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精品指南：良性阵发性位置性眩晕指南的要点解析

2017-05-11 MedSci MedSci原创

良性阵发性位置性眩晕诊断治疗指南要点解析
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2017年3月，美国耳鼻咽喉头颈外科学会(AAO-HNS)更新发布了良性阵发性位置性眩晕（BPPV）指南；新版指南是对2008年发布的早期指南的更新；根据新的临床研究和系统评价证据，新版指南对临床上的重要建议做了修改。梅斯小编整理新版指南内容要点，供大家参考！<br><span style="font-weight: bold;">一、新版指南与旧版指南的主要区别在于：&l


2017年3月，美国耳鼻咽喉头颈外科学会(AAO-HNS)更新发布了良性阵发性位置性眩晕（BPPV）指南；新版指南是对2008年发布的早期指南的更新；根据新的临床研究和系统评价证据，新版指南对临床上的重要建议做了修改。梅斯小编整理新版指南内容要点，供大家参考！

一、新版指南与旧版指南的主要区别在于：

1.新证据源于2项临床实践指南，20项系统评价及27项随机对照研究；
2.向指南更新小组新增一名患者权益保障人员；
3.对BPPV的诊断和管理建议进行了新增与扩展。
4.加强患者教育，重视共同决策；
5.用一种新的方法来阐明动作语句关系；
二、新版指南对临床医生提出了6项中肯的建议：

1.区分BPPV与其他原因的不平衡，如眩晕和头晕；
2.执行仰卧滚转测试，以评估水平半规管BPPV；
3初始观察或治疗1个月后重新评估患者，以记录症状的缓解或持续；
4.评估影响BPPV患者管理的因素，如运动障碍/平衡障碍，中枢神经系统疾病，家庭支持不足，跌倒风险增加等；
5.教育患者注意BPPV对其自身安全的影响，疾病复发的可能性和随访的重要性。
6.当BPPV未治愈时，医师应进行重新评估或考虑其他潜在外周前庭或中枢神经系统疾病；
新版指南指出：当眩晕与旋转相关时，临床医师应通过Dix-Hallpike试验诊断患者是否为后半规管BPPV；采用耳石复位法治疗后半规管BPPV。新版指南强烈反对，耳石复位法治疗BPPV后对患者进行体位限制。新版指南建议强调了BPPV诊断的准确性和效率，增加了恰当的治疗和定位策略，减少了不恰当前庭抑制药物与辅助测试的使用。
指南原文
2017 AAO-HNS临床实践指南：良性阵发性位置性眩晕（更新版）-全文
2017年3月，美国耳鼻咽喉头颈外科学会(AAO-HNS)更新发布了良性阵发性位置性眩晕指南。该指南的前一版于2008年发布，新版指南建议强调了诊断的准确性和效率，降低了前庭抑制药物的不当使用，同时减少不恰当的辅助测试增加了恰当的治疗和定位策略。

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    #插入话题
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      2017-12-14 hongbochen

      #解析#

      0

    2. 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      2018-01-23 hb2008ye

      #良性阵发性#

      0

    3. 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      2017-05-11 cmj8wellington

      #良性阵发性位置性眩晕#

      0

    4. 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createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7cJ6ejWUr2nIia8qOvAKNdLHr32Df6G8iaoaOx6pHaoiacwp26DaslxZHCGbibZhhCGven4rvmWP60GahtzgFjgCjR/0, createdBy=6b111703011, createdName=有备才能无患, createdTime=Thu May 11 18:54:57 CST 2017, time=2017-05-11, status=1, ipAttribution=)]
      2017-05-14 绛珠草小姐

      学习了，谢谢

      0

    5. 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createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7cJ6ejWUr2nIia8qOvAKNdLHr32Df6G8iaoaOx6pHaoiacwp26DaslxZHCGbibZhhCGven4rvmWP60GahtzgFjgCjR/0, createdBy=6b111703011, createdName=有备才能无患, createdTime=Thu May 11 18:54:57 CST 2017, time=2017-05-11, status=1, ipAttribution=)]
      2017-05-13 baihao215

      中国2017地指南也更新喽

      0

    6. 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createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7cJ6ejWUr2nIia8qOvAKNdLHr32Df6G8iaoaOx6pHaoiacwp26DaslxZHCGbibZhhCGven4rvmWP60GahtzgFjgCjR/0, createdBy=6b111703011, createdName=有备才能无患, createdTime=Thu May 11 18:54:57 CST 2017, time=2017-05-11, status=1, ipAttribution=)]
      2017-05-12 绛珠草小姐

