以头晕为表现的未分化疾病诊治进展

蒋睿娟; 胡梦杰; 朱佳宏; 任菁菁

doi:10.16766/j.cnki.issn.1674-4152.003971

以头晕为表现的未分化疾病诊治进展

doi: 10.16766/j.cnki.issn.1674-4152.003971

浙江大学医学院附属第一医院全科医学科，浙江杭州 310003

基金项目:

国家自然科学基金资助项目 72274169

详细信息

通讯作者:
任菁菁，E-mail：3204092@zju.edu.cn

中图分类号: R441.2
计量
- 文章访问数: 3
- HTML全文浏览量: 0
- PDF下载量: 0
- 被引次数: 0
出版历程
- 收稿日期: 2024-04-15
- 网络出版日期: 2025-06-30

Research progress in the diagnosis and treatment of medically unspecified disease manifested by dizziness

Department of General Practice, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310003, China

摘要

摘要: 头晕是全科门诊患者常见的主诉之一，其会影响患者生活、社交、工作等多个方面，造成相关功能损害。头晕症状具有主观性和非特异性, 其病因可能涉及多个学科，目前仍缺乏精确、迅速评估头晕的相关工具。正确地认识、治疗头晕对患者及其家庭具有重要意义。鉴于头晕的病因多样且表现复杂，头晕的管理对全科医生而言仍是一大挑战。对于以头晕为表现的患者，目前全科医生的处理方法包括对因治疗、对症治疗、康复治疗及心理治疗，以减轻症状、缓解情绪及降低日常功能损害。全科医生怎样协助部分头晕患者与病情共存、寻求合理的干预措施和管理办法，仍有待深入研究。本文总结了近年来国内外头晕诊治相关文献资料，对头晕的流行病学、临床特征、病因类型、诊断、治疗和预防等领域的研究成果进行综述，以期为全科医生管理以头晕为表现的未分化疾病提供参考。
- 头晕 /
- 临床特点 /
- 未分化疾病 /
- 诊治进展
Abstract: Dizziness is the most common complaint among patients in general practice clinics. Dizziness can have negative effects on patients' life, social, work, and other aspects, causing functional impairment. The symptom of dizziness is subjective and non-specific, and the cause may involve multiple disciplines. There is still a lack of tools to assess dizziness accurately and rapidly at present. Understanding and treating dizziness correctly is of great significance to patients and their families. The etiology of dizziness is numerous and diverse, and the management of dizziness remains a challenge for general practitioners. For patients manifested by dizziness, the current management methods of general practitioners include cause-based treatment, symptomatic treatment, rehabilitation, and psychotherapy to reduce symptoms, relieve mood, and reduce impairment of daily functioning. Further research is needed on how general practitioners can help some people with dizziness to live with symptoms and find effective interventions and treatments. This article summarizes domestic and international literature on the diagnosis, and treatment of dizziness in recent years, and reviews the epidemiology, clinical characteristics, diagnosis, and treatment of dizziness, in order to provide general practitioners with reference for the management of medically unspecified diseases manifested by dizziness.
- Dizziness /
- Clinical characteristics /
- Medically unexplained symptoms /
- Research progress in the diagnosis and treatment

HTML全文

表 1 头晕的常见病因

Table 1. Common causes of dizziness

疾病分类	常见病因
前庭周围性病变	前庭神经炎、突发性耳聋、急性中耳炎、迷路炎、BPPV、梅尼埃病、前庭阵发症
前庭中枢性病变	脑干和小脑出血：脑梗死、脑出血、多发性硬化、肿瘤、感染、变性病；前庭性偏头痛；短暂性脑缺血发作；痫性发作；后颅凹占位性病变：第四脑室占位、脑干及小脑肿瘤；神经系统变性：脑干小脑退行性病变、遗传性共济失调；颅颈交界区发育异常
精神心理性头晕	持续性姿势性感知性头晕
全身疾病相关性头晕	直立性低血压、药源性眩晕、视性眩晕、严重的心肌梗死或心律失常、心力衰竭、晕动症、部分贫血、低血糖、甲状腺功能减退或亢进、电解质酸碱紊乱
其他	病因不明的头晕

下载: 导出CSV

参考文献(42)

