对选择和应用抗眩晕药的理性思考

Rational thinking on the choice and application of anti-vertigo drugs

摘要:

依据前庭性眩晕的不同病因不同病情及不同愈后结果，合理选择和应用不同的抗眩晕药物，对改善眩晕症状和促进平衡功能康复至关重要。根据各种抗眩晕药的不同药理学效应，针对眩晕症状的大部分西药可被分为促进神经代偿的药物或抑制神经代偿的药物两大类，前者属于多巴胺兴奋剂，而后者属于多巴胺抑制剂，两者的药理学机制却恰好相反。在所有引起眩晕的前庭疾病中，占总数近半的案例属于可逆性病变并可自行恢复，但另外近半病例却因发生了不可逆性前庭损害而难以自愈。对于那些可自愈的眩晕病例，应用多巴胺兴奋剂加速平衡功能的代偿是不必要的甚至是有害的；而对于那些不可逆性单侧前庭永久损害的眩晕病例，应用多巴胺兴奋剂却有助于促进平衡功能的代偿并尽早消除眩晕症状，相反，应用多巴胺抑制剂却会延长平衡障碍的过程并阻碍平衡功能的代偿性恢复。因此，在哪种眩晕条件下需要应用促进平衡代偿的药物，而在哪种眩晕条件下需要应用抑制平衡代偿的药物，以及在哪种眩晕的哪个病程阶段应该积极促进平衡代偿而在哪个病程阶段需要抑制平衡代偿，是眩晕临床工作者应该根据药理学原理和患者的病因病情及病变后果来慎重思考的问题。

关键词:眩晕;抗眩晕药物;多巴胺激动剂;多巴胺拮抗剂

Abstract:

According to the different causes, different conditions, and different prognosis of vestibular vertigo, it is very important to select and apply different anti-vertigo drugs reasonably to eliminate the symptoms of vertigo and promote the recovery of balance function. Base on the different pharmacological effects of various anti-vertigo drugs, medicines for treatment of vertigo symptoms can be divided into two categories:one is a dopamine agonist to promote neurocompensation, the other one is a dopamine antagonist to inhibit neurocompensation. The pharmacological mechanisms of the two types of anti-vertigo drugs are exactly opposite. Nearly half of all vestibular diseases that causes vertigo are reversible and can recover spontaneously. However, nearly half of the cases have irreversible vestibular damage, which are difficult to heal by themselves. For those cases of vestibular vertigo that can heal itself, the application of dopamine agonist to accelerate the compensation of balance function is unnecessary or even harmful. For those cases of vestibular vertigo with irreversible unilateral permanent destruction, the application of dopamine agonist can promote balance compensation and eliminate vertigo symptoms. In contrast, the application of dopamine antagonists prolongs the process of imbalance and hinders the compensatory restoration of balance function. Therefore, under which vertigo conditions should use dopamine agonist to promote balance compensation? Under which vertigo conditions should use dopamine antagonist to suppress balance compensation? At which stage of the vertigo should promote the balanced compensation? At which stage of the vertigo should suppress the balance compensation? Clinicians should seriously consider based on pharmacological principles and the patient's cause and disease consequences.

Key words:Vertigo;Anti-vertigo drugs;Dopamine agonist;Dopamine antagonist