颅脑手术后颈源性头痛的临床特点及治疗效果评价

Clinical characteristics and therapeutic effectiveness of post craniotomy cervicogenic headache

回顾性收集2019年1月至2021年12月首都医科大学附属北京天坛医院151例颅脑手术后颈源性头痛患者的临床资料,总结发病特点,比较复方阿片类药物和颈部神经阻滞治疗前后患者的疼痛数字评分(NRS),并统计相关不良反应及并发症的发生情况。151例患者头痛的发生时间为术后(5.5±2.0)d,其中131例(86.8%)为单侧疼痛,127例(84.1%)可由颈部活动诱发颈源性头痛,118例(78.1%)颈部活动受限。124例患者接受复方阿片类药物治疗,其中85例(68.5%)患者治疗前NRS为(8.01±0.82)分,治疗后M(Q_(1),Q_(3))降为2.0(1.0,3.0)分(P<0.001)。39例药物治疗无效的患者接受了颈部神经阻滞,在接受神经阻滞前后NRS分别为(7.49±1.12)分和2.0(1.0,2.5)分,差异有统计学意义(P<0.001)。27例未接受药物治疗的患者接受了颈部神经阻滞,治疗前后NRS分别为(9.0±0.9)分和1.0(1.0,3.0)分,差异有统计学意义(P<0.001)。接受药物治疗的124例患者中,14例(11.3%)出现轻度头晕、恶心,停药后缓解,未发现其他药物相关不良反应。接受神经阻滞的患者均未发现神经阻滞操作相关并发症。本研究显示,复方阿片类药物对大多数颅脑手术后颈源性头痛患者治疗效果较好,颈部神经阻滞对于复方阿片类药物治疗无效的患者以及未接受药物治疗的患者均有较好疗效。

From January 2019 to December 2021,the clinical data of 151 patients with post craniotomy cervicogenic headache from Beijing Tiantan Hospital affiliated to Capital Medical University were retrospectively collected.The characteristics of cervicogenic headache were summarized,the numerical rating score(NRS)of patients before and after treatment of compound opioids and/or cervical nerve block was compared,and the occurrence of related adverse reactions and complications was counted.The onset of cervicogenic headache in 151 patients was on the(5.5±2.0)d after craniotomy,of which 131(86.8%)had unilateral pain,pain in 127(84.1%)could be induced by cervical activity,and 118(78.1%)had limited neck movement.Of the 124 patients treated with compound capsule of oxycodone and acetaminophen,85(68.5%)patients had an NRS of(8.01±0.82)before treatment and 2.0(1.0,3.0)after treatment(P<0.001).Thirty-nine patients who did not respond to medical therapy received cervical nerve block,and the NRS scores before and after receiving the nerve block were(7.49±1.12)and 2.0(1.0,2.5),respectively,with a statistically significant difference(P<0.001).Twenty-seven patients who received cervical nerve block without medical treatment,and the NRS before and after treatment was(9.0±0.9)and 1.0(1.0,3.0),respectively,with a statistically significant difference(P<0.001).Among the 124 patients receiving medication,14(11.3%)developed mild dizziness and nausea,which were resolved after stopping the drug,and no other drug-related adverse reactions were found.None of the patients who received nerve blocks saw complications associated with nerve block procedures.Compound capsule of oxycodone and acetaminophen are effective for most of patients with post craniotomy cervicogenic headache.Cervical nerve block is effective and safe for patients with or without drug resistance.