Chinese Journal of Tissue Engineering Research ›› 2024, Vol. 28 ›› Issue (34): 5500-5507.doi: 10.12307/2024.839
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Sun Yiming, Yang Xinming, Cai Liqun, Liu Aining
Received:
2024-01-18
Accepted:
2024-01-25
Online:
2024-12-08
Published:
2024-03-14
Contact:
Cai Liqun, Chief physician, Liqun Hospital of Shanghai Putuo District, Shanghai 200333, China
Liu Aining, Chief physician, Liqun Hospital of Shanghai Putuo District, Shanghai 200333, China
About author:
Sun Yiming, Attending physician, Liqun Hospital of Shanghai Putuo District, Shanghai 200333, China
Yang Xinming, Attending physician, Liqun Hospital of Shanghai Putuo District, Shanghai 200333, China
Supported by:
CLC Number:
Sun Yiming, Yang Xinming, Cai Liqun, Liu Aining. Bibliometric analysis of vertigo-related histopathology, vestibular rehabilitation, physical rehabilitation, and Chinese and Western medical treatments[J]. Chinese Journal of Tissue Engineering Research, 2024, 28(34): 5500-5507.
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共被引次数最高的文献为KATTAH等[7]的一项横断面研究(被引74次),这项研究主要探讨了床边眼动检查在急性前庭综合征(AVS,以持续性眩晕为主要症状)中识别脑卒中的可行性,研究者对101例急性前庭综合征患者进行前瞻性横断面研究,发现正常水平头部冲击试验、方向变化性眼球震颤或斜视倾斜(垂直眼球错位)对脑卒中具有高度敏感性和特异性;斜视倾斜与脑干损伤相关,能正确预测侧脑桥缺血性脑卒中;在首次MRI扩散加权成像中,有12%的病例出现假阴性。研究结果表明,三步骤床边眼动检查(HINTS:头部-冲击-眼球震颤-斜视测试)在急性前庭综合征脑卒中检测方面比早期MRI更敏感。 其他的大部分为一些与眩晕有关的指南和标准,如头晕障碍量表(被引71次)[8]、前庭性偏头痛:诊断标准(被引63次)[9]、前庭症状分类:前庭障碍的国际分类(被引54次)[11]、梅尼埃病的诊断标准(被引51次)[12]、听力与平衡委员会梅尼埃病诊断与治疗评估指南(被引46次)[13]、临床实践指南:良性阵发性位置性眩晕(更新版)(被引45次)[14]。 此外,值得住的是,有一项关于前庭神经炎患者的临床试验(被引43次)结果表明,甲基强的松龙在治疗前庭神经炎方面具有显著效果,能显著改善患者外周前庭功能的恢复;而伐昔洛韦在该试验中未能显示出明显的治疗效果[15]。因此,对于前庭神经炎患者,使用甲基强的松龙可能是一个有效的治疗选择。 关于良性阵发性位置性眩晕,有2项流行病学研究表明,良性阵发性位置性眩晕是一种常见的前庭障碍,会导致严重的社会心理影响(被引62次)[10],其中良性阵发性位置性眩晕和前庭性偏头痛以及合并焦虑症在人群中的发病率很高(被引35次)[16]。 2.6 高被引文献分析 2.6.1 中文高被引文献分析 文章总结了万方数据库2014-2023年眩晕治疗方面的高被引文献TOP10[17-26],见表6。"
