Nursing care of a patient with massive cerebral infarction complicated by paradoxical herniation after decompressive craniectomy

doi:10.3761/j.issn.0254-1769.2026.07.005

Abstract

Abstract:

To summarize the nursing experience of a patient with massive cerebral infarction who developed paradoxical herniation after decompressive craniectomy. The key nursing interventions were as follows：activating a multidisciplinary team to identify the cause of paradoxical herniation；maintaining the balance between intracranial pressure and atmospheric pressure to improve cerebrospinal fluid circulation；fine-tuning volume management to maintain cardiac and cerebral perfusion balance；providing precise early warnings based on multimodal neuromonitoring for effective prevention and control of hernia recurrence. After 18 days of meticulous treatment and nursing care，the patient improved and was discharged.Follow-up at 1 month after discharge showed good recovery.

Key words: Massive Cerebral Infarction, Decompressive Craniectomy, Paradoxical Herniation, Nursing Care

摘要：

总结1例大面积脑梗死行去骨瓣减压术后继发反常性脑疝患者的护理经验。护理要点：启动多学科救治小组，明确反常性脑疝诱因；维持颅内压与大气压的平衡，改善脑脊液循环；精细调控患者容量，维持心脑灌注平衡；基于多模态神经监测精准预警，有效防控脑疝复发。经过18 d精心的治疗与护理，患者好转出院；出院1个月随访，患者恢复良好。

关键词: 大面积脑梗死, 去骨瓣减压术, 反常性脑疝, 护理

LIANG Shuang, CAO Xiaobai, WANG Pengju, GAO Lan, WANG Yujiao. Nursing care of a patient with massive cerebral infarction complicated by paradoxical herniation after decompressive craniectomy[J]. Chinese Journal of Nursing, 2026, 61(7): 897-900.

梁爽, 曹笑柏, 王鹏举, 高岚, 王宇娇. 1例大面积脑梗死行去骨瓣减压术后继发反常性脑疝患者的护理[J]. 中华护理杂志, 2026, 61(7): 897-900.

