基于良性阵发性位置性眩晕患者临床症状特点的快速筛查问卷研究
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摘要
目的:探讨基于良性阵发性位置性眩晕(BPPV)主观症状的基本特征并据此设计快速筛查问卷的可行性。方法:纳入以头晕为主诉的患者276例,除去参与问卷修订的48例患者和诊断意见不一致的9例患者,纳入问卷信度和效度评价的有效问卷219例。依据BPPV诊断标准,分为BPPV组和非BPPV组。①所有患者均填写以位置性头晕症状为基准的调查问卷,并比较组间差异。②问卷的信度评价采用重测信度和克朗巴赫α系数;内容效度采用专家判断法,结构效度采用因子分析。结果:①信度及效度检验:问卷重测信度为0.945;内部一致性分析克朗巴赫α系数0.649;结构效度KMO值为0.720;特征根>0.9的因子2个,累积贡献率为61.2%。②问卷题目分析:头晕多为起床/躺下/翻身时发生者BPPV组78例(94.0%),非BPPV组57例(41.9%),两组间差异有统计学意义(P<0.01);头晕时有天旋地转感者BPPV组82例(98.8%),非BPPV组96例(70.6%),两组间差异有统计学意义(P<0.01);头晕/眩晕持续小于1min者BPPV组65例(78.3%),非BP-PV组53例(39.0%),两组间差异有统计学意义(P<0.01);头晕发作期听力下降或耳鸣者BPPV组8例(9.6%),非BPPV组31例(22.8%),两组间差异有统计学意义(P<0.05);头晕发作时意识清楚者BPPV组79例(95.2%),非BPPV组128例(94.1%),两组之间比较差异无统计学意义(P>0.05)。结论:该问卷具有临床实用性,可用于头晕患者中BPPV的快速筛查。
Objective:To fomulate a rapid screening questionnaire for benign paroxysmal positional vertigo(BPPV)according to the symptoms of patients with BPPV.Method:A total of 276 patients with dizziness participated in this study,and 219 cases were included in the questionnaire validity evaluation except for 48 patients who participated in the revision of the questionnaire and 9 patients with inconsistent diagnosis.Subjects were divided into BPPV group and non-BPPV group according to the diagnostic criteria.①All patients completed questionnaires based on positional dizziness,and the differences between the two groups were compared.②Reliability test adopted test-retest reliability and Cronbach'sαcoefficient;content validity adopted expert judgment method,and structural validity adopted factor analysis.Result:①Reliability test:test-retest reliability was 0.945,Cronbach'sαcoefficient was 0.649.Validity test:KMO value was 0.720.Two factors were used with a characteristic root of higher than 0.9.The total cumulative contribution rate was 61.2%.②Results of the questionnaire:The patients who developed dizziness when getting up/down or turning over in bed,accounted for 78(94.0%)in the BPPV group and 57(41.9%)in the non-BPPV group,with a statistical difference(P<0.01).In the cases of vertigo,there were 82 cases(98.8%)in the BPPV group and 96 cases(70.6%)in the non-BPPV group,with a statistical difference(P<0.01).There were 65 cases(78.3%)in the BPPV group and 53 cases(39.0%)in the non-BPPV group with dizziness/vertigo attack time less than 1 minute,with a statistical difference(P<0.01).Patients who had hearing loss or tinnitus during the dizziness episode accounted for 8(9.6%)in the BPPV group and 31(22.8%)in the non-BPPV group,with a statistically difference(P<0.05).The patients with consciousness during dizziness episode were in 79 patients(95.2%)in the BPPV group and 128 patients(94.1%)in the non-BPPV group,with no statistical difference(P>0.05).Conclusion:This questionnaire has clinical applicability and can be used for rapid differential screening of BPPV in patients with dizziness.
Objective:To fomulate a rapid screening questionnaire for benign paroxysmal positional vertigo(BPPV)according to the symptoms of patients with BPPV.Method:A total of 276 patients with dizziness participated in this study,and 219 cases were included in the questionnaire validity evaluation except for 48 patients who participated in the revision of the questionnaire and 9 patients with inconsistent diagnosis.Subjects were divided into BPPV group and non-BPPV group according to the diagnostic criteria.①All patients completed questionnaires based on positional dizziness,and the differences between the two groups were compared.②Reliability test adopted test-retest reliability and Cronbach'sαcoefficient;content validity adopted expert judgment method,and structural validity adopted factor analysis.Result:①Reliability test:test-retest reliability was 0.945,Cronbach'sαcoefficient was 0.649.Validity test:KMO value was 0.720.Two factors were used with a characteristic root of higher than 0.9.The total cumulative contribution rate was 61.2%.②Results of the questionnaire:The patients who developed dizziness when getting up/down or turning over in bed,accounted for 78(94.0%)in the BPPV group and 57(41.9%)in the non-BPPV group,with a statistical difference(P<0.01).In the cases of vertigo,there were 82 cases(98.8%)in the BPPV group and 96 cases(70.6%)in the non-BPPV group,with a statistical difference(P<0.01).There were 65 cases(78.3%)in the BPPV group and 53 cases(39.0%)in the non-BPPV group with dizziness/vertigo attack time less than 1 minute,with a statistical difference(P<0.01).Patients who had hearing loss or tinnitus during the dizziness episode accounted for 8(9.6%)in the BPPV group and 31(22.8%)in the non-BPPV group,with a statistically difference(P<0.05).The patients with consciousness during dizziness episode were in 79 patients(95.2%)in the BPPV group and 128 patients(94.1%)in the non-BPPV group,with no statistical difference(P>0.05).Conclusion:This questionnaire has clinical applicability and can be used for rapid differential screening of BPPV in patients with dizziness.
