220例儿童鼻源性头痛的循证医学诊断

Evidence-based medical diagnosis of the 220 children' nasal headache

目的探讨循证医学方法在鼻源性头痛临床诊断中的应用。方法选取220例笔者所在医院经临床诊断并治疗验证的鼻源性头痛患者,用循证医学方法分析头痛特点、鼻部症状、伴随症状、CT检查、实验室检查、随访结果,提取有价值的诊断依据。结果实验室检查:白细胞或CRP任何一项增高者65例,最后诊断为鼻窦性头痛201例;接触点头痛19例。194例暂保守治疗,头痛7天内缓解152例,2个月内复发128例,再保守治疗102例缓解。无效或复发37例和有手术指征者26例共63例转手术治疗,随访6个月头痛全部缓解。结论额、颞、颅面部特定部位规律性疼痛,有鼻腔急、慢性炎症或黏膜接触点证据,实验室检查有急性炎症,排除鼻外病因,可以诊断为鼻源性头痛。不典型病例需进一步循证诊断。

Objective Evidence - based medicine approach is to investigate the nose headache clinical diagnosis. Methods Selected 220 cases of patients who were diagnosed and verified by the treatment of rhinogenic headache in our hos- pital. Used Evidence - based medicine to analysis the characteristics of headache, nasal symptoms, accompanying symptoms, CT examination, laboratory tests and follow - up results. Extracted the valuable diagnostic evidence. Results Laboratory tests： Any of the leukocytes and CRP levels increased were 65 cases. Final diagnosis of sinus headache were 201 cases. Contact point headaches were 19 cases. There were 194 cases of temporary conservative treatment. There were 159 patients with headache relief in seven days. 128 cases were recurrcnced in 2 months. Of them there were 102 patients released after a con- servative treatment. 63 cases were converted to surgical treatment including 37 cases who were inefficiency or recurrenced and 26 cases who had surgical indications. All these headaches released in follow - up 6 months. Conclusion Nasal headache can be diagnosed if the regular pain were in specified sites of frontal, temporal and craniofacial, having nasal acute, chronic inflammation or evidence of mucosal contact points, laboratory tests were acute infammated and excluding external causes of nasal.Non-classical cases needs further evidence - based diagnosis.