重复经颅磁刺激对良性阵发性位置性眩晕伴睡眠障碍的疗效

Effect of repetitive transcranial magnetic stimulation on sleep disorders in patients with benign paroxysmal positional vertigo

摘要:

目的 探讨重复经颅磁刺激（rTMS）对良性阵发性位置性眩晕（BPPV）患者伴睡眠障碍的疗效。方法 纳入在上海中医药大学附属市中医医院治疗的BPPV合并睡眠障碍患者（270例）作为研究对象。随机分为对照组（134例）和观察组（136例）。2组患者均给予耳石复位联合盐酸倍他司汀治疗，观察组在此基础上给予rTMS，均治疗4周。于治疗前后，采用匹兹堡睡眠质量指数量表（PSQI）评价患者睡眠情况，汉密尔顿抑郁量表-17（HAMD-17）评价患者抑郁程度，眩晕障碍量表（DHI）评价眩晕程度。比较2组的临床总疗效。结果 治疗前2组患者的PSQI、HAMD-17、DHI评分差异无统计学意义（P>0.05）。治疗后2组患者的PSQI、HAMD及DHI评分显著低于治疗前，且观察组患者的PSQI、HAMD-17及DHI评分显著低于对照组（P<0.05）。观察组临床总有效率（86.8%）高于对照组（53.0%）（P<0.05）。结论 rTMS联合耳石复位及盐酸倍他司汀能有效改善BPPV患者的睡眠障碍及抑郁情绪，疗效高于单独应用耳石复位联合盐酸倍他司汀治疗。

Abstract:

Objective To investigate the clinical effect of repetitive transcranial magnetic stimulation （rTMS） in the treatment of sleep disorders in patients with benign paroxysmal positional vertigo （BPPV）.Methods A total of 270 patients with BPPV and sleep disorders who were treated in Shanghai Municipal Hospital of Traditional Chinese Medicine were enrolled as subjects and were randomly divided into control group with 134 patients and observation group with 136 patients. The patients in both groups were given canalith repositioning maneuver combined with betahistine， and in addition， those in the observation group were given rTMS； the course of treatment was 4 weeks for both groups. Before and after treatment， Pittsburgh Sleep Quality Scale （PSQI） was used to assess the sleep status of patients， Hamilton Depression Scale-17 （HAMD-17） was used to evaluate the degree of depression， and Dizziness Handicap Inventory （DHI） was used to assess the degree of dizziness. Overall treatment response was compared between the two groups.Results Before treatment， there were no significant differences in PSQI， HAMD， and DHI scores between the two groups （P>0.05）. After treatment， both groups had significant reductions in PSQI， HAMD-17， and DHI scores， and the observation group had significantly lower PSQI， HAMD， and DHI scores than the control group （P<0.05）. The observation group had a significantly higher overall response rate than the control group （86.8% vs 53.0%， P<0.05）.Conclusions rTMS combined with canalith repositioning maneuver and betahistine can effectively improve sleep disorders and depression in BPPV patients， with a better clinical effect than canalith repositioning maneuver combined with betahistine.