Thelandersson A, Cider A, Nellgård B
Department of Physical Therapy, Sahlgrenska University Hospital, Gothenburg, Sweden.
Acta Anaesthesiol Scand. 2006 Sep;50(8):937-41. doi: 10.1111/j.1399-6576.2006.01037.x.
Prone position has been used for several years to treat acute lung insufficiency, but in previous studies patients with unstable intracranial pressure (ICP) are mostly excluded. The aim of this study was to investigate if prone position is a safe and useful treatment in patients with reduced intracranial compliance.
A consecutive, prospective pilot study of 11 patients admitted to the neuro intensive care unit (NICU) due to traumatic brain injury or intracerebral haemorrhage. ICP, cerebral perfusion pressure (CPP), heart rate (HR), mean arterial blood pressure (MABP), arterial partial pressure of oxygen (PaO(2)), arterial partial pressure of carbon dioxide (PaCO(2)), arterial oxygen saturation (SaO(2)) and respiratory system compliance were measured before, three times during and two times after the patients were placed in the prone position.
No significant changes were demonstrated in ICP, CPP or MABP. PaO(2) and SaO(2) were significantly increased in the prone position. HR was significantly increased in the prone position and after 10 min in the supine post-prone position and the respiratory system compliance was increased after 1 h in the supine post-prone position.
Turning NICU patients from the supine to the prone position did not influence ICP, CPP or MABP, but significantly improved patient PaO(2), SaO(2) and respiratory system compliance.
俯卧位已被用于治疗急性肺功能不全数年，但在以往研究中，颅内压（ICP）不稳定的患者大多被排除在外。本研究的目的是调查俯卧位对颅内顺应性降低的患者是否是一种安全有效的治疗方法。
对11例因创伤性脑损伤或脑出血入住神经重症监护病房（NICU）的患者进行了一项连续的前瞻性试点研究。在患者置于俯卧位之前、期间三次和之后两次测量ICP、脑灌注压（CPP）、心率（HR）、平均动脉压（MABP）、动脉血氧分压（PaO₂）、动脉血二氧化碳分压（PaCO₂）、动脉血氧饱和度（SaO₂）和呼吸系统顺应性。
ICP、CPP或MABP无显著变化。俯卧位时PaO₂和SaO₂显著升高。俯卧位时HR显著升高，俯卧后仰卧位10分钟后HR也显著升高，俯卧后仰卧位1小时后呼吸系统顺应性增加。
将NICU患者从仰卧位转为俯卧位不会影响ICP、CPP或MABP，但能显著改善患者的PaO₂、SaO₂和呼吸系统顺应性。
