动脉瘤性蛛网膜下腔出血后头痛的多模式镇痛疗效评价

首都医科大学学报 ›› 2010, Vol. 31 ›› Issue (1): 109-112.

动脉瘤性蛛网膜下腔出血后头痛的多模式镇痛疗效评价

陆菁菁, 杨中华, 赵性泉

首都医科大学附属北京天坛医院神经内科

收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2010-02-21 发布日期:2010-02-21
通讯作者: 赵性泉

Evaluation of the Effects of Multi-modality Analgesia for Headache Occurred after Aneurismal Subarachnoid Hemorrhage

LU Jing-jing, YANG Zhong-hua, ZHAO Xing-quan^*

Department of Neurology, Beijing Tiantan Hospital, Capital Medical University

Received:1900-01-01 Revised:1900-01-01 Online:2010-02-21 Published:2010-02-21
Contact: ZHAO Xing-quan

摘要/Abstract

摘要：

目的应用影像、超声检查和临床特征分析等方法探讨动脉瘤性蛛网膜下腔出血（aneurismal subarachnoid hemorrhage，aSAH）后头痛的原因，并观察氨酚羟考酮多模式镇痛治疗中-重度头痛患者的临床疗效和不良反应。方法 107名aSAH患者分别在出血后1、2、3、5、7、10、14 d行头痛10 cm数字评分(numerical rating scale，NRS)，中重度头痛患者行头颅电子计算机X射线断层扫描（computed tomography，CT）和经颅三维多普勒（transcranial doppler，TCD）检查，明确其发生原因。对无明确病因学的患者用随机数字表法分成2组，治疗组给予氨酚羟考酮片剂，每次1片,每日3次 ,疗程3 d；对照组给予罗痛定，每次2片,每日3次 ,疗程3 d。结果 86.9%（93/107）的aSAH患者病程中存在中重度头痛，其中 9.7%（9/93）源自动脉瘤再出血，16.1%（15/93）的头痛患者经CT发现继发性脑积水，12.9%（12/93）经TCD发现存在颅内血管痉挛，其余61.3%（57/93）无阳性发现，考虑为出血后对脑膜和神经根刺激所致疼痛。对此类患者，氨酚羟考酮的总体显效率和疼痛强度差(pain intensity difference，PID)均明显优于对照组（均P<0.01）。结论大多数aSAH患者存在中-重度头痛，氨酚羟考酮多模式镇痛对其中无病理学改变者具有较好的临床疗效。

关键词: 动脉瘤性蛛网膜下腔出血, 多模式镇痛, 病因学

Abstract:

Objective This prospective study was designed to explore the etiology of headache occurred after aneurismal subarachnoid hemorrhage(aSAH) and evaluate the effects of the multi-modality analgesia with compound tablet of oxycodone and acetaminophen in treatment of this kind of headache. Methods All of the 107 patients had angiographic demonstration of the presence of intracranial aneurysm and SAH was diagnosed upon CT studies within 24 hours of onset. Assessment of headache was made on the numeric rating scales(NRS) on days 1, 2, 3, 5, 7, 10 and 14 after SAH. Patients suffered from moderate-severe headache were examined by cranial CT scan and transcranial doppler(TCD) to find the reason, and their diversities were analyzed. Patients without etiological findings were divided to compound tablet of oxycodone and acetaminophen in a regimen of 1 tablet tid or Rotundine tablet in a regimen of 2 tablets tid for 3 days. Results Of the 107 patients, 93(86.9%) patients with SAH suffered from moderate-severe headache; in 9.7%(9/93) of them the headache was caused by rebleeding of untreated aneurysm, CT scan found hydrocephalus in 16.1%(15/93) patients with headache, TCD found intracranial vasospasm in 12.9%(12/93) of patients, 61.3%(57/93) of patients had negative results. There was a significant difference(P<0.01) between the actively treated group and control group in analgesic effects. Conclusion Majority of aSAH patients suffered from moderate to severe headache Multi-modality analgesia with compound tablet of oxycodone and acetaminophen was effective in treatment of moderate to severe headache occurred after aSAH without any pathological changes.

Key words: aneurismal subarachnoid hemorrhage, multi-modality analgesia, etiology

中图分类号:

743.35

陆菁菁;杨中华;赵性泉. 动脉瘤性蛛网膜下腔出血后头痛的多模式镇痛疗效评价[J]. 首都医科大学学报, 2010, 31(1): 109-112.

LU Jing-jing;YANG Zhong-hua;ZHAO Xing-quan. Evaluation of the Effects of Multi-modality Analgesia for Headache Occurred after Aneurismal Subarachnoid Hemorrhage[J]. Journal of Capital Medical University, 2010, 31(1): 109-112.

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