蛛网膜下腔出血剧烈头痛相关因素分析

Analysis of associated factors of severe headache after subarachnoid hemorrhage.

目的 了解蛛网膜下腔出血 (SAH)后剧烈头痛的相关因素 ,探讨SAH性头痛发病机制 ,为头痛的治疗提供理论依据和途径。方法 制定头痛程度量表 ,根据CT分析SAH在颅内的分布情况以及脑压、脑脊液 (CSF)改变与头痛程度的关系。结果 CT显示阴性或阳性结果均出现剧烈头痛 ;SAH头痛程度与CSF发生血性质变有关 ,而与血性程度和出血部位无关 ;脑压在 30 0mmH2 O以下时 ,头痛加重不明显 ;当脑压升高超过 30 0mmH2 O时 ,头痛明显加重 (P <0 0 0 5 ) ;用地塞米松鞘内注射能显著改善头痛。结论 发生质变的血性CSF引起蛛网膜下腔广泛的炎性反应是导致头痛的重要原因 ,高颅压是SAH头痛的次要因素 ,出血量导致高颅压引起头痛 ,可能与头痛持续时间有关。

Objective To examine the associated factors of severe headache after subarachnoid hemorrhage(SAH) and to search for the pathogenesis of headache,the theoretical secundum and more therapeutics were provid for headache with SAH.Methods Firstly,the headache severity measuring scale was instituted.Secondly,the relationship between the severity of headache and cerebrospinal fluid(CSF)changes,intracranial pressure as well as bleeding in subarachnoid space according to lumbar puncture and CT scan were examined.Results All patients had severe headache regardless of CT scan findings.The severity of headache was associated with the presence but not the amount of blood in CSF,and unrelated to the location of SAH.The severity of headache obviously aggravated when intracranial pressure was under 300mm H 2O and was so above 300mm H 2O.The SAH-related headache was markedly improved after intrathecal decamethasone.Conclusions The main cause for headache was the widespread inflammatory response in the subarachnoid space caused by blood in the CSF.The high intracranial pressure was secondary factor for headache after SAH.Bleeding-induced raised intracranial pressare resulted in headache,and was probably associated with the duration of the headache. [