[1]王愚,殷振生,鲁涛,等.高压氧联合阿司匹林治疗成人缺血型脑底异常血管网症相关性头痛的疗效[J].中国临床神经外科杂志,2024,29(09):527-531.[doi:10.13798/j.issn.1009-153X.2024.09.004]
　WANG Yu,YIN Zhen-sheng,LU Tao,et al.Efficacy of hyperbaric oxygen treatment combined with aspirin in adult ischemic moyamoya disease-related headache[J].,2024,29(09):527-531.[doi:10.13798/j.issn.1009-153X.2024.09.004]
点击复制

高压氧联合阿司匹林治疗成人缺血型脑底异常血管网症相关性头痛的疗效()
分享到：

《中国临床神经外科杂志》[ISSN:1009-153X/CN:42-1603/TN]

卷:
29
期数:
2024年09期
页码:
527-531
栏目:
论著
出版日期:
2024-09-30

文章信息/Info

Title:
Efficacy of hyperbaric oxygen treatment combined with aspirin in adult ischemic moyamoya disease-related headache
文章编号:
1009-153X（2024）09-0527-05
作者:
王愚; 殷振生; 鲁涛; 陈阳; 郇林春; 刘于海; 宫健; 李冰
261000 山东潍坊，山东第二医科大学临床医学院（王　愚、殷振生）；276000 山东，临沂市人民医院高压氧科（鲁　涛），神经外科（陈　阳、郇林春、刘于海、李　冰），神经内科（宫　健）
Author(s):
WANG Yu1;  YIN Zhen-sheng1;  LU Tao2;  CHEN Yang3;  HUAN Lin-chun3;  LIU Yu-hai3;  GONG Jian4;  LI Bing3
1. School of Clinical Medicine, Shangdong Second Medical University, Weifang 261000, China; 2. Department of Hyperbaric Oxygen, Linyi People's Hospital, Linyi 276000, China; 3. Department of Neurosurgery, Linyi People's Hospital, Linyi 276000, China; 4. Department of Neurology, Linyi People's Hospital, Linyi 276000, China
关键词:
脑底异常血管网症; 头痛; 高压氧; 阿司匹林; 疗效
Keywords:
Moyamoya disease;  Headache;  Hyperbaric oxygen therapy;  Aspirin;  Efficacy
分类号:
R 743
DOI:
10.13798/j.issn.1009-153X.2024.09.004
文献标志码:
A
摘要:
目的 探讨高压氧联合阿司匹林治疗成人缺血型脑底异常血管网症（MMD）相关性头痛的疗效。方法 2011年3月至2022 年1月前瞻性收集48例成人缺血型MMD合并相关性头痛，根据病人治疗意愿分为对照组（n=20）和联合治疗组（n=28）。对照组仅进行高压氧治疗（1次/d，每周5次，共4周），联合治疗组在高压氧治疗基础上加用阿司匹林治疗（100 mg/d）。采用数字疼痛分级评分表（NRS）评定疼痛情况，同时观察不良反应情况及脑梗死、脑出血、短暂性脑缺血发作（TIA）等。结果 治疗4周，联合治疗组NRS评分[（1.81±1.95）分]较对照组[（5.94±1.68）分]明显降低（P<0.001）；联合治疗组总有效率（85.7%）明显高于对照组（20.0%；P<0.001）。在高压氧治疗的升压过程中，1例耳胀，考虑气压伤，立即停止升压，并多次行咽鼓管减压动作后，耳胀消失，继续进行高压氧治疗；5例耳鸣、耳胀，对症处理后继续高压氧治疗。对照组出现新发脑梗死1例、新发脑出血1例、TIA有3例；治疗组出现TIA有1例，无新发脑梗死及脑出血。联合治疗组并发症总发生率（3.6%）明显低于对照组（25.0%；P=0.039）。结论 高压氧联合阿司匹林综合治疗可以有效改善成人缺血型MMD相关性头痛，而且明显降低脑血管事件的发生率。
Abstract:
Objective To explore the efficacy of hyperbaric oxygen (HBO) treatment combined with aspirin in adult ischemic moyamoya disease (MMD)-related headache. Methods From March 2011 to January 2022, 48 adult patients with MMD-related headache were prospectively collected. The patients were divided into the control group (n=20) and the combined treatment group (n=28) based on their treatment preferences. The control group underwent HBO treatment alone (1 session/day, 5 sessions/week for 4 weeks), while the combined treatment group received HBO treatment plus aspirin treatment (100 mg/day). The Numerical Rating Scale (NRS) was employed to assess the pain condition, and adverse reactions as well as cerebral infarction, cerebral hemorrhage, and transient ischemic attack (TIA) were observed. Results After 4 weeks of treatment, the NRS score in the combined treatment group[(1.81±1.95) points]was significantly lower than that[(5.94±1.68) points]in the control group (P<0.001); the total effective rate in the combined treatment group (85.7%) was significantly higher than that (20.0%) in the control group (P<0.001). During the pressure increase process of HBO treatment, one case presented with ear distension (considered as barotrauma) causing the pressure increase immediately halted, after multiple Eustachian tube decompression maneuvers, the ear distension vanished and HBO treatment was resumed; five cases experienced tinnitus and ear distension and continued HBO treatment after symptomatic treatment. In the control group, there was 1 new case of cerebral infarction, 1 new case of cerebral hemorrhage, and 3 cases of TIA; in the treatment group, there was 1 case of TIA, and no new cases of cerebral infarction or cerebral hemorrhage. The total incidence of complications in the combined treatment group (3.6%) was significantly lower than that (25.0%) in the control group (P=0.039). Conclusion HBO treatment combined with aspirin can effectively alleviate MMD-related headache and significantly reduce the incidence of cerebrovascular events.

