Classification Of Acute Vertigo Diseases In Emergency Department And Study Of Early Warning Model Of Stroke Vertigo

PART I CLASSIFICATION OF ACUTE VERTIGO DISEASES IN THE EMERGENCY DEPARTMENTObjective:To analyze the clinical epidemiological characteristics of acute vertigo diseases in emergency departments,and to clarify the diagnostic classification of acute vertigo diseases in order to improve the emergency diagnosis and treatment of acute vertigo patients.Methods:From November 2016 to October 2017,he was referred to the emergency department of Yongchuan Hospital,a subsidiary of Chongqing Medical University.The patients were mainly patients with acute dizziness,and demographic characteristics and detailed case data were collected.Diagnosis is based on internationally accepted diagnostic criteria,relevant guidelines,and expert consensus.Results:1.According to the NaiFang standard,a total of 1349 patients were included in the study,accounting for 2.91%of the total number of emergency department attendances(46,496)in the same period.The ratio of male to female is 1:1.8;the age is 18-94 years old and the average age is 54.22±14.18.2.All patients were stratified by age.The number and percentage of patients were as follows:31 cases(2.29%)aged 18-29,94 cases(6.46%)aged 30-39,and 218 cases(16.16%)aged 40-49.,389 cases(28.83%)aged 50-59,363 cases(26.90%)aged 60-69,209 cases(15.49%)aged 70-79,40 cases(2.96%)aged 80-89,and 5 cases older than 90 years old(0.37%).3.An average of 112 acute vertigo cases were received each month throughout the year.129 cases in January,103 in February,117 in March,128 in April,95 in May,87 in June,94 in July,85 in August,117 in September,and 128 in October.139 cases in November and 127 in December.Winter and spring were significantly higher than summer and autumn.(2.17%vs.3.35%,p=0.033).4.120 Pre-hospital referral or referral of 274 patients,91 inpatients(33.21%);1075 patients coming to the hospital on their own and 418(30.99%)hospitalized.5.Diagnosis and classification results:Systemic disease-related dizziness in 544 cases(40.32%)included:infection-related vertigo in 131 cases(9.71%),hypertension in 117 cases(8.67%),and cardiogenic vertigo in 87 cases(6.45%)),Hypoglycemia in 65 cases(4.82%),hypotension in 58 cases(4.30%),various causes of anemia in 49 cases(3.63%),poisoning in 24 cases(1.78%),and other causes in 13 cases(0.96%);vestibular center 257 cases(19.05%)included:109 cases(8.08%)of transient ischemic attack,102 cases(7.56%)of cerebral infarction,36 cases(2.67%)of vestibular migraine,and 7 cases of intracranial occupying(0.52%),cerebral hemorrhage in 3 cases(0.22%);etiology unknown 244(18.08%);vestibular peripheral lesions in 209 cases(15.49%)included:vestibular neuritis in 73 cases(5.41%),Meniere's disease in 72 cases(5.34%),benign positional vertigo in 53 cases(3.93%),abnormity with vertigo in 11 cases(0.82%);psychosomatic in 95 cases(7.04%):persistent postural dizziness in 95 cases(7.04%).Conclusions:1.More women than men.The age of 50 to 69 is the peak period of onset.2.The number of visits to acute vertigo in the emergency department is related to climate change.Winter and spring were significantly higher than summer and autumn.3.There was no statistical difference in hospital admissions or referrals between self-care patients before 120 hospital visits.4.The top three cause of the cause:244 cases with unknown cause,131 cases with dizziness related to infection,117 cases with hypertension;transient ischemic attack,brain Infarct and persistent postural dizziness accounted for similar proportions in patients with emergency vertigo.5.Classification of acute vertigo disease:Systemic disease-related vertigo accounted for the highest;vestibular central lesion was slightly higher than vestibular peripheral lesions.PART II STUDY OF STROKE DIZZINESS EARLY WARNING MODEL IN EMERGENCY DEPARTMENTObjective:1.Analyze the high risk factors of stroke vertigo in the emergency department.2.Establish an early warning model of stroke vertigo and explore the diagnostic value of the early warning model for patients with stroke vertigo.Methods:1.According to the criteria for inclusion of patients,patients were admitted to the emergency department of Yongchuan Hospital affiliated to Chongqing Medical University from November 2016 to October 2017.Patients with acute dizziness were the main complaints.Patient demographics and detailed case data were collected.2.According to the diagnosis results,it was divided into stroke vertigo group and non-stroke vertigo group.Univariate logistic stepwise regression analysis of relevant factors was performed to understand the risk factors for stroke vertigo patients.3.Through multi-factor logistic regression analysis,and assigning the corresponding parameters according to regression coefficients,an early warning model was established.4.All patients were assessed with ABCD2 and early warning model.The area of the curve was calculated and compared by plotting the characteristics of the subjects' work curves.The diagnostic