[1]	娄铮, 刘颖, 邵双阳, 等. 未分化性疾患(未分化疾病)的研究进展[J]. 全科医学临床与教育, 2021, 19(7): 636-639. LOU Z, LIU Y, SHAO S Y, et al. Advances in research on undifferentiated diseases (medically unspecified disease)[J]. Clinical Education of General Practice, 2021, 19(7): 636-639.
[2]	娄铮, 刘颖, 任菁菁. 全科医生对未分化疾病诊治观点的质性研究[J]. 中国现代医生, 2022, 60(32): 16-19, 24. LOU Z, LIU Y, REN J J. A qualitative study of general practitioners' views on the diagnosis and treatment of medically unspecified disease[J]. China Modern Doctor, 2022, 60(32): 16-19, 24.
[3]	潘琦, 任菁菁, 张萌, 等. 未分化疾病如何与全科医学同频共振?[J]. 中国全科医学, 2023, 26(31): 3877-3883. doi: 10.12114/j.issn.1007-9572.2023.W0007 PAN Q, REN J J, ZHANG M, et al. How can undifferentiated diseases be synchronized with general practice?[J]. Chinese General Practice, 2023, 26(31): 3877-3883. doi: 10.12114/j.issn.1007-9572.2023.W0007
[4]	朱佳宏, 刘颖, 任菁菁. 以乏力为表现的未分化疾病全科诊疗思路[J]. 中华全科医学, 2023, 21(4): 539-543. doi: 10.16766/j.cnki.issn.1674-4152.002926 ZHU J H, LIU Y, REN J J. Diagnosis and treatment of medically unspecified disease manifested by fatigue: a general practice perspective[J]. Chinese Journal of General Practice, 2023, 21(4): 539-543. doi: 10.16766/j.cnki.issn.1674-4152.002926
[5]	DRACHMAN D A, HART C W. An approach to the dizzy patient[J]. Neurology, 1972, 22(4): 323-334. doi: 10.1212/WNL.22.4.323
[6]	BISDORFF A, VON BREVERN M, LEMPERT T, et al. Classification of vestibular symptoms: towards an international classification of vestibular disorders[J]. J Vestib Res, 2009, 19(1-2): 1-13. doi: 10.3233/VES-2009-0343
[7]	中华医学会神经病学分会, 中华神经科杂志编辑委员会. 眩晕诊治多学科专家共识[J]. 中华神经科杂志, 2017, 50(11): 805-812. doi: 10.3760/cma.j.issn.1006-7876.2017.11.002 Chinese Society of Neurology, Editiorial Board of Chinese Journal of Neurology. Multidisciplinary expert consensus on vertigo diagnosis and treatment[J]. Chin J Neurol, 2017, 50(11): 805-812. doi: 10.3760/cma.j.issn.1006-7876.2017.11.002
[8]	BISDORFF A R, STAAB J P, NEWMAN-TOKERD E. Overview of the international classification of vestibular disorders[J]. Neurologic clinics, 2015, 33(3): 541-550. doi: 10.1016/j.ncl.2015.04.010
[9]	ROGERS T S, NOEL M A, GARCIA B. Dizziness: evaluation and management[J]. American Family Physician, 2023, 107(5): 514-523.
[10]	漆微韡, 徐雪, 黄海威. 头晕/眩晕的临床诊断基本功: 病史采集与体格检查[J]. 重庆医科大学学报, 2021, 46(7): 769-772. QI W W, XUE X, HUANG H W. Basic clinical skills for diagnosing dizziness/vertigo: history taking and physical examination[J]. Journal of Chongqing Medical University, 2021, 46(7): 769-772.
[11]	NOUINI A, MAT Q, VAN NECHEL C, et al. Diagnosis of dizziness in the emergency department: A 1-year prospective single-center study[J]. J Vestib Res, 2023, 33(3): 195-202. doi: 10.3233/VES-220109
[12]	REGAUER V, SECKLER E, GRILL E, et al. Development of a complex intervention to improve mobility and participation of older people with vertigo, dizziness and balance disorders in primary care: a mixed methods study[J]. BMC Family Practice, 2021, 22(1): 89. DOI: 10.1186/s12875-021-01441-9.
[13]	武霞. 头晕的病因调查及5-HTR6基因多态性与前庭性偏头痛的相关性研究[D]. 广州: 南方医科大学, 2021. WU X. Investigations of the etiology of dizziness and correlation of 5-HTR6 gene polymorphism with vestibular migraine[D]. Guangzhou: Southern Medical University, 2021.
