under medical integration mode[J]. Chinese Journal of Brain Diseases and Rehabilitation(Electronic Edition), 2021, 11(03): 164-167.

目的

探讨医联体条件下良性阵发性位置性眩晕（BPPV）诊疗方案优化效果，为BPPV诊治提供参考。

方法

选择自2018年1月至2019年12月由医联体单位诊治后在南通大学附属建湖医院神经内科确诊的55例BPPV患者为优化前组，自2020年1月至12月由南通大学附属建湖医院神经内科对医联体单位多次组织培训后（即流程优化后）诊治的55例BPPV患者为优化后组。比较2组患者的基线资料，治疗前后眩晕障碍量表（DHI）总分、情感、躯体、功能，以及焦虑和抑郁情况。

结果

2组患者的性别、年龄、高血压、糖尿病、低密度脂蛋白、胆固醇、睡眠障碍情况对比，差异均无统计学意义（P>0.05），病程中位数[8（7，13）、7（5，9）d]、复位次数[3（2，4）、2（2，3）次]、费用[（3157.53±1077.49）、（338.51±60.50）元]对比差异均有统计学意义（P<0.05）。2组患者复位前DHI总分、情感、躯体、功能以及HADS焦虑和抑郁总分比较差异均无统计学意义（P>0.05），复位后2组分值均较复位前明显变小，差异均有统计学意义（P<0.05）。优化后组复位后HADS-焦虑评分小于优化前组，差异具有统计学意义（P<0.05），余指标差异均无统计学意义（P>0.05）。

结论

医联体模式下良性阵发性位置性眩晕诊疗方案优化有利于患者诊治。

关键词: 良性阵发性位置性眩晕, 医联体, 诊疗方案
Objective

To explore the feasibility and effectiveness of optimizing diagnosis and treatment process of BPPV under medical integration mode.

Methods

From January 2018 to December 2019, 55 patients with BPPV diagnosed in the Department of Neurology of Jianhu Hospital Affiliated to Nantong University were selected as the pre-process optimization group. From January 2020 to December 2020, 55 patients with BPPV diagnosed and treated after many trainings organized by the medical association unit (after process optimization) were selected as the post-process optimization group. The baseline data, total score of DHI, DHI-emotion, DHI-body, DHI-function, HADS-anxiety and depression were compared between the two groups.

Results

There was no significant difference in gender, age, hypertension, diabetes, low density lipoprotein cholesterol, sleep disturbance between the 2 groups (P>0.05), and the median duration [8 (7, 13), 7(5, 9) d], reduction times [3(2, 4), 2(2, 3) times] and cost comparison [(3157.53±1077.49), (338.51±60.50) yuan] were statistically significant (P<0.05). There was no significant difference in the total scores of DHI, DHI-emotion, DHI-body, DHI-function, HADS-anxiety and depression between the two groups before reduction (P>0.05), but the scores of the two groups after reduction were significantly smaller than those before reduction (P<0.05). After reduction, the HADS-anxiety scores of the two groups were lower in the optimized group than in the pre-optimized group, and the difference was statistically significant (P<0.05), but there was no significant difference in other indexes (P>0.05).

Conclusion

Optimization of diagnosis and treatment scheme for BPPV under medical integration mode is beneficial to the BPPV patients.

