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目的探讨急性颅脑损伤后颈源性头痛的发病特点及治疗效果,分析其发病原因及治疗对策。方法选择14例轻度颅脑损伤后出现重度头痛、按照颈源性头痛(CEH)的国际诊断标准确定为CEH的患者进行研究。根据查体体征行枕大、枕小、耳大神经或颈2横突阻滞,应用曲安奈德10mg配成利多卡因浓度为0.4%的消炎镇痛液,每个穿刺点注射3ml。观察治疗前后头痛程度数字评分(NRS)、颈部僵硬感和颈部活动度(ROM)。结果治疗前NRS为(8.21±1.15)分,治疗后15min、第1天、第3天和第5天分别降低至(1.36±0.64)分、(1.71±0.88)分、(1.62±0.72)分和(1.09±0.29)分,与治疗前比较均有显著性差异(P﹤0.01);ROM由治疗前的(2.43±0.73)分,降低至(1.21±0.41)分、(1.14±0.35)分、(1.07±0.26)分和(1.07±0.26)分,与治疗前比较均有显著性差异(P﹤0.01)。结论CEH可能是急性颅脑损伤后头痛的原因之一,行类固醇激素神经阻滞对于缓解颅脑损伤后的CEH症状有显著的疗效。
Objective To investigate the incidence and treatment of cervical headache after acute craniocerebral injury and to analyze its etiology and treatment. Methods Severe headache was diagnosed in 14 mild craniocerebral injuries and was studied in patients with CEH identified according to international diagnostic criteria for cervical headache (CEH). According to the investigation of physical signs of occipital, occipital small, large auricular or cervical 2 transverse process block, the application of triamcinolone 10mg dubbed lidocaine concentration of 0.4% anti-inflammatory analgesic, each puncture point injection 3ml. The headache severity digital score (NRS), neck stiffness and neck mobility (ROM) were observed before and after treatment. Results The pre-treatment NRS was (8.21 ± 1.15) minutes, 15 minutes after treatment, the first day, the third day and the fifth day were respectively 1.36 ± 0.64, 1.71 ± 0.88 and 1.62 ± 0.72 And (1.09 ± 0.29) points, respectively, which were significantly different from those before treatment (P <0.01). The ROM decreased from 1.43 ± 0.73 to 1.21 ± 0.41 and 1.14 ± 0.35 before treatment , (1.07 ± 0.26) points and (1.07 ± 0.26) points respectively, which were significantly different from those before treatment (P <0.01). Conclusions CEH may be one of the causes of headache after acute craniocerebral injury. Steroid hormone blockade has a significant effect on relieving CEH symptoms after craniocerebral injury.