摇动加重征
原作者： Danya Khoujah, 葛赟译, 文章来源： 《中华急诊医学杂志》编辑部 发布日期：2015-01-25

Title: Jolt Accentuation Sign

题目：摇动加重征

Author 作者: Danya Khoujah

翻译：葛赟 校对：肖锋

 

Jolt accentuation, the exacerbation of a headache with horizontal rotation of the neck, or shaking of the stretcher in the less cooperative patient, has been promoted for the past few years as the "go-to" test to assess for meningeal irritation in patients with headache. Previous studies have quoted sensitivities as high as 97.1%. (1)

 

摇动加重，是指按水平线旋转颈部或对不配合的病人摇动担架时引起头痛加剧，在过去几年中被认为作为头痛病人脑脊膜刺激的体征之一。过去的研究引证敏感性高达97.1%。（1）

A new prospective study in AJEM challenges this belief by looking at a total of 230 patients with headaches and subsequent LPs. 197 of them had the jolt accentuation test done, which had a sensitivity of only 21% for pleocytosis (defined as greater than or equal to 5 cells/high power field in the 4th CSF tube). Kernig's and Brudzinski's signs both did even more poorly, with a sensitivity of 2% each. (2)

 

最近发表在AJEM上的一项前瞻性研究对这一论点进行了验证，对230例头痛并做了腰穿的患者观察中发现，197例摇动加重试验阳性病人中只有21%有脑脊液细胞增多（定义为在第四个脑脊液试管里每高倍镜下有≥5个细胞）。克氏征和布氏征都更不敏感，敏感性分别为2%。（2）

References 参考文献：

(1) Uchihara T. Jolt accentuation of headache: the most sensitive sign of CSF pleocytosis. Headache. 1991 Mar;31(3):167-171.

(2) Nakao JH et al. Jolt accentuation of headache and other clinical signs: poor predictors of meningitis in adults. Am J Emerg Med. 2014 Jan;32(1):24-28.