Key words: Benign paroxysmal positional vertigo, Medical association, Diagnosis and treatment plan
表1 优化前组和优化后组患者的基线资料比较
资料 优化前组（n=55） 优化后组（n=55） t/Z/χ2值 P值
男性 19（34.5%） 25（45.5%） -1.364 0.240
年龄（岁） 64.60±7.13 63.64±8.34 0.651 0.074
病程（d） 8（7，13） 7（5，9） 4.002 <0.001
费用（元） 3157.53±1077.49 338.51±60.50 19.379 <0.001
高血压 6（10.9%） 9（16.4%） -0.695 0.405
糖尿病 11（18.3%） 10（18.2%） 0.000 0.983
低密度脂蛋白（mmol/L） 1.94±0.47 2.03±0.49 -0.934 0.769
胆固醇（mmol/L） 4.13±0.99 4.00±1.09 0.667 0.635
复位次数（次） 3（2，4） 2（2，3） 2.535 0.011
睡眠障碍 22（30.6%） 20（36.4%） 0.475 0.491
表2 2组患者的DHI和HADS评分比较（分，Mean±SD）
评分 优化前组（n=55） 优化后组（n=55）
复位前 复位后 t值 P值 复位前 复位后 t值 P值
DHI总分 45.31±6.94 9.89±3.14 34.484 <0.001 43.24±7.24 9.34±3.67 30.971 <0.001
DHI-情感 9.16±4.12 3.64±2.04 8.913 <0.001 9.42±4.14 3.35±2.07 9.726 <0.001
DHI-躯体 15.96±3.93 2.51±1.50 23.694 <0.001 14.80±3.58 2.32±1.62 23.524 <0.001
DHI-功能 20.18±4.41 3.75±2.28 24.556 <0.001 19.01±4.35 3.67±2.30 23.114 <0.001
HADS-焦虑 9.54±3.88 6.80±2.97 4.162 0.001 9.18±3.49 4.85±2.09a 7.883 0.001
HADS-抑郁 6.36±2.53 3.80±2.09 5.804 0.001 6.11±2.14 3.89±1.95 5.669 0.001
[1]
Lou Y, Cai M, Xu L, et al. Efficacy of BPPV diagnosis and treatment system for benign paroxysmal positional vertigo[J]. Am J Otolaryngol, 2020, 41(3): 102412.
[2]
吴沛霞,刘建平,王武庆,等.良性阵发性位置性眩晕患者复位后残余症状的干预策略:单中心随机对照试验[J].中华耳鼻咽喉头颈外科杂志, 2021, 56(1): 41-46.
[3]
von Brevern M, Bertholon P, Brandt T, et al. Benign paroxysmal positional vertigo: diagnostic criteria[J]. J Vestib Res, 2015, 25(3-4): 105-117.
[4]
丁雷,刘畅,王嘉玺,等.眩晕残障程度评定量表(中文版)的评价[J].中华耳科学杂志, 2013, 11(2): 228-230.
[5]
Zamyslowska-Szmytke E, Politanski P, Jozefowicz-Korczynska M. Dizziness handicap inventory in clinical evaluation of dizzy patients[J]. Int J Environ Res Public Health, 2021, 18(5): 2210.
[6]
Traboulsi H, Teixido M. BPPV viewer: a downloadable 3D BPPV model for study of otolith disease[J]. World J Otorhinolaryngol Head Neck Surg, 2021, 7(1): 34-39.
[7]
陈哲,彭新,刘金梅,等.多半规管良性阵发性位置性眩晕仪器辅助诊疗效果分析[J].北京医学, 2017, 39(8): 766-769.
[8]
Gonzalez-Aguado R, Domenech-Vadillo E, Alvarez-Morujo de Sande MG, et al. Subjective benign paroxysmal positional vertigo in patients with osteoporosis or migraine[J]. Braz J Otorhinolaryngol, 2020, 86(1): 83-90.
[9]
Choi HG, Song YS, Wee JH, et al. Analyses of the relation between BPPV and thyroid diseases: a nested case-control study[J]. Diagnostics (Basel), 2021, 11(2): 329.
[10]
Fu CY, Zhang ZZ, Chen J, et al. Unhealthy lifestyle Is an important risk factor of idiopathic BPPV[J]. Front Neurol, 2020, 11: 950.
[11]
Kim SK, Hong SM, Park IS, et al. Mood disorders are associated with increased risk of BPPV: a national sample cohort[J]. Laryngoscope, 2021, 131(2): 380-385.
[12]
Zhu C, Li Y, Ju Y, et al. Dizziness handicap and anxiety depression among patients with benign paroxysmal positional vertigo and vestibular migraine[J]. Medicine (Baltimore), 2020, 99(52): e23752.
[13]
Gunes A, Yuzbasioglu Y. Effects of treatment on anxiety levels among patients with benign paroxysmal positional vertigo[J]. Eur Arch Otorhinolaryngol, 2019, 276(3): 711-718.
[14]
刘明勇,周立春.特发性良性阵发性位置性眩晕患者发病前焦虑抑郁情况的调查[J].中华神经科杂志, 2017, 50(5): 358-361.
[15]
Kahraman SS, Arli C, Copoglu US, et al. The evaluation of anxiety and panic agarophobia scores in patients with benign paroxysmal positional vertigo on initial presentation and at the follow-up visit[J]. Acta Otolaryngol, 2017, 137(5): 485-489.
[16]
钱淑霞,李斐,庄建华,等.良性阵发性位置性眩晕的误诊及其关联成本分析[J].中华医学杂志, 2017, 97(14): 1057-1060.
[1] 梁柳婵, 陈坤, 秦碧蕉, 吴祖爱, 张宁, 贺红英. 改良单孔腹腔镜卵巢囊肿剔除在基层医联体的推广应用[J]. 中华腔镜外科杂志(电子版), 2020, 13(02): 108-112.
[2] 刘宇鹏, 杨荣利, 万献尧. 重型新型冠状病毒肺炎的临床决策与思考[J]. 中华重症医学电子杂志, 2020, 06(03): 329-334.
[3] 王家健, 章雷, 陶然, 杨万丰, 雷秀明, 夏宇跃, 马骥, 张威, 余银辉, 李舒贝, 刘洪芳, 苏文芳, 陈建波, 任健康, 孙爱宝, 汪垚. 从化检验专科医联体在分级诊疗中的作用初探[J]. 中华临床实验室管理电子杂志, 2017, 05(03): 141-145.
[4] 楼跃, 徐良国, 蔡苗, 王晏雯, 张思然, 刘小利. 眩晕诊疗系统在老年良性阵发性位置性眩晕诊治中的应用[J]. 中华老年病研究电子杂志, 2019, 06(04): 18-22.
[5] 史红娟, 郝冬琳, 毛伦林. 倍他司汀联合Brandt-Daroff习服训练治疗主观性良性阵发性位置性眩晕的疗效观察[J]. 中华卫生应急电子杂志, 2018, 04(06): 354-357.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号