      学习了，谢谢

      0

    7. 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createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7cJ6ejWUr2nIia8qOvAKNdLHr32Df6G8iaoaOx6pHaoiacwp26DaslxZHCGbibZhhCGven4rvmWP60GahtzgFjgCjR/0, createdBy=6b111703011, createdName=有备才能无患, createdTime=Thu May 11 18:54:57 CST 2017, time=2017-05-11, status=1, ipAttribution=)]
      2017-05-12 meiliwuxian

      非常不错

      0

    8. [GetPortalCommentsPageByObjectIdResponse(id=1672843, encodeId=592e16e284384, content=<a href='/topic/show?id=b79b910345c' target=_blank style='color:#2F92EE;'>#解析#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=91034, encryptionId=b79b910345c, topicName=解析)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f42d26916490, createdName=hongbochen, createdTime=Thu Dec 14 21:51:00 CST 2017, time=2017-12-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1810937, encodeId=de3e181093e1b, content=<a href='/topic/show?id=3b3a866e264' target=_blank style='color:#2F92EE;'>#良性阵发性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=86672, encryptionId=3b3a866e264, topicName=良性阵发性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=hb2008ye, createdTime=Tue Jan 23 16:51:00 CST 2018, time=2018-01-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1969166, encodeId=91b019691664c, content=<a href='/topic/show?id=ba12866e322' target=_blank style='color:#2F92EE;'>#良性阵发性位置性眩晕#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=86673, encryptionId=ba12866e322, topicName=良性阵发性位置性眩晕)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c689267, createdName=cmj8wellington, createdTime=Thu May 11 16:51:00 CST 2017, time=2017-05-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=197972, encodeId=c52f19e972ef, content=学习了，谢谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, 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authenticateStatus=null, createdAvatar=http://q.qlogo.cn/qqapp/101296147/1A51842815047D40BFDAA8D69AA8E519/100, createdBy=fd7f2029163, createdName=绛珠草小姐, createdTime=Fri May 12 12:50:49 CST 2017, time=2017-05-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=196871, encodeId=8cd91968e128, content=非常不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=445f1740270, createdName=meiliwuxian, createdTime=Fri May 12 06:48:26 CST 2017, time=2017-05-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=196754, encodeId=2094196e54a7, content=好东西学习了！, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=92191944782, createdName=thlabcde, createdTime=Thu May 11 21:25:33 CST 2017, time=2017-05-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=196721, encodeId=c433196e21f2, content=学习了谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/PiajxSqBRaEJicFGXtYqfjGiaibNdjOiaRgkexnXiciaDeXaLiaKicovcicDugdYwRPSnQj3FlfXBwVLB5ANB9PGFyB0kraQ/0, createdBy=35b01663265, createdName=1ddf3e1dm99(暂无匿称), createdTime=Thu May 11 19:20:05 CST 2017, time=2017-05-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=196713, encodeId=c09e196e13b8, content=bppv属自限性疾病, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7cJ6ejWUr2nIia8qOvAKNdLHr32Df6G8iaoaOx6pHaoiacwp26DaslxZHCGbibZhhCGven4rvmWP60GahtzgFjgCjR/0, createdBy=6b111703011, createdName=有备才能无患, createdTime=Thu May 11 18:54:57 CST 2017, time=2017-05-11, status=1, ipAttribution=)]
      2017-05-11 thlabcde

