吸痰操作对不同镇静程度脑出血患者颅内压及脑灌注压、血压的影响  

Effect of Sputum Aspiration on Intracranial Pressure and Cerebral Perfusion Pressure in Patients with Cerebral Hemorrhage of Different Sedation Degree

作　　者：王钰涵 车腾雨 王云龙 成杰 李茹雪 孙泽林 刘玉敬 于颖 唐启群 WANG Yu-han;CHE Teng-yu;WANG Yun-long;CHENG Jie;LI Ru-xue;SUN Ze-lin;LIU Yu-jing;YU Ying;TANG Qi-qun(School of Nursing and Rehabilitation,North China University of Science and Technology,Tangshan,Hebei 063000,China;Affiliated Hospital of North China University of Science and Technology,Tangshan,Hebei 063000,China)

机构地区：[1]华北理工大学护理与康复学院,河北唐山063000 [2]华北理工大学附属医院,河北唐山063000

出　　处：《河北北方学院学报（自然科学版）》2023年第6期15-22,共8页Journal of Hebei North University:Natural Science Edition

基　　金：唐山市省级院士工作站奖补资金(No.19130203A)。

摘　　要：目的探讨不同镇静程度下吸痰对脑出血患者颅内压(ICP)、脑灌注压(CPP)及血压(BP)的影响。方法选取26例脑出血患者作为研究对象,根据RASS镇静评测量表将评分-2~1分设为浅镇静组,<-2分设为深镇静组。记录患者术后每次吸痰前、吸痰准备、吸痰中及吸痰后1、5、10、15 min的ICP、CPP及BP,探究吸痰操作对脑出血患者ICP、CPP及BP随时间的变化趋势。结果浅镇静组ICP、CPP、BP上升幅度均高于深镇静组,组内差异均有统计学意义(P<0.05);重复测量方差分析显示,随着吸痰进展,2组患者ICP、CPP及BP均有显著变化(F=43.322,26.616,36.610,30.962,P<0.001);不同镇静程度下吸痰患者收缩压变化幅度不同(F=15.012,P<0.001),不同镇静程度下吸痰患者ICP、CPP、舒张压变化幅度差异无统计学意义(F=3.852,1.752,0.155,P>0.05)。结论吸痰操作会导致脑出血患者ICP、CPP、BP升高。镇静程度较深的患者吸痰时ICP、CPP、BP上升幅度低于镇静程度较浅的患者,有利于减少继发性脑损伤的发生。良好的镇静可作为吸痰操作中控制ICP的有效手段。Objective To investigate the effect of sputum aspiration on ICP,CPP and BP in patients with cerebral hemorrhage under different degrees of sedation.Methods 26 patients with cerebral hemorrhage were selected as the research objects.According to RASS sedation evaluation scale,the scores of-2 to 1 were classified as light sedation group,and the scores<-2 were classified as deep sedation group.ICP,CPP and BP of each time before sputum aspiration,preparation for sputum aspiration,during sputum aspiration,1 min after sputum aspiration,5 min after sputum aspiration,10 min after sputum aspiration and 15 min after sputum aspiration were recorded,and the change trend of ICP,CPP and BP of patients with cerebral hemorrhage with time was investigated.Results The increases of ICP,CPP and BP in the light sedation group were higher than those in the deep sedation group,and the differences between the two groups were statistically significant(P<0.05).Analysis of variance of repeated measurements showed that ICP,CPP and BP of patients in both groups had significant changes with the change of sputum aspiration time(F=43.322,26.616,36.610,30.962,P<0.001);The changes of systolic blood pressure in patients with different degrees of sedation were different(F=15.012,P<0.001),but there was no significant difference in ICP,CPP and diastolic blood pressure in patients with different degrees of sedation(F=3.852,1.752,0.155,P>0.05).Conclusion The operation of sputum aspiration can lead to the increase of ICP,CPP and BP in patients with cerebral hemorrhage.The increase of ICP,CPP and BP in patients with deep sedation is lower than that in patients with light sedation,which is beneficial to reduce the occurrence of secondary brain injury.Good sedation can be used as an effective mean to control ICP during sputum aspiration.

关 键 词：镇静 吸痰 颅内压 脑灌注压 

分 类 号：R473[医药卫生—护理学]