参考文献/References:

[1]NEVES N, COELHO S, MARTO N, et al. Moyamoya disease and syndrome in caucasian patients[J]. Cureus, 2023, 15(4): e37768.
[2]KALASHNIKOVA LA. Moyamoya disease and syndrome[J]. Zh Nevrol Psikhiatr Im S S Korsakova, 2023, 123(6): 7-15.
[3]ZHANG XH, HE JH, ZHANG XS, et al. Comparison of revascularization and conservative treatment for hemorrhagic moyamoya disease in East Asian Countries: a single-center case series and a systematic review with meta-analysis[J]. Front Neurol, 2023, 14:1169440.
[4]CHIANG CC, SHAHID AH, HARRIOTT AM, et al. Evaluation and treatment of headache associated with moyamoya disease--a narrative review[J]. Cephalalgia, 2022, 42(6): 542-552.
[5]SEOL HJ, WANG KC, KIM SK, et al. Headache in pediatric moya-moya disease: review of 204 consecutive cases[J]. J Neurosurg,2005, 103(5 Suppl): 439-442.
[6]ROACH ES, GOLOMB MR, ADAMS R, et al. American heart association stroke council;council on cardiovascular disease in the young: management of stroke in infants and children:a scientific statement from a special writing group of the American heart association stroke council and the council on cardiovascular disease in the young[J]. Stroke, 2008, 39(9): 2644-2691.
[7]KURODA S, FUJIMURA M, TAKAHASHI J, et al. Diagnostic criteria for moyamoya disease--2021 revised version[J]. Neurol Med Chir (Tokyo), 2022, 62(7): 307-312.
[8]ZHANG H, ZHENG L, FENG L. Epidemiology, diagnosis and treatment of moyamoya disease[J]. Exp Ther Med, 2019, 17(3): 1977-1984.
[9]FUENTES AM, CHIU RG, MEHTA AI. Disparities in the sympto-matic presentation of Moyamoya disease in the United States: anationwide all-payer analysis[J]. J Clin Neurosci, 2021, 87: 92-96.
[10]GAO B, KANG K, ZHANG J, et al. Clinical characteristics and long-term outcome of headaches associated with moyamoya disease in the chinese population--a cohort study[J]. Front Neurol, 2020,11: 605-636.
[11]LEE JY, CHOI YH, CHEON JE, et al. Delayed posterior circulation insufficiency in pediatric moyamoya disease[J]. J Neurol, 2014, 261(12): 2305-2313.
[12]KAWABORI M, KURODA S, NAKAYAMA N, et al. Effective surgical revascularization improves cerebral hemodynamics and resolves headache in pediatric Moyamoya disease[J]. World Neurosurg,2013, 80(5): 612-619.
[13]KAWAGUCHI S, SAKAKI T, MORIMOTO T, et al. Characteristics of intracranial aneurysms associated with moyamoya disease: areview of 111 cases[J]. Acta Neurochir (Wien), 1996, 138(11):1287-1294.
[14]SEWELL RA, JOHNSON DJ, FELLOWS DW. Cluster headacheassociated with moyamoya[J]. J Headache Pain, 2009, 10(1): 65-67.
[15]KATANO H, NISHIKAWA Y, YAMADA H, et al. Association ofsuperficial temporal artery dilatation with headache after revascularization in adult moyamoya disease[J]. World Neurosurg, 2019, 129:e594-e606.
[16]AL-WAILI NS, BUTLER GJ, BEALE J, et al. Hyperbaric oxygen in the treatment of patients with cerebral stroke, brain trauma, and neurologic disease[J]. Adv Ther, 2005, 22(6): 659-678.
[17]SCHIAVO S, DEBACKER J, DJAIANI C, et al. Mechanistic rationale and clinical efficacy of hyperbaric oxygen therapy in chronic neuropathic pain: an evidence-based narrative review[J]. Pain Res Manag, 2021, 2021: 8817504.
[18]MIJAJLOVIC MD, ALEKSIC V, MILOSEVIC N, et al. Hyperbaric oxygen therapy in acute stroke: is it time for Justitia to open her eyes[J]. Neurol Sci, 2020, 41(6): 1381-1390.
[19]FISCHER BR, PALKOVIC S, HOLLING M, et al. Rationale of hyperbaric oxygenation in cerebral vascular insult[J]. Curr Vasc Pharmacol, 2010, 8(1): 35-43.
[20]ESCHENFELDER CC, KRUG R, YUSOFI AF, et al. Neuroprotection by oxygen in acute transient focal cerebral ischemia is dose dependent and shows superiority of hyperbaric oxygenation[J].Cerebrovasc Dis, 2008, 25(3): 193-201.
[21]FUJIMURA M, TOMINAGA T, KURODA S, et al. 2021 Japanese guidelines for the management of moyamoya disease: guidelines from the research committee on moyamoya disease and Japan Stroke Society[J]. Neurol Med Chir (Tokyo), 2022, 62(4): 165-170.
[22]AIHARA Y, KASHIWASE S, CHIBA K, et al. Aspirin use and platelet aggregation in ischemic onset-type pediatric moyamoya patients with intractable headaches (moya-ache)[J]. Childs Nerv Syst, 2021, 37(5): 1649-1657.

