基于增长混合模型的脑肿瘤患者开颅术后头痛发展轨迹分析

doi:10.6040/j.issn.1671-7554.0.2024.0178

摘要/Abstract

摘要： 目的确定接受开颅手术治疗的脑肿瘤患者术后头痛(post-craniotomy headache, PCH)症状的轨迹。方法采用纵向研究设计,对2023年3—6月就诊于山东第一医科大学附属肿瘤医院神经外科确诊为脑肿瘤住院治疗的患者304例,在第7天、第1个月、第3个月使用视觉模拟评分量表(visual analogue scale, VAS)评估术后头痛症状,确定PCH发生情况,得分越高表示头痛症状越严重。使用潜增长曲线模型以及增长混合模型来确定VAS评分随时间变化及可能的潜在类别。结果 304例脑肿瘤患者的VAS评分完成完整的3个月PCH随访,随访测量期间呈下降趋势且发展趋势存在3个不同的类别。加重组和稳定组分别占1.3%、19.0%,缓解组占79.6%。结论脑肿瘤患者开颅术后头痛发展存在个体差异且有3类头痛症状轨迹,了解开颅术后头痛症状的发展轨迹有助于临床对开颅术后头痛进行更科学的调控。

关键词: 脑肿瘤, 头痛, 开颅手术, 发展轨迹, 增长混合模型

Abstract: Objective To determine the trajectory of post-craniotomy headache symptoms in patients with brain tumors treated with craniotomy. Methods A longitudinal study design was used to assess postoperative headache symptoms using the visual analogue scale(VAS)score at the 7th day, the first month, the third month postoperatively in patients who were diagnosed with brain tumors and hospitalized in the Shandong Cancer Hospital Affiliated to Shandong First Medical Univerisity from March to June 2023. The higher VAS scores indicated more severe headache symptoms. Changes in VAS scores over time and possible underlying categories were determined using Latent Growth Curve Models as well as Growth Mixture Modeling. Results The VAS scores of 304 patients with brain tumors who completed a complete 3-month follow-up were analyzed and found to be decreased during the three follow-up measurements and the trend existed in three different categories. The plus group and the stable group accounted for 1.3% and 19.0%, and the remission group accounted for 79.6%. Conclusion There are individual differences in the development of post-craniotomy headache in patients with brain tumors and there are three types of headache symptom trajectories. Understanding the developmental trajectory of post-craniotomy headache symptoms can help clinics to regulate post-craniotomy headache more scientifically.

Key words: Brain tumor, Headache, Craniotomy, Trajectory, Growth mixture modeling

中图分类号:

R739.41

张新蕊,孙鹏,李峰. 基于增长混合模型的脑肿瘤患者开颅术后头痛发展轨迹分析[J]. 山东大学学报 (医学版), 2024, 62(6): 102-107.

ZHANG Xinrui, SUN Peng, LI Feng. Trajectory analysis of post-craniotomy headache in brain tumor patients based on growth mixture modeling[J]. Journal of Shandong University (Health Sciences), 2024, 62(6): 102-107.

