重症开颅术后患者的体位护理对颅内压、平均动脉压及脑灌注压的影响  

Influence of posture nursing on intracranial pressure,mean arterial pressure and cerebral perfusion pressure in patients with critical conditions undergone craniotomy

作　　者：孙杰[1] 刘炳兰[1] 雷员华 

机构地区：[1]深圳市宝安人民医院(集团)第二人民医院外科二区,广东深圳518108

出　　处：《中国当代医药》2017年第10期172-174,共3页China Modern Medicine

摘　　要：目的探讨重症开颅术后患者的体位护理对颅内压(ICP)、平均动脉压(MAP)及脑灌注压(CPP)的影响。方法选取2015年3月~2016年2月于我院接受开颅术治疗的重症颅脑损伤患者40例。所有患者均进行0°、10°、20°、30°以及40°体位的改变,分别比较不同体位时患者的ICP、MAP及CPP,并作相关性分析。结果患者体位在0~40°时ICP水平呈逐渐下降趋势,差异有统计学意义(P<0.05)。患者体位在0~40°时MAP水平呈逐渐下降趋势,差异有统计学意义(P<0.05)。患者体位在0~30°时CPP水平分别为(69.7±5.5)、(70.2±4.4)、(71.1±3.9)和(74.5±3.6)mmHg,呈逐渐上升趋势,而体位在40°时患者CPP为(63.5±3.5)mmHg,显著低于0~30°时的CPP,差异均有统计学意义(t=6.015,P=0.000;t=7.537,P=0.000;t=9.173,P=0.000;t=13.856,P=0.000)。经相关性分析,体位与重症开颅术后患者ICP、MAP均呈显著负相关关系(r=0.732,P=0.000;r=0.757,P=0.000)。结论体位护理对重症开颅术后患者的ICP、MAP以及CPP均有一定影响,其中体位为30°~40°时患者ICP与MAP水平可能存在明显下降,同时CPP水平上升,有利于患者预后。Objective To explore the influence of posture nursing on intracranial pressure （ICP）,mean arterial pressure （MAP） and cerebral perfusion pressure （CPP） in patients with severe eonditions undergone eraniotomy.Methods A total of 40 patients with severe craniocerebral injury who were provided with craniotomy from March 2015 to February 2016 were selected.All patients were nursed in 0°,10°,20°,30° and 40° postures.The ICP, MAP and CPP were compared in different positions,and the correlation analysis was performed.Results The level of ICP was gradually decreased ranging from 0° to 40°with statistical differences （P〈0.05）.The MAP level was also decreased gradually at 0° to 40°,which was displayed statistical differences （P〈0.05）.The levels of CPP was （69.7±5.5）,（70.2±4.4）,（71.1±3.9）,（74.5±3.6） mmHg were gradually increased at 0° to 30°.At 40°,the level of CPP was （63.5±3.5） mmHg,significantly lower than those at 0° to 30° with statistical differences （t=6.015,P=0.000;t=7.537,P=0.000;t=9.173,P=0.000;t=13.856,P=0.000）.By correlation analysis,posture was in great negative correlation with ICP and MAP in patients with critical conditions after craniotomy （r=0.732,P=0.000;r=0.757,P=0.000）.Conclusion Posture nursing has a certain influence on the levels of ICP,MAP,and CPP in patients with critical conditions undergone craniotomy.Among them,posture at 30°to 40°,the levels of ICP and MAP are both decreased,and CPP is in rise simultaneously,which is beneficial to patient＇s prognosis.

关 键 词：重症 体位 颅内压 平均动脉压 脑灌注压 

分 类 号：R651.1[医药卫生—外科学]