Chiang V L, Torbey M, Rigamonti D, Williams M A
Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA.
J Neurosurg. 2001 Jul;95(1):116-8. doi: 10.3171/jns.2001.95.1.0116.
The authors report an unusual case of a patient with low-pressure hydrocephalus and a ventriculopleural shunt, in whom routine respiratory management performed using positive-pressure ventilation caused shunt obstruction and coma. While the patient received positive-pressure ventilation with external cerebrospinal fluid (CSF) drainage at subatmospheric pressure, the ventricles returned to normal size and the coma rapidly reversed. After the authors' recognition of the effect of positive-pressure ventilation on intrapleural pressure and ventriculopleural shunt function, and the subsequent removal of positive-pressure ventilation, CSF flow through the shunt resumed and the patient's coma resolved.
作者报告了一例罕见病例，患者患有低压性脑积水并接受了脑室-胸膜分流术，在使用正压通气进行常规呼吸管理时，导致分流管阻塞并昏迷。当患者在低于大气压的情况下接受正压通气并进行外部脑脊液引流时，脑室恢复正常大小，昏迷迅速逆转。在作者认识到正压通气对胸腔内压力和脑室-胸膜分流功能的影响，并随后停止正压通气后，脑脊液通过分流管的流动恢复，患者的昏迷症状得以缓解。