引文
[1]PARKER I G,HARTEL G,PARATZ J,et al.A Systematic Review of the Reported Proportions of Diagnoses for Dizziness and Vertigo[J].Otol Neurotol,2019,40:6-15.
[2]中华耳鼻咽喉头颈外科杂志编辑委员会,中华医学会耳鼻咽喉头颈外科学分会.良性阵发性位置性眩晕诊断和治疗指南(2017)[J].中华耳鼻咽喉头颈外科杂志,2017,52(3):173-177.
[3]NEUHAUSER H K,RADTKE A,VON BREVERNM,et al.Burden of dizziness and vertigo in the community[J].Arch Int Med,2008,168:2118-2124.
[4]WU C L,WANG F T,CHIANG Y C,et al.Unplanned emergency department revisits within 72hours to a secondary teaching referral hospital in Taiwan[J].J Emerg Med,2010,38:512-517.
[5]ROYL G,PLONER C,LEITHNER C.Dizziness in the emergency room:diagnoses and misdiagnoses[J].Eur Neurol,2011,66:256-263.
[6]POLENSEK S H,TUSA R.Unnecessary diagnostic tests often obtained for benign paroxysmal positional vertigo[J].Med Sci Monit,2009,15:MT89-94.
[7]BHATTACHARYYA N,GUBBELS S P,SCHWAR-TZ S R.Clinical Practice Guideline:Benign Paroxysmal Positional Vertigo(Update)[J].Otolaryngol Head Neck Surg,2017,156:S1-S47.
[8]刘博,孙建军.重视眩晕诊疗的规范化,提升前庭疾病诊治水平[J].临床耳鼻咽喉头颈外科杂志,2016,30(8):593-594.
[9]李琳,刘建国,王志伟,等.良性阵发性位置性眩晕快速诊断问卷的制订及评价[J].中华医学杂志,2017,97(14):1061-1064.
[10]IMAI T,HIGASHI-SHINGAI K,TAKIMOTO Y,et al.New scoring system of an interview for the diagnosis of benign paroxysmal positional vertigo[J].Acta Otolaryngol,2016,136:283-288.
[11]LAPENNA R,FARALLI M,DEL ZOMPO M R,et al.Reliability of an anamnestic questionnaire for the diagnosis of benign paroxysmal positional vertigo in the elderly[J].Aging Clin Exp Res,2016,28:881-888.
[12]文骏雄,马秀岚,刘东亮.五项病史评分表在良性阵发性位置性眩晕诊断中的意义[J].临床耳鼻咽喉头颈外科杂志,2016,30(10):784-787.
[13]张祎,刘博,左丽静,等.良性阵发性位置性眩晕临床特点[J].中国耳鼻咽喉头颈外科,2010,17(12):L646-649.
[14]张娜,陈太生,董红,等.良性阵发性位置性眩晕病因学分析[J].临床耳鼻咽喉头颈外科杂志,2011,25(7):307-311.
[2]中华耳鼻咽喉头颈外科杂志编辑委员会,中华医学会耳鼻咽喉头颈外科学分会.良性阵发性位置性眩晕诊断和治疗指南(2017)[J].中华耳鼻咽喉头颈外科杂志,2017,52(3):173-177.
[3]NEUHAUSER H K,RADTKE A,VON BREVERNM,et al.Burden of dizziness and vertigo in the community[J].Arch Int Med,2008,168:2118-2124.
[4]WU C L,WANG F T,CHIANG Y C,et al.Unplanned emergency department revisits within 72hours to a secondary teaching referral hospital in Taiwan[J].J Emerg Med,2010,38:512-517.
[5]ROYL G,PLONER C,LEITHNER C.Dizziness in the emergency room:diagnoses and misdiagnoses[J].Eur Neurol,2011,66:256-263.
[6]POLENSEK S H,TUSA R.Unnecessary diagnostic tests often obtained for benign paroxysmal positional vertigo[J].Med Sci Monit,2009,15:MT89-94.
[7]BHATTACHARYYA N,GUBBELS S P,SCHWAR-TZ S R.Clinical Practice Guideline:Benign Paroxysmal Positional Vertigo(Update)[J].Otolaryngol Head Neck Surg,2017,156:S1-S47.
[8]刘博,孙建军.重视眩晕诊疗的规范化,提升前庭疾病诊治水平[J].临床耳鼻咽喉头颈外科杂志,2016,30(8):593-594.
[9]李琳,刘建国,王志伟,等.良性阵发性位置性眩晕快速诊断问卷的制订及评价[J].中华医学杂志,2017,97(14):1061-1064.
[10]IMAI T,HIGASHI-SHINGAI K,TAKIMOTO Y,et al.New scoring system of an interview for the diagnosis of benign paroxysmal positional vertigo[J].Acta Otolaryngol,2016,136:283-288.
[11]LAPENNA R,FARALLI M,DEL ZOMPO M R,et al.Reliability of an anamnestic questionnaire for the diagnosis of benign paroxysmal positional vertigo in the elderly[J].Aging Clin Exp Res,2016,28:881-888.
[12]文骏雄,马秀岚,刘东亮.五项病史评分表在良性阵发性位置性眩晕诊断中的意义[J].临床耳鼻咽喉头颈外科杂志,2016,30(10):784-787.
[13]张祎,刘博,左丽静,等.良性阵发性位置性眩晕临床特点[J].中国耳鼻咽喉头颈外科,2010,17(12):L646-649.
[14]张娜,陈太生,董红,等.良性阵发性位置性眩晕病因学分析[J].临床耳鼻咽喉头颈外科杂志,2011,25(7):307-311.