反常性脑疝的临床治疗与分析

Clinical therapy of paradoxical herniation

目的探讨去骨瓣减压术后反常性脑疝的有效治疗方法。方法对山西大医院神经外科自2014年4月至2017年7月诊治的12例反常性脑疝患者的临床资料进行回顾性分析，探讨体位调节、容量补充及颅骨修补等方法对患者的治疗效果。结果本组12例反常性脑疝患者中9例发生于术后2周内，2例发生于术后2周～1月，1例发生于术后2个月．其中8例发生术区皮瓣塌陷下沉。12例患者接受体位调节、控制脑脊液流失、补液扩容等综合治疗后，脑疝症状均获得阶段性的改善；9例患者接受颅骨修补后脑神经功能得到明显恢复。结论当发生反常性脑疝时，应及早给予体位调节、减少脑脊液流失、补液扩容改善脑灌注和颅骨修补等措施，可有效改善患者预后。

Objective To explore the treatment of paradoxical herniation after bone flap decompression surgery, and improve people＇s understanding of paradoxical herniation. Methods From April 2014 to July 2017, the clinical data of 12 patients with paradoxical herniation were retrospectively analyzed. The treatment efficacies of position adjusting, sufficient hydration, and cranioplasty were explored. Results Nine patients （75%） had paradoxical herniation within two weeks of surgery, two（16.67%） developed paradoxical herniation from two weeks to one month of surgery, and one （8.33%） developed paradoxical herniation at two months after operation. But no all the patients had sunken and collapsed skin flap. After position adjusting, sufficient hydration, and cranioplasty, 12 patients had periodic improvement; the neurological function of 9 patients accepted cranioplasty recovered obviously. Conclusion Paradoxical herniation is reversible after effective treatments, as position adjusting, sufficient hydration, and cranioplasty, enjoying good results.