体位及头高位对重型颅脑损伤病人颅内压和脑灌注压的影响  

Effects of body position and head up tilt on intracranial pressure and cerebral perfusion pressure in patients with severe brain injury

作　　者：典慧娟 范艳竹[1] 王琳琳[1] 王磊[1] DIAN Huijuan;FAN Yanzhu;WANG Linlin;WANG Lei(Beijing Tiantan Hospital,Capital Medical University,Beijing 100070 China)

机构地区：[1]首都医科大学附属北京天坛医院,北京100070

出　　处：《护理研究》2020年第14期2520-2523,共4页Chinese Nursing Research

基　　金：首医护理学专项面上课题,编号:17HL27。

摘　　要：[目的]探讨体位及头高位对重型颅脑损伤病人颅内压和脑灌注压的影响。[方法]收集2016年10月—2017年12月某三级甲等医院颅脑外伤病区50例住院病人为研究对象。在静息状态下,依次将病人置于仰卧位合并头位抬高0°、30°、45°,左半侧卧位合并头位抬高0°、30°、45°,右半侧卧位合并头位抬高0°、30°、45°,每种体位保持15 min。记录每种体位保持15 min时的颅内压、平均动脉压、心率、血氧饱和度,并计算得出相应脑灌注压。[结果]同一头高位,病人三种卧位下颅内压、平均动脉压、脑灌注压比较差异无统计学意义(P>0.05);同一体位,病人颅内压、平均动脉压、脑灌注压随头部抬高角度增加呈下降趋势,除脑灌注压在头高位30°与45°时差异无统计学意义(P>0.05)外,其余指标同一卧位不同头高位数据两两比较,差异均有统计学意义(P<0.05)。同一体位,病人头高位0°与45°相比,心率差异有统计学意义(P<0.05),同一体位不同头高位、同一头高位不同体位,病人血氧饱和度比较差异均无统计学意义(P>0.05)。[结论]重型颅脑损伤病人床头抬高30°,有利于控制颅内压、平均动脉压,保持脑灌注压水平的稳定,且对病人生命体征没有影响。Objective:To probe into the effects of body position and head up tilt on intracranial pressure and cerebral perfusion pressure in patients with severe brain injury.Methods:A total of 50 in-patients in craniocerebral trauma ward in a tertiary grade A hospital were selected as research objects from October 2016 to December 2017.In resting state,place patient in a supine position with head position raised by 0°,30°,45°,left side position with head position raised by 0°,30°,45°,right side position with head position raised by 0°,30°,and 45°in sequence.Each position was maintained for 15 mins.Intracranial pressure,mean arterial pressure,heart rate,and blood oxygen saturation were recorded,when each position was maintained for 15 minutes.And corresponding cerebral perfusion pressure was calculated.Results:There were no statistically significant differences in intracranial pressure,mean arterial pressure and cerebral perfusion pressure of patients in three supine positions with the same head height(P>0.05).In same position,patient's intracranial pressure,mean arterial pressure and cerebral perfusion pressure presented a downward trend,as their head height raised.There was no significant difference in cerebral perfusion pressure between head height with 30°and 45°(P>0.05).And other indicators were compared in pairs in same lying position but with different head heights.There were statistically significant differences(P<0.05).In same position,difference in heart rate between patient's head height with 0°and 45°was statistically significant(P<0.05).There was no statistically significant difference in patient's blood oxygen saturation between different head heights in same position and different head positions in same head height(P>0.05).Conclusions:Elevating the bed head of patients with severe brain injury by 30°,which is helpful for controlling intracranial pressure and mean arterial pressure,keeping level of cerebral perfusion pressure stable,and has no effect on the vital signs.

关 键 词：体位 头高位 重症病人 颅脑损伤 颅内压 脑灌注压 

分 类 号：R473.6[医药卫生—护理学]