急性小脑扁桃体疝的临床实践

Clinical practice of cerebellar tonsillar herniation

本文报告16例急性小脑扁桃体疝,抢救成活11例,植物生存1例,死亡4例。对其临床表现、发生机制、呼吸停止的抢救等问题进行探讨。为提高疗效,在脑疝前驱期或脑疝代偿期即应作出诊断。一旦呼吸停止,采取迅速的气管插管人工呼吸、准确的颅骨钻孔脑室引流、有效的脱水药物。自主呼吸恢复,及时将原发病灶清除,解除对脑干的直接压迫。

16 cases of acute cerebellartonsillar herniation(ACTH)are reported.There were 11 cases ofsuccessful rescue,1 vegetable status and 4 deaths.The clinical manifestation,mechanism of ACTHand rescue of respiratory arrest are discussed.Toimprove the effect of treatment,the diagnosisshould be made timely at prodromal stage orcompensatory stage of the herniation.Noteworthi-ness were 5 cases which stopped breathing 1 to12 hours after lumbar puncture.So lumbar punctureis,generally speaking,not recommendable forintracranranial space occupying lessions,especiallyin posterior fossa accompanied with advancedpapilledema.Once respiration stops,tracheal in-tubation should be performed and ventricular drain-age,and effective dehydration drugs.When naturalrespiration restores,primary lesions should be removedquickly for relieving the direct compression uponbrain stem.