采用腰穿加压注液方法抢救急性枕骨大孔疝致呼吸停止的临床疗效

Clinical experiences of normal saline pressed injection via lumbar puncture in the treatment of apnea due to acute tonsillar hernia

目的 总结应用快速细孔钻颅脑室体外引流术或开颅病变清除减压术后,进行腰穿加压注液抢救枕骨大孔疝所致呼吸骤停患者的经验.方法 自1969至2005年山东大学齐鲁医院及山东大学第二医院共同采用腰穿加压注液方法,救治43例急性枕骨大孔疝患者,43例均为进行快速细孔钻颅脑室外引流或幕上病变开颅清除减压术后,自主呼吸仍不恢复者.结果 43例中11例（25.6％）不仅恢复自主呼吸且完全康复,16例（37.2％）出现不同时间的自主呼吸但最终死亡,无自主呼吸恢复迹象者16例（37.2％）.结论 因急性枕骨大孔疝致呼吸停止,应用快速细孔钻颅脑室引流,或幕上病变开颅清除减压术后,自主呼吸仍无恢复的患者,给予腰穿加压注液有可能使部分患者获救.

Objective To summarize the clinical experiences of normal saline pressed injection via lumbar puncture in the treatment of acute tonsillar hernia induced apnea.This procedure was routinely carried out after external ventricular drainage and/or lesion removal via open craniotomy.Methods During the period of 1969 to 2005,a total of 43 patients failed to regain respiratory after external ventricular drainage using rapid small hole cranio-puncture apparatus or lesion removal via open craniotomy.They underwent lumbar puncture and normal saline was pressed injected via a lumbar puncture needle.The patient data were retrospectively analyzed.Results Eleven of 43 patients had spontaneous respiration and fully recovered （25.6% ）,16 patients regained respiration but died eventually （37.2% ） and 16 patients failed to regain respiration （ 37.2% ）.The effective rate was 62.8%.Conclusion For the patients failing to regain respiration after external ventricular drainage or supratentorial lesion removal via open craniotomy,the conservative treatment should not be the first choice.The pressed injection of normal saline via lumbar puncture may rescue some patients.