[14]	KATZENBERGER B, KOLLER D, STROBL R, et al. Referral trajectories in patients with vertigo, dizziness and balance disorders and their impact on health-related quality of life and functioning: results from the longitudinal multicenter study MobilE-TRA[J]. J Neurol, 2022, 269(12): 6211-6221. doi: 10.1007/s00415-022-11060-8
[15]	李长青, 郭东升, 刘思维, 等. 神经内科门诊中老年人群头晕/眩晕患者病因分层特点[J]. 武警医学, 2022, 33(6): 476-479. LI C Q, GUO D S, LIU S W, et al. Etiological distribution of middle-aged and elderly patients with dizziness/vertigo in neu-rology outpatient department[J]. Medical Journal of the Chinese People' s Armed Police Forces, 2022, 33(6): 476-479.
[16]	潘雁斐, 陈敏, 刘献增. 754例头晕患者经颅多普勒与颈部血管超声检查结果对比分析[J]. 国际神经病学神经外科学杂志, 2020, 47(1): 49-53. PAN Y F, CHEN M, LIU X Z. Transcranial Doppler findings versus cervical vascular ultrasound findings in patients with a chief complaint of dizziness: a comparative analysis of 754 cases[J]. Journal of International Neurology and Neurosurgery, 2020, 47(1): 49-53.
[17]	任菁菁, 江孙芳. 全科常见未分化疾病诊疗手册[M]. 3版. 北京: 人民卫生出版社, 2023: 191-198. REN J J, JIANG S F. The treatment of common medically unspecified disease in general practice[M]. 3nd edition. Beijing: People' s Medical Publishing House, 2023: 191-198.
[18]	SAMAN Y G, ARSHAD Q, DUTIA M, et al. Stress and the vestibular system[J]. Int Rev Neurobiol, 2020, 152: 221-236.
[19]	MURPHY C, REINHARDT C, LINEHAN, D, et al. A review of primary care referrals for patients with dizziness and vertigo: prevalence and demographics[J]. Ir J Med Sci, 2022, 191(1): 385-389. doi: 10.1007/s11845-021-02575-6
[20]	SMYTH D, BRITTON Z, MURDIN L, et al. Vestibular migraine treatment: a comprehensive practical review[J]. Brain, 2022, 145(Pt. 11): 3741-3754.
[21]	STAAB J P. Persistent postural-perceptual dizziness: review and update on key mechanisms of the most common functional neuro-otologic disorder[J]. Neurol Clin, 2023, 41(4): 647-664.
[22]	中华医学会心身医学分会整体健康协作学组. 精神性头晕诊疗中国专家共识[J]. 中国全科医学, 2024, 27(2): 125-131. Holistic Health Coordination Group of the Psychosomatic Medicine Society of the Chinese Medical Association. Chinese expert consensus on diagnosis and treatment of psychiatric dizziness[J]. Chinese General Practice, 2024, 27(2): 125-131.
[23]	江自望, 米明珊. 头晕眩晕的评估[J]. 中西医结合心血管病电子杂志, 2020, 8(36): 196, 198. JIANG Z W, MI M S. Assessment of dizziness and vertigo[J]. Cardiovascular Disease Electronic Journal of Integrated Traditional Chinese and Western Medicine, 2020, 8(36): 196, 198.
[24]	JANG Y, HUR H J, PARK B, et al. Psychosocial Factors Associated with dizziness and chronic dizziness: a nationwide cross-sectional study[J]. BMC Psychiatry, 2024, 24(1): 13. DOI: 10.1186/s12888-023-05464-7.
[25]	KOUKOULITHRAS I, DROUSIA G, KOLOKOTSIOS S, et al. A holistic approach to a dizzy patient: a practical update[J]. Cureus, 2022, 14(8): e27681. DOI: 10.7759/cureus.27681.
[26]	卓实, 江川, 陈文玲, 等. 中西药联合治疗椎基底动脉供血不足性眩晕疗效的Meta分析及中药处方用药规律分析[J]. 临床合理用药, 2023, 16(31): 20-24. ZHUO S, JIANG C, CHEN W L, et al. Meta-analysis of curative effect of the combination of TCM and Western medicine in treatment for vertebroasilar insufficiency vertigo and prescription principles[J]. Chin J of Clinical Rational Drug Use, 2023, 16(31): 20-24.
[27]	SHENDE C, RATHOD T N, MARATHE N, et al. Degenerative cervical spondylosis: a cause of vertigo?[J]. Global Spine Journal, 2023, 13(5): 1273-1279.
[28]	CHOI J Y, LEE E S, KIM J S. Vestibular syncope[J]. Curr Opin Neurol, 2024, 37(1): 66-73.
