Olson DaiWai M, Thoyre Suzanne M, Turner Dennis A, Bennett Stacey, Graffagnino Carmelo
The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Neurocrit Care. 2007;6(2):100-3. doi: 10.1007/s12028-007-0015-y.
Management of intracranial hypertension is pivotal in the care of brain-injured patients.
We report the case of a patient with both a closed head injury and anoxic encephalopathy, who subsequently experienced episodes of refractory intracranial hypertension. The patient's care was complicated by the development of a pneumonia, which required frequent turning of the patient and chest physiotherapy. Conventional wisdom suggests that these interventions may stimulate the patient and worsen intracranial pressure, and therefore should be avoided.
Our observations on this patient, however, contradict this belief. This single-subject study presents data to support the use of chest physiotherapy in patients at risk for intracranial hypertension.
Further, the evidence is compelling that a randomized-controlled trial is indicated to test the hypothesis that chest physiotherapy may actually result in short-term resolution of high intracranial pressure, and thus provide one more clinical tool in the management of elevated intracranial pressure.
颅内高压的管理在脑损伤患者的护理中至关重要。
我们报告了一例同时患有闭合性颅脑损伤和缺氧性脑病的患者，该患者随后出现难治性颅内高压发作。患者的护理因肺炎的发生而复杂化，这需要频繁为患者翻身和进行胸部物理治疗。传统观念认为，这些干预措施可能会刺激患者并使颅内压恶化，因此应避免。
然而，我们对该患者的观察结果与这种观点相矛盾。这项单病例研究提供的数据支持在有颅内高压风险的患者中使用胸部物理治疗。
此外，有令人信服的证据表明，需要进行一项随机对照试验来检验胸部物理治疗实际上可能导致颅内高压短期缓解这一假设，从而为颅内压升高的管理提供又一种临床工具。