value of the early warning model for stroke vertigo was evaluated.Results:1.According to the criteria for nasopharyngeal exclusion,347 patients were included in the study,including 116 males and 231 females,64 stroke vertigo patients,and 273 non-stroke vertigo patients.In the stroke vertigo group,there were 61 cases(17.58%)of cerebral infarction and 3 cases(0.86%)of cerebral hemorrhage.Non-stroke vertigo group:96 cases of transient ischemic attack(27.67%),25 cases of hypertension(7.20%),23 cases of cardiogenic vertigo(6.63%),19 cases of benign vertigo(5.48%),Meniere's disease in 18 cases(5.19%),infection-related dizziness in 16 cases(4.61%),vestibular neuritis in 16 cases(4.61%),hypoglycemia in 14 cases(4.03%),and various causes of anemia in 14 cases(4.03(%),10 cases of vestibular migraine(2.88%),8 cases of hypotension(2.31%),7 cases of persistent postural dizziness(2.02%),7 cases of intracranial occupying(2.02%),various 6 cases(1.73%)were poisoned and 4 cases(1.15%)with sudden vertigo.2.systolic blood pressure>140 mm Hg and/or diastolic blood pressure>90 mm Hg,unilateral limb weakness,red blood cell distribution width,postural ataxia,diabetes history,language disorder,duration of symptoms,profuse sweating,random blood glucose The difference between the two groups was statistically significant.3.The results of multivariate logistic regression analysis were:systolic blood pressure? 140 mm Hg and/or diastolic blood pressure?90 mm Hg:1.926±0.611,6.861(2.071-22.732),unilateral limb weakness:3.510±0.624,6.979(1.101).-4.776),Erythrocyte distribution width:1.143±0.622,3.137(0.927-10.619),Language impairment:1.088±0.575,2.96(0.962-9.154),Postural ataxia:0.974±0.495,2.648(1.004 to 6.987),The history of diabetes:2.545 ± 0.499,12.739(4.792?33.865),duration of symptoms:2.945 ± 0.615,2.544(2.544?9.931).4.Compare the area under the curve of ABCD2 with the early warning model,the Z value is 3.121,the difference is statistically significant(P?0.05).Conclusions:1.High blood pressure,unilateral limb weakness,red blood cell distribution width,postural ataxia,diabetes history,and duration of symptoms are risk factors for stroke vertigo in the emergency department.2.The early warning model has diagnostic value for stroke vertigo.Its use is convenient and quick to guide the clinical work of the emergency department.PART III PERSISTENT POSTURAL PERCEPTION DIZZINESS TREATMENT RESEARCHObjective:1.Assess whether cognitive-behavioral therapy can improve the efficacy and acceptability of sertraline in patients with persistent postural dizziness.2.Assess whether cognitive-behavioral therapy can reduce the incidence of dose and adverse events in sertraline in patients with persistent postural dizziness.Methods:1.Patients with persistent postural dizziness were recruited and randomized into control and experimental groups.Both groups received sertraline 50-200 mg/day,and only experimental patients received cognitive-behavioral therapy(twice a week,one hour each).Treatment lasted eight weeks.2.At baseline,Week 2,Week 4,and Week 8,patients with persistent postural dizziness were evaluated using the Sickness Disabilities Scale,the Hamilton Anxiety Scale,and the Hamilton Depression Scale.3.Record and analyze sertraline use doses and adverse events in both groups.Results:1.According to the row-ranking criteria,a total of 91 patients with persistent posture-conscious dizziness completed the study.Randomly divided into control group(n = 45)and experimental group(n = 46).2.After 8 weeks of treatment,the average DHI score,HDRS score and HARS score of both groups were significantly reduced.However,compared with the control group,at the 4th and 8th week,the average DHI score of the experimental group was significantly lower than that of the control group(p<0.00001,p<0.00001);the average HDRS score of the experimental group was significantly lower than the control group.(p =0.004,p = 0.005);the mean HARS score was significantly lower in the experimental group than in the control group(p<0.00001,p<0.00001).3.The dose of sertraline in the experimental group was significantly lower than that in the control group,and the frequency of adverse events in the control group was higher than that in the experimental group(48.9%vs 26.1%,p=0.025).At week 1,both groups of patients received sertraline 50 mg/day.At week 2,there was no statistically significant difference in the mean dose of sertraline between the two groups(p=0.091),although the mean dose of sertraline in the experimental group was lower.However,compared with the control group,the experimental group needed to significantly reduce the degree of change at week 3(p=0.0008),week 4(p=0.0006),week 5(p=0.0002),and week 6(p=0.0004),Week 7(p=0.0005)and Week 8(p=0.0003)The average dose for the forest.Conclusions:1.Cognitive behavioral therapy can significantly improve the efficacy and acceptability of sertraline in the treatment of persistent postural dizziness.2.Cognitive behavioral therapy can reduce the dose of sertraline and reduce the occurrence of adverse events.