参考文献

[1] Ostrom QT, Gittleman H, Liao P, et al. CBTRUS statistical report: primary brain and central nervous system tumors diagnosed in the United States in 2007-2011[J]. Neuro Oncol, 2014, 16(Suppl 4): iv1-iv63.
[2] Shibata Y, Hatayama T, Matsuda M, et al. Epidemiology of post-suboccipital craniotomy headache: a multicentre retrospective study[J]. J Perioper Pract, 2023, 33(7/8): 233-238.
[3] Palmieri A, Valentinis L, Zanchin G. Update on headache and brain tumors[J]. Cephalalgia, 2021, 41(4): 431-437.
[4] Hadidchi S, Surento W, Lerner A, et al. Headache and brain tumor[J]. Neuroimaging Clin N Am, 2019, 29(2): 291-300.
[5] Lutman B, Bloom J, Nussenblatt B, et al. A contemporary perspective on the management of post-craniotomy headache and pain[J]. Curr Pain Headache Rep, 2018, 22(10): 69.
[6] Headache Classification Committee of the International Headache Society(IHS). The international classification of headache disorders, 3rd edition[J]. Cephalalgia, 2018, 38(1): 1-211.
[7] Fiore G, Porto E, Pluderi M, et al. Prevention of post-operative pain after elective brain surgery: a meta-analysis of randomized controlled trials[J]. Medicina, 2023, 59(5): 831.
[8] Kim TK, Yoon JR, Kim YS, et al. Pneumocephalus and headache following craniotomy during the immediate postoperative period[J]. BMC Surg, 2022, 22(1): 252.
[9] Santos CMT, Pereira CU, Chaves PHS, et al. Options to manage postcraniotomy acute pain in neurosurgery: no protocol available[J]. Br J Neurosurg, 2021, 35(1): 84-91.
[10] Leslie K, Troedel S, Irwin K, et al. Quality of recovery from anesthesia in neurosurgical patients[J]. Anesthesiology, 2003, 99(5): 1158-1165.
[11] 张雪梅, 侯春梅, 王会文, 等. 神经外科开颅术后患者疼痛及控制状况的调查[J]. 中华现代护理杂志, 2012, 18(29): 3517-3519. ZHANG Xuemei, HOU Chunmei, WANG Huiwen, et al. Investigation of postoperative pain and analgesia of patients after craniotomy[J]. Chinese Journal of Modern Nursing, 2012, 18(29): 3517-3519.
[12] 万丽,赵晴,陈军,等. 疼痛评估量表应用的中国专家共识(2020版)[J]. 中华疼痛学杂志, 2020, 16(3):177-187.
[13] 温忠麟, 侯杰泰, 马什赫伯特. 结构方程模型检验: 拟合指数与卡方准则[J]. 心理学报, 2004, 36(2): 186-194. WEN Zhonglin, HAU KitTai, Herbert W. Structural equation model testing: cutoff criteria for goodness of fit indices and Chi-square test[J]. Acta Psychologica Sinica, 2004, 36(2): 186-194.
[14] Yuan KH, Zhang ZY, Deng LF. Fit indices for mean structures with growth curve models[J]. Psychol Methods, 2019, 24(1): 36-53.
[15] 王孟成, 毕向阳, 叶浩生. 增长混合模型: 分析不同类别个体发展趋势[J]. 社会学研究, 2014, 29(4): 220-241, 246. WANG Mengcheng, BI Xiangyang, YE Haosheng. Growth Mixture Modeling: a method for describing specific class growth trajectory[J]. Sociological Studies, 2014, 29(4): 220-241, 246.
[16] Berlin KS, Parra GR, Williams NA. An introduction to latent variable mixture modeling(part 2): longitudinal latent class growth analysis and growth mixture models[J]. J Pediatr Psychol, 2014, 39(2): 188-203.
[17] Yang X, Ma J, Li K, et al. A comparison of effects of scalp nerve block and local anesthetic infiltration on inflammatory response, hemodynamic response, and postoperative pain in patients undergoing craniotomy for cerebral aneurysms: a randomized controlled trial[J]. BMC Anesthesiol, 2019, 19(1): 91.
[18] Viderman D, Brotfain E, Bilotta F, et al. Risk factors and mechanisms of postoperative delirium after intracranial neurosurgical procedures[J]. Asian J Anesthesiol, 2020, 58(1): 5-13.
[19] Rocha-Filho PAS. Post-craniotomy headache: a clinical view with a focus on the persistent form[J]. Headache, 2015, 55(5): 733-738.
[20] Ji YB, Bo CL, Xue XJ, et al. Association of inflammatory cytokines with the symptom cluster of pain, fatigue, depression, and sleep disturbance in Chinese patients with cancer[J]. J Pain Symptom Manage, 2017, 54(6): 843-852.
[21] Stec NE, Walbert T. Neuro-oncology and supportive care: the role of the neurologist[J]. Neurol Sci, 2022, 43(2): 939-950.
[22] Rocha-Filho PAS, Gherpelli JLD, de Siqueira JTT, et al. Post-craniotomy headache: characteristics, behaviour and effect on quality of life in patients operated for treatment of supratentorial intracranial aneurysms[J]. Cephalalgia, 2008, 28(1): 41-48.
[23] Hassouneh B, Centofanti JE, Reddy K. Pain management in post-craniotomy patients: a survey of Canadian neurosurgeons[J]. Can J Neurol Sci, 2011, 38(3): 456-460.
[24] Andreou AP, Edvinsson L. Mechanisms of migraine as a chronic evolutive condition[J]. J Headache Pain, 2019, 20(1): 117.
[25] Iturri F, Valencia L, Honorato C, et al. Narrative review of acute post-craniotomy pain. Concept and strategies for prevention and treatment of pain[J]. Rev Esp Anestesiol Reanim, 2020, 67(2): 90-98.
[26] Rozen T, Swidan SZ. Elevation of CSF tumor necrosis factor alpha levels in new daily persistent headache and treatment refractory chronic migraine[J]. Headache, 2007, 47(7): 1050-1055.

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