单侧去骨瓣减压术后并发反常性脑疝诊疗探讨

目的分析并总结反常性脑疝患者的临床特征及诊疗方案。方法回顾性分析9例单侧去骨瓣减压术后并发反常性脑疝患者的临床资料，并对相关文献进行复习。结果9例反常性脑疝患者中，有2例发生于去骨瓣减压术后第2个月，5例出现于术后第3个月，2例发生于术后第5个月。9例患者均表现为骨窗处皮瓣塌陷、CT均提示脑中线移位且伴有不同程度的意识下降。5例患者临床表现为间断性头晕或头痛。在给予大量静脉补液和（或）头低脚高位和（或）腰穿注液和颅骨修补后患者病情均较前好转。结论静脉补液、头低脚高位与腰穿注液是改善反常性脑疝患者临床症状的应急方案；此外，及时行颅骨修补为改善反常性脑疝患者预后的较优方案。

Abstract： Objective To analyze and summarize the clinical characteristics and diagnosis and treatment protocol of patients with paradoxical herniation(PH). Methods The clinical data of 9 patients with PH after unilateral decompressive craniectomy(DC) were analyzed retrospectively, and the relevant literature was reviewed. Results Among the 9 patients with abnormal cerebral hernia, 2 occurred in the second month after DC, 5 cases in the third month and 2 cases in the fifth month. All 9 patients showed flap collapse at bone window, CT showed midline displacement of brain, and decreased consciousness in varying degrees. The clinical manifestations of 5 patients were intermittent dizziness or headache. After giving a large amount of intravenous rehydration and/or head low foot high and/or lumbar puncture and skull repair, the patient’s condition was better than before. Conclusions Intravenous fluids, trendelenburg positioning, and umbar puncture rehydration are emergency protocols to improve the clinical symptoms of patients with PH. Furthermore, early cranioplasty is the reliable way to improve the prognosis of patients with PH.