去大骨瓣减压术后腰穿诱发反常性脑疝  

Paradoxical Herniation after Decompressive Craniectomy Provoked by Lumbar Puncture

作　　者：简志宏[1] 刘佳[1] 刘仁忠[1] 熊晓星[1] 秦兴平[1] JIAN Zhihong;LIU Jia;LIU Renzhong;XIONG Xiaoxing;QIN Xingping(Dept. of Neurosurgery , Renmin Hospital of Wuhan University ,Wuhan 430060 ,Chin)

机构地区：[1]武汉大学人民医院神经外科,湖北武汉430060

出　　处：《武汉大学学报（医学版）》2017年第6期998-1001,共4页Medical Journal of Wuhan University

摘　　要：目的:分析总结反常性脑疝的发生机制、病因、临床特点、影像学特征及治疗措施。方法:回顾分析我院收治的2例去大骨瓣减压术后腰穿和腰穿置管引流诱发反常性脑疝的病例,并复习相关文献资料。结果:1例去大骨瓣减压的患者在术后3周行腰穿诱发反常性脑疝,腰穿20h后患者病情恶化,置患者于头低脚高位,停用脱水药物,并予以扩容补液治疗,患者1周后逐渐恢复;1例去大骨瓣减压的患者在术后2周行腰穿置管引流诱发反常性脑疝,引流15h后患者病情恶化,夹闭腰大池引流管,置患者于头低脚高位,并予以扩容补液治疗,18h后患者病情明显改善。结论:去大骨瓣减压术后的患者在脑组织肿胀消退后、未行颅骨修补前,行腰穿或腰穿置管引流有诱发反常性脑疝的风险,一旦出现反常性脑疝的表现,应及时进行干预,治疗措施包括杜绝一切导致脑脊液流失的因素、升高颅内压以及颅骨修补。Objective： To analyze and summarize the pathogenesis, etiology, clinical features, imaging features and treatment of paradoxical herniation. Methods： We retrospectively analyzed two pa- tients of paradoxical herniation after decompressive craniectomy provoked by lumbar puncture and reviewed related literature. Results： One patient of 3 weeks after decompressive craniectomy re- ceived a lumbar puncture, and 20 hours after the lumbar puncture, paradoxical herniation was provoked. The patient responded to the Trendelenburg position and intravenous fuids, and she recovered one week later. The other patient of 2 weeks after decompressive craniectomy received a lumbar drain. 15 hours after the drain, paradoxical herniation was provoked. The patient was placed in the Trendelenberg position with the drain closed, and intravenous fuid resuscitation was administered. He achieved neurologic recovery 18 hours later. Conclusion： Lumbar puncture may provoke paradoxical herniation when performed in a patient after decompressive craniectomy and before cranioplasty. Paradoxical herniation is an emergency which need prompt first aid treat- ment, including reducing cerebrospinal fluid loss, elevating intracranial pressure and cranioplasty.

关 键 词：去大骨瓣减压 腰穿 反常性脑疝 

分 类 号：R619[医药卫生—外科学]