良性阵发性位置性眩晕的耳石复位手法：家庭医疗中的随机对照试验
Canalith repositioning maneuver for benign paroxysmal positional vertigo: randomized controlled trial in family practice.
作者信息
Munoz Juan E, Miklea Jonel T, Howard Michelle, Springate Russ, Kaczorowski Janusz
机构信息
Department of Family Medicine, McMaster University, McMaster Family Practice, 690 Main St W, Suite A, Hamilton, ON L8S 1A4.
出版信息
Can Fam Physician. 2007 Jun;53(6):1049-53, 1048.
OBJECTIVE
To determine whether the canalith repositioning maneuver (CRM) is effective for treating benign paroxysmal positional vertigo when it is used by family physicians in primary care settings.
DESIGN
Randomized, prospective, double-blind, sham-controlled trial.
SETTING
An academic family practice in Hamilton, Ont.
PARTICIPANTS
Eighty-one patients 18 years or older whose dizziness was confirmed by the Dix-Hallpike (DH) vertigo-triggering maneuver and who had no contraindications to the CRM.
INTERVENTIONS
At the first visit, the intervention group received the CRM and the control group received a sham maneuver. Both groups received the CRM at the second and third visits 1 and 2 weeks later.
MAIN OUTCOME MEASURES
Negative results of the DH test or self-reported resolution of vertigo after the initial treatment.
RESULTS
Eighty-one patients were randomized and received the first treatment. After the first treatment, 34.2% of patients in the intervention group and 14.6% of patients in the control group had negative DH test results (relative risk 2.3, 95% confidence interval 1.03 to 5.2, P = .04); and 31.6% of patients in the intervention group and 24.4% of patients in the control group reported resolution of dizziness (relative risk 1.2, 95% confidence interval 0.7 to 1.9, P = .48). One week later, patients in both intervention and control groups received the CRM, and 61.8% and 57.1% of them, respectively, had negative DH test results (P = .81). By week 3, approximately 75% of patients in both groups had improved.
CONCLUSION
A statistically significant proportion of patients in the CRM group returned to a negative response to the DH maneuver immediately after the first treatment. Family physicians can use the CRM to treat benign paroxysmal positional vertigo and potentially avoid delays in treatment and unnecessary referrals.
TRIAL REGISTRATION NUMBER
NCT00182273 (ClinicalTrials.gov).
目的
确定在基层医疗环境中，家庭医生使用耳石复位手法（CRM）治疗良性阵发性位置性眩晕是否有效。
设计
随机、前瞻性、双盲、假手术对照试验。
地点
安大略省汉密尔顿的一家学术性家庭医疗诊所。
参与者
81名18岁及以上的患者，其头晕经Dix-Hallpike（DH）眩晕诱发手法确诊，且无CRM治疗的禁忌证。
干预措施
首次就诊时，干预组接受CRM，对照组接受假手法。两组在1周和2周后的第二次和第三次就诊时均接受CRM。
主要观察指标
初始治疗后DH试验结果为阴性或自我报告眩晕症状缓解。
结果
81名患者被随机分组并接受首次治疗。首次治疗后，干预组34.2%的患者和对照组14.6%的患者DH试验结果为阴性（相对危险度2.3，95%置信区间1.03至5.2，P = .04）；干预组31.6%的患者和对照组24.4%的患者报告头晕症状缓解（相对危险度1.2，95%置信区间0.7至1.9，P = .48）。1周后，干预组和对照组患者均接受CRM，分别有61.8%和57.1%的患者DH试验结果为阴性（P = .81）。到第3周时，两组中约75%的患者病情有所改善。
结论
CRM组中相当比例的患者在首次治疗后立即对DH手法恢复阴性反应。家庭医生可以使用CRM治疗良性阵发性位置性眩晕，并可能避免治疗延误和不必要的转诊。
试验注册号
NCT00182273（ClinicalTrials.gov）。
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