相似文献/References:

[1]刘尧发,黄金生,陈文培,等.以顽固性头痛、高血压为首发表现的椎动脉动脉瘤1例[J].中国临床神经外科杂志,2018,(09):639.[doi:10.13798/j.issn.1009-153X.2018.09.024]
[2]张华建,万蕾,罗先武,等.基于自我效能理论的有氧运动处方在脑底异常血管网症中的应用[J].中国临床神经外科杂志,2024,29(06):327.[doi:10.13798/j.issn.1009-153X.2024.06.002]
　ZHANG Hua-jian,WAN Lei,LUO Xian-wu,et al.Application of aerobic exercise prescription based on self-efficacy theory in patients with moyamoya disease[J].,2024,29(09):327.[doi:10.13798/j.issn.1009-153X.2024.06.002]
[3]王浩,王晨潮,董阳,等.脑底异常血管网症合并颅内动脉瘤破裂风险评分系统的建立和验证[J].中国临床神经外科杂志,2024,29(06):332.[doi:10.13798/j.issn.1009-153X.2024.06.003]
　WANG Hao,WANG Chen-chao,DONG Yang,et al.Establishment and validation of risk score for intracranial aneurysm rupture in patients with moyamoya disease[J].,2024,29(09):332.[doi:10.13798/j.issn.1009-153X.2024.06.003]
[4]吴明洪,徐海涛,黄书岚.脑底异常血管网症血流重建术后并发脑高灌注综合征的危险因素[J].中国临床神经外科杂志,2024,29(08):495.[doi:10.13798/j.issn.1009-153X.2024.08.012]
　WU Ming-hong,XU Hai-tao,HUANG Shu-lan.Risk factors for cerebral hyperperfusion syndrome after revascularization surgery in patients with moyamoya disease[J].,2024,29(09):495.[doi:10.13798/j.issn.1009-153X.2024.08.012]

备注/Memo

备注/Memo:
（2023-07-05收稿，2024-01-12修回）
基金项目：国家自然科学基金（82171887）
通信作者：李　冰，Email：libingys@163.com
更新日期/Last Update: 2024-09-30