被引次数最高的文献为“良性阵发性位置性眩晕诊断和治疗指南(2017)”(被引563次)[17],其他相关指南还有“眩晕诊治多学科专家共识”(被引287次)[18],这2个眩晕相关指南为中国最权威指南,详细列举了眩晕的诊断和治疗规范标准。 最有影响力的一项临床研究主要介绍了针刺手法对后循环缺血性眩晕的疗效(被引62次) [20],该研究将120例后循环缺血性眩晕患者随机分为4组,分别采用不同的针刺手法进行治疗。结果显示,各组患者临床疗效差异无统计学意义,但不同针刺手法对眩晕症状的改善程度存在差异;其中,针刺风池3组的效果最好,可能与调节去甲肾上腺素(NE)水平有关;此外,研究还发现,不同组别的患者治疗后血浆中5-羟色胺(5-HT)、γ-氨基丁酸(GABA)、谷氨酸(Glu)水平也存在差异,这些变化可能与针刺治疗的效果有关。总之,这项研究为针刺治疗后循环缺血性眩晕提供了新的理论依据和实践指导。 此外,还有一项为期3个月随访的临床研究报道显示,“小醒脑开窍”针刺法可明显改善后循环缺血性眩晕的临床症状,其机制可能与改善椎动脉及基底动脉的血流速度,提高脑组织血液供应有关,且其治疗效果长期持续,复发率低(被引45次) [22]。还有一项临床研究研究强调了,前庭康复训练可有效缓解良性阵发性位置性眩晕复位后的残疾情况(被引45次) [23]。 进一步分析近3年的最新中国研究热点文献发现,关于眩晕的治疗方面,取得一些可喜的临床研究成果[27-36],见表7。例如,银杏叶提取物联合天麻素注射液对血管源性眩晕患者的血管功能具有改善作用(被引15次) [27],针刺联合加味半夏白术汤可能通过调节良性阵发性眩晕患者的单胺类神经递质水平改善其头晕症状(被引13次) [28],倍他司汀联合天麻素对椎基底动脉供血不足性眩晕症患者具有一定治疗效果(被引12次) [29],通过前庭康复训练联合Epley耳石复位法可有效提高良性阵发性位置性眩晕的临床疗效(被引11次) [30]。因此,近年来,中国特色药物如银杏叶提取物、天麻素、半夏白术汤治疗眩晕有一定效果,但都需要与西药(如倍他司汀)或针刺联合使用,前庭康复训练联合中医手法复位对良性阵发性位置性眩晕有一定治疗效果。"
CARLSON等[38](被引176次)讨论了治疗散发性前庭神经鞘瘤的最佳方法。研究通过一系列问卷调查了接受不同治疗方法的患者的健康相关生命质量(HRQOL),并与一般人群进行了比较,对于小到中等大小的前庭神经鞘瘤应最初采取观察方法,而将干预方法留给确实出现肿瘤增长或不能通过治疗缓解症状的患者。未来评估前庭神经鞘瘤患者HRQOL的研究应优先使用经过验证的特定于疾病的测量工具,例如佩恩听神经瘤生活质量量表(PANQOL),因为一般工具在区分治疗组和肿瘤与非肿瘤对象方面存在显著限制。 LAHMANN等[43](被引142次)的一项临床研究评估患有有机性和非有机性(即不可解释的)眩晕/头晕综合征的大样本患者的精神障碍共病和心理社会功能受损,参与者包括来自一个专门的眩晕/头晕综合征多学科治疗中心的547例患者。神经学诊断发现80.8%的患者出现有机性眩晕/头晕,19.2%的患者有非有机性眩晕/头晕;在48.8%的患者中,结构化临床访谈确认了目前存在的精神障碍,最常见的是焦虑/恐怖症、心因性障碍和情感障碍;在有机性眩晕/头晕组中,42.5%的患者,特别是患有前庭突发症或前庭偏头痛的患者存在目前精神障碍;与未患精神障碍的患者相比,患有精神障碍的患者报告了更多的眩晕相关障碍、更多的抑郁、焦虑和躯体化症状,以及更低的心理生活质量;眩晕/头晕和精神共病的非有机性组合是最严重的,这应在疾病早期的诊断和治疗中予以考虑。 文章进一步分析了近3年该领域的研究热点,见表9。在2021年,有研究报道了首例因前庭神经炎而出现双面无力和麻痹的孕妇病例(被引26次)[46],这是 COVID-19感染后的表现,患者出现双侧面瘫、双下肢麻痹、眩晕、恶心、呕吐和右耳痛到急诊科就诊,说明COVID-19感染后患者可能出现前庭神经炎导致的面瘫。在2021年,有研究描述了一例感染 COVID-19 并仅有眩晕和发热症状的儿童病例[50]。该研究认为该患儿患的是 COVID-19 引起的前庭神经炎,考虑到症状的自发改善,除了中枢神经系统的自然代偿外,不需要任何治疗调整。该病例表明,对于出现眩晕的儿科患者,怀疑 COVID-19 感染非常重要。在2021年,有研究从一家土耳其三甲医院眩晕中心3年内接受前庭评估的3 400例患者中收集了203例儿童患者的数据进行回顾性分析(被引13次)[51],结果发现,良性阵发性位置性眩晕和前庭性偏头痛是最常见的小儿前庭疾病,其次是儿童良性阵发性眩晕、前庭神经炎和精神性眩晕,而梅尼埃病和中枢性眩晕在儿童中较少诊断。在2022年,巴拉尼学会前庭疾病分类委员会发布了急性单侧前庭病/前庭神经炎的诊断标准(被引22次)[47]。"
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