脑出血患者肺复张对颅内压及脑灌注的影响  

The influence of pulmonary reexpansion on intracranial pressure and cerebral perfusion in patients with cerebral hemorrhage

作　　者：陈勋 

机构地区：[1]广东普宁市人民医院神经内科,普宁515300

出　　处：《中国实用神经疾病杂志》2013年第13期22-23,共2页Chinese Journal of Practical Nervous Diseases

摘　　要：目的观察脑出血患者进行肺复张对颅内压及脑灌注压的影响。方法选取2011-09—2012-08,在我院住院的脑出血合并肺部感染或出现ARDS需要进行肺复张的12例病人,在进行肺复张时监测颅内压、有创血压、脉搏氧饱和度、颈静脉球氧饱和度等。结果 12例病人共进行18次肺复张,其中16次达到肺泡复张。观察到随着PEEP水平的变化,相对应的MAP(平均动脉压)、SjVO2(颈静脉球氧饱和度)、ICP(颅内压)、CCP(脑灌注压)与复张前相比差异统计学意义(P>0.05);其中MAP的变化与CPP变化呈高度相关(P<0.05)。PEEP与CVP、ICP呈高度相关(P<0.05);PEEP与CPP呈高度负相关(P<0.05)。结论肺复张时病人MAP、ICP、CPP、SjVO2的变化大,实时MAP、ICP、CPP监测有助于在脑出血病人进行肺复张时进行安全性观察。Objective To observe the influence of pulmonary reexpansion on intracranial pressure and cerebral perfusion in patients with cerebral hemorrhage.Methods 12 patients with cerebral hemorrhage were selected with pulmonary infection or ARDS needed for lung recruitment from September 2011 to August 2012 in our hospital,monitoring intracranial pressure,IBP,pulse oximetry,jugular bulb oxygen saturation and so on during pulmonary reexpansion.Results 12 patients carried out 18 pulmonary reexpansion,and 16 of them reached alveolar reexpansion.We could see that,with the PEEP level changes,the corresponding MAP（mean arterial pressure）,SjVO2（jugular bulb oxygen saturation）,ICP（intracranial pressure）,CCP（cerebral perfusion pressure） had no significant statistical difference compared with before pulmonany reexpansion（P 0.05）;and the changes between MAP and CPP were highly correlated（P0.05）;the changes between PEEP and CVP,ICP were highly correlated（P0.05）;However,the changes between PEEP and CPP were highly negative correlation（P 0.05）.Conclusion Patients with pulmonary reexpansion have larger changs in MAP,ICP,CPP,SjVO2 Real-time monitoring MAP,ICP,CPP helps safety observation for patients with cerebral hemorrhage receiving pulmonary reexpansion.

关 键 词：脑出血 肺复张 颅内压 脑灌注压 

分 类 号：R743.34[医药卫生—神经病学与精神病学]