警告性头痛与动脉瘤性蛛网膜下腔出血-再出血的关系  

Association between prodromal headache and propensity of rebleeding after aneurysmal subarachnoid hemorrhage

作　　者：林高平[1] 郑锦志[1] 盛莉莉[1] 

机构地区：[1]浙江大学医学院附属第二医院神经科,杭州浙江省人民医院310009

出　　处：《中华急诊医学杂志》2007年第10期1062-1065,共4页Chinese Journal of Emergency Medicine

摘　　要：目的研究有警告性头痛的动脉瘤性蛛网膜下腔出血患者是否更容易发生再出血。方法以本院2003—2006年收治的209例动脉瘤性蛛网膜下腔出血患者为研究对象,记录年龄、性别、Hunt—Hess分级、D-二聚体、FBG(纤维蛋白原)、动脉瘤位置、动脉瘤数量、有无警告性头痛等指标;根据有无再出血分为再出血组和无再出血组,采用病例对照研究方法,回顾性比较两组各指标的差异。对两组间年龄、动脉瘤数量、D-二聚体、FBG的比较采用￡检验,警告性头痛、性别、动脉瘤位置的比较采用卡方检验,Hunt-Hess分级比较采用秩和检验。结果再出血患者22例,占总数的10.5%。再出血组中有警告性头痛的有10例,占再出血组的45.5%。无再出血组187例患者中,有警告性头痛的有21例,占11.2%。有警告性头痛者比无警告性头痛者更易发生再出血(P<0.01),OR(比数比)值为6.59。结论有警告性头痛的动脉瘤性蛛网膜下腔出血患者比无警告性头痛者再出血的风险更大,应该采取更为积极的治疗措施。Objective To investigate the association between prodromal headache and the propensity of rebleeding after aneurysmal subaraclmoid hemorrhage. Method Prodromal headache was defined as a sudden attack of severe headache lasting at least one hour with or without accompanying symptoms, not leading to a diagnosis of SAH 4 weeks before the confirmation of subaraclmoid hemorrhage. Two hundred and nine patients with aneurymal subaraclmoid hemorrhage were enrolled in this research. Age, gender, Hunt-Hess grade, D-dimer, （FBG）, site and number of aneurysms and prodromal headache were recorded. Patients were divided into rebleeding group and non-rebleeding group. Comparing the above survey components between two groups was carried out by using case control study method. Age, aneurysm number, D-dimer and fibrinogen of the two groups were analyzed by t test. Prodromal headache, gender, site of aneurysms were analyzed by chi square test. Hunt-Hess grade was analyzed by rank test. Results Twenty-two （ 10.5 % ） patients had rebleeding . In the rebleeding group, 10 patients （45.5%） had prodromal headache, while in the non-rebleeding group （n = 187）, 21 patients （11.2%） had prodromal headache. Patients with prodromal headache had greater propensity of rebleeding compared with those without predromal headache （P〈0. 01, OR, 6.59; 95% CI,）, In the rebleeding group, the mumber of average aneurysm on average was greater , and the HUNT Hess grade was higher while the age, sex, D-dimer, FBG, and site of aneurysms showed no difference between the two groups. Conclusions Patients with warning headache have a higher propensity of rebleeding after aneurysmal subaraclmoid hemorrhage, suggesting needing aggressive treatment for the patients with predromal headache.

关 键 词：警告性头痛 动脉瘤 蛛网膜下腔出血 再出血 

分 类 号：R743.3[医药卫生—神经病学与精神病学]