透析头痛:血液透析和肾移植患者的患病率和临床表现

Bruno Teixeira Gomes, A. Costa, M. Mazzali
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摘要

头痛是血液透析患者的常见症状,患病率约为70%。根据国际头痛疾病分类(ICHD-3),透析头痛被定义为在血液透析期间发生并由血液透析引起的无特定特征的头痛,并在透析后72小时内自行消失。在触发因素或生理病理方面尚无共识。目的探讨透析头痛的患病率、临床特点及相关因素。方法采用定量分析的观察研究方法。研究患者分为两组:(HD) 25例血液透析患者和(Tx) 25例早期肾移植后患者。所有患者采用结构化问卷,包括医院焦虑抑郁量表(HADS)和Epworth嗜睡量表。分析了透析前后的实验室数据、血压和体重。结果:HD组有8例(32%)患者诊断为透析性头痛,并伴有搏动性头痛(n=6, 75%)、畏光(n=6, 75%)、恐音(n=4, 50%)、恶心或呕吐(n=6, 75%),疼痛评分平均为7.75±1.58。头痛组焦虑评分(7.00±3.93比3.82±3.23,p=0.03)、嗜睡评分(9.13±3.94比4.76±3.85,p=0.01)较高,血钙水平较低(p=0.01),透析前收缩压(p=0.02)和舒张压(p=0.02)较高。Tx组有5例(20%)报告透析头痛,伴搏动性头痛(n=4, 80%),恶心或呕吐(n=4, 80%),平均疼痛评分8.0±1.41。头痛组嗜睡评分较高(9.20±4.32比4.80±4.51,p=0.029),且年龄较轻(38.93±14.43比54.02±8.31,p=0.03)。结论血液透析患者头痛多见,且与偏头痛症状相似。在这个系列中,透析头痛与透析前较高的焦虑和嗜睡评分、较高的血压和较低的钙有关。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Dialysis headache: prevalence and clinical presentation in hemodialysis and kidney transplant patients
Introduction Headache is a common symptom among hemodialysis patients, with a prevalence around 70%. Dialysis headache is defined according to International Classification of Headache Disorders (ICHD-3) as a headache without specific characteristics, occurring during and caused by hemodialysis that spontaneously disappears within 72 hours after the dialysis session. There is no consensus on trigger factors or physiopathology. Objective To evaluate prevalence, clinical characteristics, and associated factors with dialysis headache. Methods Observational study with quantitative analysis. Study patients were divided into two groups: (HD) 25 hemodialysis patients and (Tx) 25 early post kidney transplant patients. A structured questionnaire was applied to all patients, including Hospital Anxiety and Depression Scale (HADS) and Epworth Sleepiness Scale. Laboratory data, blood pressure and body weight were analyzed before and after one dialysis session. Results: In group HD, eight patients (32%) had diagnosis of dialysis headache, with pulsating headache (n=6, 75%), photophobia (n=6, 75%), phonophobia (n=4, 50%), and nauseas or vomiting (n=6, 75%), with a mean pain score of 7.75 ± 1.58. Headache group had higher scores of anxieties (7.00 ± 3.93 vs. 3.82 ± 3.23, p=0.03) and sleepiness (9.13 ± 3.94 vs. 4.76 ± 3.85, p=0.01), lower levels of serum calcium (p=0.01), and higher systolic (p=0.02) and diastolic (p=0.02) blood pressure pre dialysis. In group Tx, five patients (20%) reported dialysis headache, with pulsating headache (n=4, 80%), nauseas or vomiting (n=4, 80%), with a mean pain score of 8.0 ± 1.41. Headache group had a higher score of sleepiness (9.20 ± 4.32 vs. 4.80 ± 4.51, p=0.029) and were younger (38.93 ± 14.43 vs. 54.02 ± 8.31, p=0.03). Conclusion Headache is frequent among hemodialysis patients and had similar symptoms of migraine. In this series dialysis headache was associated with higher scores of anxieties and sleepiness, higher blood pressure and lower calcium pre dialysis.
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