[29]	DLUGAICZYK J, LEMPERT T, LOPEZ-ESCAMEZ J A, et al. Recurrent vestibular symptoms not otherwise specified: clinical characteristics compared with vestibular migraine and Menière' s disease[J]. Front Neurol, 2021, 12: 674092. DOI: 10.3389/fneur.2021.674092.
[30]	台耀军. 眩晕/头晕患者的临床研究分析[J]. 中国基层医药, 2019, 26(9): 1126-1128. TAI Y J. Clinical analysis of patients with vertigo or dizziness[J]. Chinese Journal of Primary Medicine and Pharmacy, 2019, 26(9): 1126-1128.
[31]	WANG C H, WINNICK A A, KO Y H, et al. Test-retest reliability of subjective visual vertical measurements with lateral head tilt in virtual reality goggles[J]. Tzu Chi Med J, 2021, 33(3): 294-300.
[32]	余力生, 孔维佳, 黄海威, 等. 从病例探讨头晕眩晕诊疗思路[J]. 临床耳鼻咽喉头颈外科杂志, 2023, 37(4): 302-306. YU L S, KONG W J, HUNAG H W, et al. Discussion on diagnosis and treatment of dizziness from cases[J]. J Clin Otorhinolaryngol Head Neck Surg(China), 2023, 37(4): 302-306.
[33]	古丽波斯坦·买买提艾力, 阿孜古丽·图尔逊江, 王子源. 视频眼震电图和视频头脉冲检查在急性前庭综合征患者快速定位诊断中的应用效果[J]. 广西医学, 2023, 45(12): 1422-1426. GULIBOSITAN M, AZIGULI T, WANG Z Y. Application effect of video electronystagmography and video head impulse test in the rapid location diagnosis of patients with acute vestibular syndrome[J]. Guangxi Medical Journal, 2023, 45(12): 1422-1426.
[34]	陈学智, 孙井松. CT、MRI和磁共振动脉成像对后循环缺血性眩晕的诊断意义分析[J]. 黑龙江医药, 2021, 34(5): 1189-1191. CHEN X Z, SUN J S. Analysis of the diagnostic significance of CT, MRI, and magnetic resonance arterial imaging in posterior circulation ischemic vertigo[J]. Heilongjiang Medicine Journal, 2021, 34(5): 1189-1191.
[35]	赵毓. 急性眩晕/头晕的中枢病因识别方法研究进展[J]. 北京医学, 2022, 44(8): 729-731, 735. ZHAO Y. Research progress on the identification of central causes of acute vertigo/dizziness[J]. Beijing Medical Journal, 2022, 44(8): 729-731, 735.
[36]	李康之, 刘博, 顾平, 等. 持续性姿势-感知性头晕(PPPD)诊断标准: Bárány学会前庭疾病分类委员会共识[J]. 神经损伤与功能重建, 2020, 15(2): 63-72. LI K Z, LIU B, GU P, et al. Diagnostic criteria for persistent postural-perceptual dizziness (PPPD): consensus document of the committee for the classification of vestibular disorders of the Barany Society[J]. Neural Injury and Functional Reconstruction, 2020, 15(2): 63-72.
[37]	庄建华. 头晕眩晕疾病诊治思路[J]. 重庆医科大学学报, 2021, 46(7): 764-768. ZHUANG J H. Thoughts on diagnosis and treatment of dizzy and vertigo diseases[J]. Journal of Chongqing Medical University, 2021, 46(7): 764-768.
[38]	战丽丽. 慢性头晕的流行病学特点、发病机制及治疗方法的研究进展[J]. 当代医药论丛, 2021, 19(18): 10-11. ZHAN L L. Research progress on the epidemiological characteristics, pathogenesis and treatment of chronic dizziness[J]. Contemporary Medical Symposium, 2021, 19(18): 10-11.
[39]	李一青, 鞠奕. 常用头晕/眩晕相关量表及其研究进展[J]. 北京医学, 2019, 41(9): 820-822. LI Y Q, JU Y. Commonly used dizziness/vertigo-related scales and their research progress[J]. Beijing Medical Journal, 2019, 41(9): 820-822.
[40]	BUKUROV B, NENEZIC D, POT D, et al. Adoption of clinical practice guidelines in cases of benign paroxysmal positional vertigo[J]. Eur Arch Otorhinolaryngol, 2023, 280(10): 4477-4483.
[41]	WATERSTON J, CHEN L, MAHONY K, et al. Persistent postural-perceptual dizziness: precipitating conditions, co-morbidities and treatment with cognitive behavioral therapy[J]. Front Neurol, 2021, 12: 795516. DOI: 10.3389/fneur.2021.795516.
[42]	VAN VUGT V A, BAS G, VAN DER WOUDEN J C, et al. Prognosis and survival of older dizzy patients in primary care: a 10-year prospective cohort study[J]. Ann Fam Med, 2020, 18(2): 100-109.