      好东西学习了！

      0

    9. [GetPortalCommentsPageByObjectIdResponse(id=1672843, encodeId=592e16e284384, content=<a href='/topic/show?id=b79b910345c' target=_blank style='color:#2F92EE;'>#解析#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=91034, encryptionId=b79b910345c, topicName=解析)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f42d26916490, createdName=hongbochen, createdTime=Thu Dec 14 21:51:00 CST 2017, time=2017-12-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1810937, encodeId=de3e181093e1b, content=<a href='/topic/show?id=3b3a866e264' target=_blank style='color:#2F92EE;'>#良性阵发性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=86672, encryptionId=3b3a866e264, topicName=良性阵发性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=hb2008ye, createdTime=Tue Jan 23 16:51:00 CST 2018, time=2018-01-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1969166, encodeId=91b019691664c, content=<a href='/topic/show?id=ba12866e322' target=_blank style='color:#2F92EE;'>#良性阵发性位置性眩晕#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=86673, encryptionId=ba12866e322, topicName=良性阵发性位置性眩晕)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c689267, createdName=cmj8wellington, createdTime=Thu May 11 16:51:00 CST 2017, time=2017-05-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=197972, encodeId=c52f19e972ef, content=学习了，谢谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://q.qlogo.cn/qqapp/101296147/1A51842815047D40BFDAA8D69AA8E519/100, createdBy=fd7f2029163, createdName=绛珠草小姐, createdTime=Sun May 14 12:32:12 CST 2017, time=2017-05-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=197288, encodeId=6cd819e288a5, content=中国2017地指南也更新喽, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLCclExeQ6LOGMD4dTsia4Ty4HtZCxRmG5vO5XIKfKX3a3vusfhHSej4Iib517vmhFW7RQgh7bpDp1yw/0, createdBy=50951609779, createdName=baihao215, createdTime=Sat May 13 00:44:54 CST 2017, time=2017-05-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=197100, encodeId=3da119e100b6, content=学习了，谢谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, 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May 11 21:25:33 CST 2017, time=2017-05-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=196721, encodeId=c433196e21f2, content=学习了谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/PiajxSqBRaEJicFGXtYqfjGiaibNdjOiaRgkexnXiciaDeXaLiaKicovcicDugdYwRPSnQj3FlfXBwVLB5ANB9PGFyB0kraQ/0, createdBy=35b01663265, createdName=1ddf3e1dm99(暂无匿称), createdTime=Thu May 11 19:20:05 CST 2017, time=2017-05-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=196713, encodeId=c09e196e13b8, content=bppv属自限性疾病, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7cJ6ejWUr2nIia8qOvAKNdLHr32Df6G8iaoaOx6pHaoiacwp26DaslxZHCGbibZhhCGven4rvmWP60GahtzgFjgCjR/0, createdBy=6b111703011, createdName=有备才能无患, createdTime=Thu May 11 18:54:57 CST 2017, time=2017-05-11, status=1, ipAttribution=)]
      2017-05-11 1ddf3e1dm99(暂无匿称)

      学习了谢谢分享

      0

    10. [GetPortalCommentsPageByObjectIdResponse(id=1672843, encodeId=592e16e284384, content=<a href='/topic/show?id=b79b910345c' target=_blank style='color:#2F92EE;'>#解析#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=91034, encryptionId=b79b910345c, topicName=解析)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f42d26916490, createdName=hongbochen, createdTime=Thu Dec 14 21:51:00 CST 2017, time=2017-12-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1810937, encodeId=de3e181093e1b, content=<a href='/topic/show?id=3b3a866e264' target=_blank style='color:#2F92EE;'>#良性阵发性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=86672, encryptionId=3b3a866e264, topicName=良性阵发性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=hb2008ye, createdTime=Tue Jan 23 16:51:00 CST 2018, time=2018-01-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1969166, encodeId=91b019691664c, content=<a href='/topic/show?id=ba12866e322' target=_blank style='color:#2F92EE;'>#良性阵发性位置性眩晕#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=86673, encryptionId=ba12866e322, topicName=良性阵发性位置性眩晕)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c689267, createdName=cmj8wellington, createdTime=Thu May 11 16:51:00 CST 2017, time=2017-05-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=197972, encodeId=c52f19e972ef, content=学习了，谢谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, 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authenticateStatus=null, createdAvatar=http://q.qlogo.cn/qqapp/101296147/1A51842815047D40BFDAA8D69AA8E519/100, createdBy=fd7f2029163, createdName=绛珠草小姐, createdTime=Fri May 12 12:50:49 CST 2017, time=2017-05-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=196871, encodeId=8cd91968e128, content=非常不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=445f1740270, createdName=meiliwuxian, createdTime=Fri May 12 06:48:26 CST 2017, time=2017-05-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=196754, encodeId=2094196e54a7, content=好东西学习了！, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=92191944782, createdName=thlabcde, createdTime=Thu May 11 21:25:33 CST 2017, time=2017-05-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=196721, encodeId=c433196e21f2, content=学习了谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/PiajxSqBRaEJicFGXtYqfjGiaibNdjOiaRgkexnXiciaDeXaLiaKicovcicDugdYwRPSnQj3FlfXBwVLB5ANB9PGFyB0kraQ/0, createdBy=35b01663265, createdName=1ddf3e1dm99(暂无匿称), createdTime=Thu May 11 19:20:05 CST 2017, time=2017-05-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=196713, encodeId=c09e196e13b8, content=bppv属自限性疾病, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7cJ6ejWUr2nIia8qOvAKNdLHr32Df6G8iaoaOx6pHaoiacwp26DaslxZHCGbibZhhCGven4rvmWP60GahtzgFjgCjR/0, createdBy=6b111703011, createdName=有备才能无患, createdTime=Thu May 11 18:54:57 CST 2017, time=2017-05-11, status=1, ipAttribution=)]
      2017-05-11 有备才能无患

      bppv属自限性疾病

      0

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