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目的:通过对我科门诊确诊的青海高海拔地区偏头痛患者进行问卷调查,了解青海省部分高海拔地区偏头痛诊治的现状。方法:所有患者均为2014年1月—2014年10月来自青海高海拔地区(海拔2 500m~3 500m)在青海大学附属医院神经科门诊就诊并确诊为偏头痛的患者,共623例,其中520人(83.47%)配合接受了问卷调查、包括病程、发作频率、诱发因素、伴随症状、误工情况、医院就诊次数、首诊医院及科室、辅助检查、诊断、治疗及预防情况、住院情况、诊治花费等。结果:所有接受调查患者过去诊断为偏头痛者为48人,正确诊断率为9.23%。首次发病到确诊平均等待时间为(6.52±4.54)年,需要预防治疗者接受预防治疗的平均等待时间为(3.51±1.82)年。首次就诊乡镇或县医院内科者为405人(77.88%),首次就诊省级医院神经科者为115人(22.12%)。确诊前平均门诊就诊次数(6.67±3.45)次,平均急诊就诊次数(2.45±1.16)次,有请假休息者占15%,平均诊治总费用为(4 560±2 885)元。其中95位患者头痛住院,只有20位诊断偏头痛,正确诊断率为21.05%,平均诊治总费用(9 120±1 130)元。被调查患者中发作期多服用非甾体类抗炎药者为375人(72.12%),多服用中药止痛药者为76人(14.62%),多服用阿片类药者为36人(6.92%),不服用任何药物者为28人(5.38%),服用麦角类制剂或曲普坦类药者为5人(0.96%),服药患者中反映药效差者为301人(57.88%)。需要预防治疗人数为175人,接受预防治疗人数为34人(19.43%),预防服药时间均为1个月左右。结论:青海高海拔地区偏头痛识别及诊断率低,患者反复就诊及检查,医疗花费大,影响工作明显,发作期治疗以非特异性止痛药及中药为主,应用特异性止痛药者极少,预防药物单一且时间过短。普及高海拔地区医生及头痛患者对偏头痛的认识及防治措施,可减少偏头痛患者反复检查及输液、住院的比例,节省医疗费用,减轻患者痛苦,对提高青海高海拔地区偏头痛诊治意义重大。
Objective: To investigate the status of migraine in some high altitude areas of Qinghai province through questionnaire survey of migraine patients diagnosed in our high-altitude area in Qinghai province. Methods: All patients were 623 cases from Department of Neurology, Qinghai University Affiliated Hospital, Qinghai, from January 2014 to October 2014 at a high altitude (altitude 2 500m ~ 3 500m), and were diagnosed as migraine 520 people (83.47%) received questionnaires, including the duration of the disease, the frequency of attacks, the predisposing factors, the accompanying symptoms, the number of missed workers, the number of hospital visits, the first visit to hospitals and departments, laboratory examinations, diagnosis, treatment and prevention, Treatment costs and so on. RESULTS: All of the patients surveyed had migraines in the past with 48 and had a correct diagnosis of 9.23%. The average waiting time from the first onset to the diagnosis was (6.52 ± 4.54) years, and the average wait time for prophylactic treatment was (3.51 ± 1.82) years. The number of first visit to the township or county hospital was 405 (77.88%), and the first visit to the provincial hospital was 115 (22.12%). The average number of outpatient visits (6.67 ± 3.45) before the diagnosis, the average number of emergency visits (2.45 ± 1.16), the number of leave to take rest 15% and the average total cost of diagnosis and treatment (4 560 ± 2 885) yuan. Ninety-five patients were hospitalized with headache and only 20 had migraine headaches. The correct diagnosis rate was 21.05% and the average total cost of diagnosis and treatment was 9 120 ± 1 130. Among the surveyed patients, 375 (72.12%) were taking more NSAIDs, 76 (14.62%) were taking more Chinese medicine painkillers, and 36 were taking more opioids (6.92% ), 28 (5.38%) did not take any medication, 5 (0.96%) took ergot preparations or triptans, and 301 (57.88%) patients showed poor efficacy. The number of need for prevention and treatment was 175, the number of people receiving prevention and treatment was 34 (19.43%), prevention of medication are about 1 month. Conclusion: The identification and diagnosis rate of migraine in high altitude area of Qinghai Province are low. The patients frequently visit and examine, the cost of medical treatment is large, and the work is obviously affected. In the attack period, non-specific analgesics and traditional Chinese medicines are the main treatment, Prophylaxis single and too short of time. To popularize the cognition and prevention and treatment of migraine in doctors and headache patients in high altitude area can reduce the proportion of migraine patients repeatedly check and infusion, hospitalization, save medical costs, reduce patient suffering, improve the diagnosis and treatment of migraine in Qinghai high altitude area of great significance .