References 15

[1]	中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组. 中国重症卒中管理指南2024[J]. 中华神经科杂志, 2024, 57(7):698-714.
	Chinese Society of Neurology,Chinese Society of Neurology Cerebrovascular Disease Group. Chinese guidelines for the management of severe stroke(2024)[J]. Chin J Neur, 2024, 57(7):698-714.
[2]	渠泽平, 吴丽娥. 大面积脑梗死诊治研究进展[J]. 中国实用神经疾病杂志, 2018, 21(1):114-116.
	Qu ZP, Wu LE. Research progress in diagnosis and treatment of massive cerebral infarction[J]. Chin J Pract Nerv Dis, 2018, 21(1):114-116.
[3]	中华医学会神经外科学分会,国家卫健委脑卒中筛查与防治工程委员会,海峡两岸医药卫生交流协会神经外科分会缺血性脑血管病学组. 大面积脑梗死外科治疗指南[J]. 中华医学杂志, 2021, 101(45):3700-3711.
	Neurosurgery Branch of Chinese Medical Association,National Health and Stroke Screening and Prevention Engineering Committee,Cerebrovascular Ischemia Group of Neurosurgery Branch of Cross-Strait Medical and Health Exchange Association. Guideline for surgical treatment of large hemispheric infarction[J]. Nation Med J China, 2021, 101(45):3700-3711.
[4]	Taheri M, Ghazvini MH, Javadnia P. Paradoxical brain herniation following decompressive craniectomy:a case series and systematic review of literature[J]. Int J Surg Case Rep, 2024, 125:110477. DOI URL
[5]	范国锋, 秦虎, 王增亮, 等. 去骨瓣减压术后环锯综合征和反常性脑疝特征及诊治研究进展[J]. 中华创伤杂志, 2019, 35(5):430-434.
	Fan GF, Qin H, Wang ZL, et al. Research progress on the characteristics,diagnosis and treatment of sinking skin flap syndrome and paradoxical herniation after decompressive craniectomy[J]. Chin J Trauma, 2019, 35(5):430-434.
[6]	Fawley N, Udeh C. Sinking skin flap syndrome after decompressive craniectomy:a case report[J]. A A Pract, 2018, 11(9):241-243.
[7]	国家神经系统疾病医疗质量控制中心神经重症亚专业工作组, 中国病理生理学会危重病医学专业委员会,《神经重症患者镇痛镇静治疗中国专家共识》工作组. 神经重症患者镇痛镇静治疗中国专家共识(2023)[J]. 中华危重病急救医学, 2023, 35(9):897-918.
	Neurocritical Care Subspecialty Working Group of National Center for Healthcare Quality Management in Neurological Diseases,Critical Care Medicine Committee of Chinese Society of Pathophysiology,Chinese Expert Consensus on Analgosedation in Neurocritical Care Patients Working Group. Chinese expert consensus on analgosedation in neurocritical care patients(2023)[J]. Chin Crit Care Med, 2023, 35(9):897-918.
[8]	刘芳, 王宇娇, 曹笑柏, 等. 成人重症患者颅内压增高防控护理专家共识[J]. 中华护理杂志, 2024, 59(21):2606-2610. DOI URL
	Liu F, Wang YJ, Cao XB, et al. Expert consensus on the prevention and control of intracranial hypertension in adult critical illness[J]. Chin J Nurs, 2024, 59(21):2606-2610. DOI URL
[9]	张俊, 张恒柱, 王海丽, 等. 单侧去骨瓣减压术后并发反常性脑疝诊疗探讨[J]. 临床神经外科杂志, 2021, 18(6):679-682.
	Zhang J, Zhang HZ, Wang HL, et al. Diagnosis and treatment for paradoxical herniation after decompressive craniectomy[J]. J Clin Neurosurg, 2021, 18(6):679-682.
[10]	Baram A, Zaed I, Safa A, et al. Intracranial hypotension syndrome after lumbar drainage in skull base surgery:diagnosis and correct management[J]. J Neurol Surg A Cent Eur Neurosurg, 2023, 84(6):578-583. DOI PMID
[11]	胡亚玲, 王海燕. 不同吸痰深度对重型颅脑损伤机械通气患者颅内压力的影响[J]. 中华护理杂志, 2012, 47(1):37-40.
	Hu YL, Wang HY. Effect of different suction depths on intracranial pressure in mechanically ventilated patients with severe traumatic brain injury[J]. Chin J Nurs, 2012, 47(1):37-40.
[12]	Chen SW. Treatment of intractable paradoxical herniation by invasive mechanical ventilation with increased positive end-expiratory pressure:a case report[J]. Brain Inj, 2025, 39(3):241-246. DOI URL
[13]	沈婷, 柳芳莉, 吕建森, 等. 下腔静脉膨胀指数对感染性休克患者液体复苏达标及预后的影响[J]. 浙江创伤外科, 2017, 22(2):237-238.
	Shen T, Liu FL, Lü JS, et al. Effect of inferior vena cava expansion index on fluid resuscitation and prognosis in patients with septic shock[J]. Zhejiang J Trauma Surg, 2017, 22(2):237-238.
[14]	梁云衡, 卓胜华, 羊良旺, 等. 颅内压监测和脑氧监测在颅脑损伤中应用的研究进展[J]. 中国临床神经外科杂志, 2024, 29(1):54-57.
	Liang YH, Zhuo SH, Yang LW, et al. Progress in the application of intracranial pressure monitoring and cerebral oxygen monitoring in traumatic brain injury[J]. Chin J Clin Neurosurg, 2024, 29(1):54-57.
[15]	张建波, 丁俊宏, 周立田, 等. 超声测量视神经鞘直径在颅脑外伤患者中的应用价值[J]. 实用临床医药杂志, 2024, 28(13):47-51.
	Zhang JB, Ding JH, Zhou LT, et al. Application value of ultrasonic measurement of optic nerve sheath diameter in patients with craniocerebral trauma[J]. J Clin Med Pract, 2024, 28(13):47-51.