颈动脉内膜剥脱术后并发头痛的危险因素分析  

Emergent headache after carotid endarterectomy

作　　者：来志超[1] 马江宇 邵江[1] 刘昌伟[1] 郑月宏[1] 叶炜[1] 曾嵘[1] 倪冷[1] 宋小军[1] 陈跃鑫[1] 陈宇[1] 刘志丽[1] 刘暴[1] Lai Zhichao;Ma Jiangyu;Shao Jiang;Liu Changwei;Zheng Yuehong;Ye Wei;Zeng Rong;Ni Leng;Song Xiaojun;Chen Yuexin;Chen Yu;Liu Zhili;Liu Bao(Department of Vascular Surgery,Peking Union Medical College Hospital,Beijing 100730,China)

机构地区：[1]中国医学科学院&北京协和医院血管外科,北京100730

出　　处：《中华普通外科杂志》2018年第12期1003-1006,共4页Chinese Journal of General Surgery

摘　　要：目的探讨颈动脉内膜剥脱术(carotid endarterectomy,CEA)术后头痛的临床特点及危险因素。方法回顾性分析2014年1月至2015年1月于北京协和医院血管外科行CEA手术的患者资料。男119例,女24例。其中有症状颈动脉狭窄97例,颈动脉严重狭窄110例。结果术后新发头痛发病率44%(63/143),发病时间分布在术后30min至术后第6天,有95%(60/63)的头痛在术后48h内发生。79.4%(50/63)的头痛为术侧头痛,20.6%(13/63)为双侧头痛。在头痛程度上,重度头痛占4.8%(3/63),全部为术侧额颞部头痛,均合并中枢神经症状。结论大多数CEA术后轻中度疼痛以单侧为主,可自发缓解。CEA术后术侧的重度头痛发生高灌注综合征或脑梗风险较高,应进一步行脑血流动力学检查以区分不同病理状态。既往卒中或TIA病史是术后重度头痛的独立危险因素。Objective To determine the incidence and clinical features of headache after carotid endarterectomy (CEA).Methods A retrospective analysis was made on the data of patients undergoing CEA in the Department of Vascular Surgery,Peking Union Medical College Hospital from Jan 2014 to Jan 2015.There were 119 males and 24 females,including 97 cases of symptomatic carotid stenosis and 110 cases of severe carotid stenosis.Results The incidence of newly emergent headache after surgery was 44% (63/143).The earliest time of headache was 30 minutes after surgery and the latest was 6 days after surgery.95% of headache occurred within 48 hours after surgery (60/63).79.4% (50/63) of the headache lay ipsilaterally with CEA,and bilateral headache accounted for 20.6% (13/63).Severe headache accounted for 4.8% (3/63),all were ipsilaterally frontal and temporal headache,complicating central nervous system symptoms.Conclusions After CEA headache is a common clinical symptom.Most were mild to moderate and unilateral,which can be relieved spontaneously.Cerebral hemodynamics need to be further examined to differentiate the different pathological states of severe headache on the operative side after CEA because of the high risk of developing hyperperfusion syndrome or cerebral infarction.History of TIA or stroke is the risk factor of post-CEA headache.

关 键 词：颈动脉内膜切除术 手术后并发症 头痛 

分 类 号：R654.4[医药卫生—外科学]